Major insurer will use MCG’s evidence-based criteria and technology to improve member outcomes and provider collaboration
PITTSBURGH–(BUSINESS WIRE)–#EBM–MCG Health, part of the Hearst Health network, announces that Highmark Inc. will transition to MCG’s evidence-based solutions to guide care management decisions for its plan membership of over 6 million. MCG was the sole vendor awarded the contract after an open request for proposal (RFP) for appropriate use criteria in 2020. Highmark’s transition to MCG solutions is expected to be completed by February 13, 2023.
MCG care guidelines are nationally recognized, evidence-based clinical decision support used by a majority of U.S. health plans, over 2,800 hospitals, and many U.S. federal agencies and state governments. The goals of this new business partnership include:
- Improved Payer-Provider Collaboration: MCG is now the only independent publisher of clinical decision support that is nationally recognized and widely used by both payers and providers alike. Working from a clinical language trusted by payers and providers, Highmark teams can better support clinical conversations with hospitals and reduce payer-provider abrasion.
- Optimized, Evidence-Based Care: MCG care guidelines contain thousands of references to published medical literature to support appropriate, evidence-based clinical decision-making. MCG regularly updates its content as scientific evidence evolves which will help guide best practices for Highmark member care.
- Efficiency Gains: Highmark will be integrating the MCG Cite for Collaborative Care solution which will help automate authorization decisions, reduce payer-provider burdens, and enhance communication between Highmark’s medical management platforms and participating hospital electronic medical records (EMRs) that integrate MCG Indicia for Case Management.
By leveraging MCG’s ability to integrate its solutions directly into clinical workflows, Highmark teams can access evidence-based guidance and efficiency tools directly within their existing Pega and Epic medical management platforms. This unique feature will also help support timely authorization decisions, reduce clinician burnout, and support possible future authorization requirements currently under discussion at the Centers for Medicare and Medicaid Services (CMS).
“MCG is honored to be chosen by Highmark as the exclusive provider of evidence-based support for its membership,” said Jon Shreve, President and CEO of MCG Health. “While I am confident this will be a successful partnership between MCG and Highmark, the ultimate benefits, such as effective treatments and improved authorization turnaround times, will be for their members.”
To learn more about MCG’s decision support solutions, please visit 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 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. Care guidance from Hearst Health reaches the majority of people in the U.S. The Hearst Health network includes FDB (First Databank), Zynx Health, MCG, Homecare Homebase and MHK. Hearst also holds a minority interest in the precision medicine and oncology analytics company M2GEN. Follow Hearst Health on Twitter @HearstHealth and LinkedIn @Hearst-Health.
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