Q-Guide was developed jointly by QPID, Massachusetts General Hospital (MGH) and Massachusetts General Hospital Physicians Organization (MGPO) to improve rates of appropriate use of procedures. The application guides clinicians and patients through understanding the risks and benefits of high-volume, high-cost cardiac, vascular, and orthopedic procedures. As providers join ACOs, enter shared risk contracts with payers, or operate as integrated provider/payer organizations, Q-Guide is even more critical for managing utilization and costs, as well as ensuring better outcomes.
- Eliminate the administrative costs of the pre-procedure prior authorization process
- Ensure use of evidence-based guidelines in the decision-making process
- Prepare data for reporting to federal registries to optimize payment
- Drive better health outcomes for patients and spare them the risk of inappropriate procedures
Eliminates the Need for Manual Prior Auth Calls
Providers and payers are under increasing pressure to improve patient care and substantially reduce healthcare costs. Traditionally, to keep a cap on costs, payers have required that providers obtain prior authorization for expensive procedures. With Q-Guide, payers have assurance that clinicians have validated appropriateness with respect to the patient’s history and evidence-based guidelines. In return, the payers are able to waive burdensome and costly manual prior authorization requirements.
Guides Decisions for High-Cost Procedures
Clinicians use Q-Guide to attest to an ordered procedure, or re-evaluate an intervention based on clinical guidelines and the patient’s medical history. Q-Guide creates clinical summaries inclusive of the relevant set of indications, symptoms, co-morbidities, medical therapies, lab results, imaging and other diagnostics that must be considered. QPID calculates a risk score based on evidence-based guidelines and the patient’s medical history and health status. Q-Guide includes guidelines and scores for CAS, CAE, CABG, lumbar fusion and total knee/hip replacement and other common and high cost procedures. Contact us for details on Q-Guide procedures.
Q-Guide uses decision-making algorithms that are driven by combining clinical evidence with the latest guidelines. The application makes it easier for clinicians to interpret those guidelines in the context of the patient’s individual profile by dramatically reducing the labor required for information gathering and review. Checklists and forms are pre-populated with relevant criteria, while affording the clinician complete control to over-ride. Decisions are logged and passed back to internal registries and the patient’s health record, further reducing labor. To expedite workflow, Q-Guide integrates with procedure scheduling and generates personalized consent forms.
With Q-Guide, payers have assurance that clinicians have validated appropriateness using the latest evidence-based guidelines from medical societies. Since this is the same body of evidence that payers would use, they can eliminate the prior authorization process, saving time and money.
Q-Guide cuts the use of inappropriate procedures so patients are spared the risk of a procedure that may have little value. With each treatment decision, the procedural risk score and applicable guidelines are incorporated into a custom consent form, for shared decision making between doctor and patient.