MCG's New Transparency Solution Enables Health Plans to Respond Rapidly to Market Opportunities and Regulatory Requirements
Health Plans Use Cite® Guideline Transparency to Share Clinical Rationale Supporting Medical Determinations and Comply with New Regulations
SEATTLE, Sept. 22, 2015 /PRNewswire/ -- MCG (part of the Hearst Health network) has released a medical determination transparency solution that allows health plans to share relevant sections of the industry's leading evidence-based care guidance with members and providers. Several states have added transparency requirements to their insurance regulations, with more expected to follow suit. In support, MCG collaborated with state healthcare regulators and two of the largest United States health plans to develop Cite Guideline Transparency.
"Even prior to the new mandates, innovative health plans have come to see members and providers as partners in moving patients toward health," says Jon Shreve, president of MCG. "The foundation of any partnership is good communication, and by enabling shared access to the clinical rationale underlying medical determinations, Cite Guideline Transparency supports evidence-based conversations about effective care."
New state regulations require that the clinical rationale used to support utilization review and member care determinations be made more widely available. Massachusetts law directs health plans "to make utilization review and medical necessity criteria…available to members or prospective members, and providers". Connecticut requires that health plans provide a member subject to an adverse determination with "a website link that pinpoints definitively the specific clinical criteria used to establish and to absolutely quantify all health benefit determinations". Numerous other states are developing requirements based on these precedents.
In accordance with these regulations, MCG's transparency solution responds to the broad array of new mandates by enabling a health plan to share relevant sections of the MCG care guidelines with a member, prospective member, provider, or other trusted healthcare partner.
"Our health plan customers requested a solution that fully addresses regulatory transparency compliance issues and is easy to deploy," says Shreve. "So, we built Cite Guideline Transparency as a seamless and secure extension of the health plan's existing MCG investment."
The solution supports compliance at multiple levels. Shared relevant sections of the care guidelines – including clinical indications, care alternatives, evidence summaries, and guideline methodology – were identified in collaboration with state regulators. As a hosted solution, Cite Guideline Transparency provides a controlled environment that permits access by eligible members and healthcare partners ensuring security of protected health information (PHI).
The solution can typically be implemented in less than 30 days.
About MCG
MCG, part of the Hearst Health network, independently develops and produces evidence-based clinical guidelines and software used by more than 2,200 clients, including 1,300 hospitals and eight of the ten largest U.S. health plans. Updated annually by an experienced team of clinicians, the care guidelines support the care management of a majority of Americans. For more information, visit www.mcg.com.
The Hearst Health network also includes FDB (First Databank), Zynx Health and Homecare Homebase. The mission of the Hearst Health network 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 the Hearst Health network reaches 76% of discharged patients, 133 million insured individuals, 30 million home health visits, 1.88 billion retail pharmacy prescriptions and 3.26 billion prescription claims. Extensions of the Hearst Health network include Hearst Health Ventures and the Hearst Health Innovation Lab. www.hearsthealth.com
Media Contact
Nancy Narraway
MCG
Tel +1 206 389 5405
[email protected]
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SOURCE MCG
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