We have required that any new solution supports appropriate care for the patient, and Indicia for Effective Focus bases decisions on evidence-based medicine while using data science to drive the prioritization.
SEATTLE (PRWEB) January 21, 2020
MCG Health, part of the Hearst Health network and a leading provider of informed care strategies, announces that development has begun on Indicia for Effective Focus, a new software solution that prioritizes utilization management worklists based on the probability of financial impact to the organization. The new solution is part of the MCG Indicia product suite, and is designed to optimize, in real time, the utilization management workflow to support operational decision-making and regulatory compliance while protecting revenue. Indicia for Effective Focus leverages machine learning and MCG’s knowledge base of medical evidence to guide case prioritization.
With hospital staff often overloaded with high caseloads, identifying which cases to prioritize based on the varying complexity of individual patient factors is a critical component in delivering on the tenets of the right care, at the right time, in the right setting. Untimely decisions can lead to the inappropriate placement of patients (observation vs. inpatient status, premature vs. delayed hospital discharge, etc.) as well as financial repercussions for hospitals and patients due to potential claim denials and inefficient care. Additionally, without effective prioritization, hospitals often misapply valuable case manager resources to easier cases when more complex cases would benefit from an earlier, more in-depth review. Several of MCG’s key hospital clients agreed to partner with the industry-leading guideline publisher for the development of a specific solution to address this challenge.
Indicia for Effective Focus leverages machine learning technology to improve both the efficiency and effectiveness of case management. The software identifies cases most likely to be in the incorrect status, as well as those most likely to be ready for a status change. This leads to earlier appropriate conversions and re-statusing of cases likely to experience denials. Once identified, case managers can prioritize these cases for in-depth review using their clinical knowledge and MCG care guidelines to document or adjust the level of care. MCG’s evidence-based content has been a trusted source of clinical decision support for both the payer and provider communities since 1988. Potential benefits include greater protection of hospital revenue and lower out-of-pocket costs to patients since the appropriate level of care can be assigned earlier in the patient stay.
MCG President and CEO, Jon Shreve, says, “We have required that any new solution supports appropriate care for the patient, and Indicia for Effective Focus bases decisions on evidence-based medicine while using data science to drive the prioritization.” He added, “In the future, the software solution will integrate with other MCG solutions to provide an optimal and efficient workflow.”
Indicia for Effective Focus is currently being developed with several early adopter hospital systems and is expected to be generally available later in 2020. Learn more about MCG solutions at http://www.mcg.com.
About MCG Health
MCG, part of the Hearst Health network, helps healthcare organizations implement informed care strategies that proactively and efficiently move people toward health. MCG’s transparent assessment of the latest research and scholarly articles, along with our own data analysis, gives patients, providers, and payers the vetted information they need to feel confident in every care decision, in every moment. For more information visit http://www.mcg.com or follow our Twitter handle at @MCG_Health.
About Hearst Health
The mission of Hearst Health is to help guide the most important care moments by delivering vital information into the hands of everyone who touches a person’s health journey. Each year in the U.S., care guidance from Hearst Health reaches 85 percent of discharged patients, 205 million insured individuals, 90 million home health visits and 3.2 billion dispensed prescriptions. The Hearst Health network includes FDB (First Databank), Zynx Health, MCG, Homecare Homebase, MHK (formerly MedHOK—Medical House of Knowledge) and Hearst Health Ventures (http://www.hearsthealth.com). Hearst also holds a minority interest in the precision medicine and oncology analytics company M2Gen. Follow Hearst Health on Twitter @HearstHealth or LinkedIn @Hearst-Health.