MCG Health

MCG Health, part of the Hearst Health network, develops evidence-based clinical guidelines and artificial intelligence solutions for healthcare decision-making. The company serves thousands of hospitals, a majority of U.S. health plans, and multiple state and federal government agencies with clinical decision support tools focused on utilization management, case management, and care coordination.

MCG's approach centers on annually reviewing thousands of clinical references to develop unbiased, evidence-based care guidelines. These guidelines integrate with software solutions including Indicia Synapse for utilization review and Indicia Focus for revenue protection. The company maintains independence through its ownership structure, enabling clinical evidence review without bias from specialty groups or payer/provider ownership. Solutions integrate with EHR platforms and medical management systems to embed guidance directly into clinical workflows.

The company has documented measurable outcomes including reducing utilization review time to 78 seconds per case at one Kansas hospital system and protecting $44 million in hospital revenue through automated recommendations. MCG has received multiple industry awards including the 2023 KLAS Points of Light Award and 2024 WEDI Excellence in Service Award.

Organizations should consider MCG Health when seeking to reduce administrative burden in utilization management while maintaining clinical rigor. The combination of evidence-based guidelines with AI automation particularly benefits organizations struggling with denial rates, prolonged review times, or observation-to-inpatient conversion challenges.

Expect a managed services approach with integration support for existing systems. MCG's customer service orientation and annual guideline updates provide ongoing value beyond initial implementation, making it suitable for organizations committed to long-term clinical decision support partnerships.

MCG Health operates exclusively in healthcare with 100% focus on clinical decision support. The company serves acute care hospitals, health plans, Medicare/Medicaid programs, quality improvement organizations, Recovery Audit Contractors, and Medicare Administrative Contractors. Specific healthcare applications include utilization review, prior authorization, case management, and care coordination across medical, surgical, and behavioral health specialties.

Their solutions address healthcare-specific challenges including reducing 30-day readmissions, managing observation status determinations, and navigating payer authorization requirements while maintaining compliance with evidence-based care standards.

The ideal MCG client is a mid-to-large hospital system, health plan, or government agency with established utilization management programs seeking efficiency improvements. Organizations with high denial rates, revenue leakage from observation status issues, or labor-intensive manual review processes will realize the most immediate value. Commitment to evidence-based medicine and willingness to integrate technology into clinical workflows is essential.