Change Healthcare Partners with the American Society of Addiction Medicine to Transform Utilization Management for SUD

The ASAM Criteria® Powered by InterQual® brings efficiency for payers and providers to assess the millions of patients suffering from substance use disorders.

Today, Change Healthcare (NASDAQ: CHNG) introduced The ASAM Criteria Powered by InterQual, a SaaS solution developed through an exclusive partnership with the American Society of Addiction Medicine (ASAM). This software, which seamlessly integrates into existing care-management workflows, significantly reduces the time required for substance use disorder (SUD) patient assessments, increases consistency, and streamlines the prior-authorization process using industry-standard criteria. The ASAM Criteria is a widely used and comprehensive set of guidelines for placement, continued stay, and transfer/discharge of patients with addiction and co-occurring conditions.

“We are honored to launch this product in partnership with ASAM,” said Laura Coughlin, vice president of clinical innovation and development at Change Healthcare. “With a shortage of beds and services dedicated to the care of patients with SUD, The ASAM Criteria Powered by InterQual brings much-needed efficiency to what until now has been an onerous process for utilization management. Most importantly, it will also ultimately help ensure that patients/members are receiving the treatment that best fits their needs and that resources are wisely used.”

The ASAM Criteria Powered by InterQual is a cloud-based, structured, interactive tool with an easy-to-use Q&A format designed specifically for utilization management. It helps payers and providers streamline and improve the medical review process for SUD patients, reducing their administrative burden, all while increasing consistency and simplifying documentation. It can reduce the time to perform these assessments from up to 30 minutes to less than 15. (Previously, The ASAM Criteria only existed in print, e-book , and provider-assessment formats not designed for utilization management use.) In fact, in just the first few weeks of use, The Holman Group, a managed behavioral health care services organization and beta client, was able to complete primary reviews in an average of seven minutes.

“This simplified version of The ASAM Criteria is a great efficiency boost and will allow us to bring ASAM reviews back in-house while helping us to more easily meet state and CMS requirements,” said Elizabeth Holman, MBA, president of The Holman Group. “Prior to having The ASAM Criteria Powered by InterQual, we did not have the tools in-house to allow our reviewers to apply The ASAM Criteria in care management decision-making, and we likely could not prove IRR. Now, with this solution, staff can consistently apply the criteria and will be able to make decisions very efficiently and consistently.”

The ASAM Criteria Powered by InterQual works within existing utilization management workflows. The software enables case managers to easily evaluate each case comprehensively against The ASAM Criteria and provides the user level-of-care and services recommendations in minutes. It includes all levels of care (LOC) for both adults and adolescents, covering the full ASAM continuum of care, all levels of withdrawal-management services, as well as all six dimensions of assessment.

“ASAM is pleased to partner with Change Healthcare to bring this version of The ASAM Criteria to market with a focus on utilization management,” said William F. Haning, III, MD, DLFAPA, DFASAM, president of ASAM. “They have designed a simple and elegant solution which is fully consistent with The ASAM Criteria and will help both providers and payers ensure consistent application of these standards for all patients needing substance use disorder level-of-care management.”

The ASAM Criteria is now required for level-of-care decisions for all substance use disorder patients in 20 states for providers and in seven states for payers, as well as encouraged by CMS for all Managed Medicaid coverage (except South Dakota). The ASAM Criteria Powered by InterQual is the only in-workflow utilization management solution available to meet these requirements for use of The ASAM Criteria.

Payers and providers now have an opportunity to transform their SUD assessment process and an easy and efficient way to meet state mandates and CMS-encouraged use for SUD reviews. Learn more about The ASAM Criteria Powered by InterQual here.

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About Change Healthcare

Change Healthcare (NASDAQ: CHNG) is a leading healthcare technology company focused on insights, innovation, and accelerating the transformation of the U.S. healthcare system through the power of the Change Healthcare Platform. We provide data and analytics-driven solutions to improve clinical, financial, administrative, and patient-engagement outcomes in the U.S. healthcare system.

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