Health care is undergoing a significant transformation, shifting toward a value-based and evidence-driven model of care. This innovative approach emphasizes patient outcomes over service volume, prompting providers and payers to work in closer coordination to deliver smarter, more efficient care.
This helps ensure that medical resources are distributed appropriately, minimizing wasteful spending and unnecessary procedures. As a result, healthcare systems can better manage costs, reduce hospital admissions, and lower the patient risk of infections associated with inappropriate care decisions.
In a recently published article, Laura Coughlin BSN, vice president of clinical innovation and development at Optum Insight, shares the importance of implementing evidence-based insights for better patient outcomes. “At a time when the demand for health care providers and services exceeds the current supply, it’s critical to manage resources effectively to help ensure access to care,” she writes.
Coughlin highlights 3 essential ways providers can ensure “patients receive appropriate and effective care while reducing costs for all involved.”
“Long established tools, like Optum’s InterQual suite of evidence-based criteria, are rigorously developed and regularly updated to reflect the current state of medical literature, evidence and standards of care,” Coughlin explains. “More than 4,500 hospitals, health plans and government agencies use InterQual criteria when making decisions about care and resource use.”
“The InterQual content development process is systematic and comprehensive, following evidence-based medicine principles to create objective criteria reflecting best clinical practices.” Teams of clinicians review the materials and confirm the material through “extensive literature references, allowing for transparency into the evidentiary basis of the criteria.”
Coughlin concludes by stating how “Clinical decision support tools help providers make informed decisions, while offering practice insights, automating manual processes and connecting payers and providers seamlessly. These resources allow clinicians to focus on providing quality patient care, leading to better outcomes.”
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