Cloud Access to Updated, Evidence-Based Criteria Accelerates Delivery of Clinical Decision Support

Colorectal cancer’s impact in the United States

Colorectal cancer is the third-leading cause of cancer-related deaths. According to the American Cancer Society, close to 53,000 people in the United States will die from this disease in 2021. Like so many cancers, early detection is key; and because colorectal tumors develop over a relatively long period of time, early detection is not only possible, but it can prevent the cancer from happening. Early detection through screenings, such as a colonoscopy, has reduced mortality rates for people aged 50 and older over the past 20 years or so.

However, incidences of the disease and deaths for people under age 49 have steadily increased over that same period. So, the question is: When weighing all the risks and benefits, should younger people be screened for colorectal cancer?

The answer, from the U.S. Preventative Services Task Force (USPSTF), is yes. In May, the USPSTF recommended that healthy people aged 45 and older be screened for colorectal cancer. This is obviously a big change—one that will hopefully save thousands of lives by detecting cases earlier, which will lead to interventions that are proven to be effective in detecting and preventing cancer.

Case managers rely on evidence-based criteria to determine appropriate care and support medical necessity. We needed to get them this new info fast so there would be as little lag as possible in patients having these vital earlier screenings approved.

Enter our proprietary literature surveillance and systematic, evidence-based development process and cloud access

When the new colorectal screening recommendation was announced and reviewed, the InterQual® content-development team immediately went to work, critically appraising the new literature and updating the InterQual Criteria accordingly. After a rigorous yet speedy review, including peer review by an outside expert panel, the InterQual content immediately reflected this change; and users are already able to access the new criteria via our cloud solutions. And it’s not just about colorectal screening; the InterQual criteria is updated every time a new recommendation on screening, diagnostics, or treatments is made by organizations like the USPSTF.

I find it is an extraordinary thing to be part of a venture that stays on the leading edge of medical advances and supports providers and payers who work every day to save lives. Ultimately, I’m in this business because I believe what we provide—best-in-class content and cutting-edge technology—creates a common language between payers and providers as quickly and as efficiently as possible. And when they speak the same language, truly patient-centered care is possible. This leads to a better work life for doctors and nurses, lower costs for payers and consumers, and ultimately, better outcomes for patients.

In this case, it means thousands more people between the ages of 45 and 49 will be screened; and lives will be saved.

P.S.: If you are 45 or older, go get screened. Seriously.

Monique Yohanan, M.D., M.P.H., serves as chief medical officer for InterQual Content. Dr. Yohanan joined Change Healthcare as senior medical director for the Level of Care suite in September 2019. Since then, she has expanded her role in leading the physician teams across Ambulatory Care Planning and Behavioral Healthcare. Dr. Yohanan’s background in evidence-based medicine includes content development and designing standards, which were adopted by URAC. Dr. Yohanan, who is board certified in internal medicine and geriatric medicine, earned her M.D. from the Brown-Dartmouth Medical Program and has a Master of Public Health from Johns Hopkins University.