Saúde05 fevereiro, 2026

Modernize healthcare utilization management with automated value sets: MCG Health case study

Medical professionals meeting in conference room

Discover how MCG Health moved from static spreadsheets to algorithmic logic, saving thousands of hours and improving decision confidence.

How MCG Health transformed their value set strategy to support utilization management

MCG Health, a leader in evidence-based care guidelines, faced a critical challenge. Their legacy approach to managing thousands of value sets relied on static spreadsheets, which were resource-intensive and prone to version control issues. They needed a scalable solution to support their advanced utilization management tools.

The Challenge: Static data constrained innovation

MCG maintained over 2,000 value sets in disparate files. Updating these lists was a reactive, manual process that consumed months of full-time effort. This inefficiency created a structural risk: if the codes were incomplete, the automation could not accurately interpret patient data, potentially impacting clinical outcomes and reimbursement.

The Solution: Algorithmic value set management

MCG partnered with Wolters Kluwer to implement the Health Language Data Quality Workbench. This solution allowed them to bulk-load legacy spreadsheets and convert them into intensional value sets — logic-based algorithms that automatically update as terminologies evolve. 

Wolters Kluwer is the only company we found that could deliver scalable, automated approaches to transform flat-file value sets into structured, intelligent algorithms.
Jason Gilman, MD, FIDSA, Sr. Director of Clinical Informatics at MCG Health 

The Results: Modern utilization management with speed, scale, and accuracy

The collaboration delivered immediate value.

  • Rapid implementation: MCG converted approximately 2,500 value sets into robust algorithms in just two weeks.
  • Operational savings: The shift eliminated thousands of hours of manual maintenance time.
  • Enhanced performance: The improved data foundation enabled MCG's provider solution to reduce utilization review times by 85 percent — dropping from the national average of 20 minutes to less than three minutes.
  • Financial success: One 13-hospital system client realized $42 million in additional annualized revenue through accurate level-of-care determinations.

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Data Quality Workbench
Unlock the power of your healthcare data and improve your data quality with tools for managing, enriching, and mapping healthcare datasets. Establish a trusted data foundation to improve clinical accuracy in analytics and more efficiency into reimbursement processes.
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