How to Eliminate Procedure Preapproval to Save Billions in US Health Spending - Mike Doyle, QPID Health, Inc.
Mike Doyle of QPID Health, Inc., a solution provider at the marcus evans National Healthcare CMO/CMIO Summit 2015, talks about lowering healthcare costs by ensuring appropriate use. Interview with: Mike Doyle, President & Chief Executive Officer, QPID Health, Inc.
Published on: Mar 3, 2016
Transcripts - How to Eliminate Procedure Preapproval to Save Billions in US Health Spending - Mike Doyle, QPID Health, Inc.
Interview with: Mike Doyle,
President & Chief Executive Officer,
QPID Health, Inc.
“Appropriate use of diagnostics and
procedures is a strategic imperative for
providers focused on improving
population health while lowering costs,
says Mike Doyle, President & Chief
Executive Officer, QPID Health, Inc.
“With as much as a third of US
healthcare spending wasteful or
unnecessary, payers respond by
requiring medical necessity reviews,
especially for high-cost and high-volume
procedures,” he adds.
A solution provider at the marcus
evans National Healthcare CMO/
CMIO Summit 2015, in Atlanta,
Georgia, March 9-10, Doyle discusses
how QPID Health’s customer Partners
HealthCare achieves the highest
possible rates of appropriate use and
aligns with payers to waive prior
Why did Partners HealthCare
initiate the Q-Guide program?
Partners HealthCare is a pioneer
accountable care organization (ACO)
that also operates under shared-risk
contracts with private payers. Commit-
ted to 100 percent appropriate care
because it is the right thing for patients,
Partners also was motivated to make
sure that surgeons and other clinicians
were applying evidence-based care
standards to keep costs in check.
What are some of the benefits of
Elimination of preapproval requirements
in the US could increase billing
efficiency by 50 percent and save
hospitals USD 17 billion and physicians
USD 6.9 billion, while ensuring better
outcomes. Now ACOs and other
providers who share risks with payers
have additional incentives to be vigilant
What is Q-Guide?
Q-Guide is an application that delivers
guidelines from the literature and
synthesizes them with patient factors
automatically gleaned from the medical
record. It applies sophisticated decision
criteria to patient medical profiles to
produce an optimal procedure recom-
Hospitals can forego the prior authoriza-
tion process for some procedures where
physicians have attested the appropri-
ate use with Q-Guide. This eliminates a
huge administrative burden for
providers and reduces the pain and
uncertainty for patients who tradition-
ally must wait while medical necessity
reviews are underway. And most
importantly, healthcare decisions
remain in the hands of medical
providers and their patients.
Q-Guide currently covers 15 procedures,
seven of which account for 55 percent
of the 20 most costly surgical proce-
dures in the US.
The technology frees up time spent
mining electronic health records and
data repositories, while dramatically
shifting the patient/doctor conversation
toward shared decision-making.
Any final comments?
Two major payers have agreed with this
approach so far, and waived require-
ments for manual prior authorization Q-
Guide. The incorporation of patient-
reported outcomes into the decision
model is the latest development effort
to improve care, engage patients, and
track long-term outcomes.
To view a webinar by Partners Health-
care sharing their experience with
Q-Guide, click here
what is a huge
causes grief for
must wait while
How to Eliminate Procedure Preapproval
to Save Billions in US Health Spending
About QPID Health
QPID Health’s clinical intelligence software automatically delivers relevant patient information from electronic health records and
other data sources into clinical and administrative workflows. With QPID, clinicians are more productive, patients benefit from
decisions based on their complete health information, and hospitals gain cost efficiencies. The QPID solution was developed at
Massachusetts General Hospital and usage spread virally throughout the Partners HealthCare system. QPID Health launched in late
2012 to bring the power of QPID to health systems nationwide.
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