Milliman Care Guidelines, Quality Improvement Organization and State Hospital Association Collaborate to Use Milliman Care Guidelines for Medicare and Medicaid Reviews in Kansas.

Business & Health Editors

SEATTLE--(BUSINESS WIRE)--Aug. 5, 2002

Milliman USA today announced that the Kansas Foundation for Medical Care (KFMC), a Quality Improvement Organization (QIO) has entered into an agreement to use the Milliman Care Guidelines for health care reviews of Kansas Medicare and Medicaid beneficiaries.

Concurrently, the Kansas Hospital Association (KHA) has signed an agreement with Milliman Care Guidelines to allow member hospitals to license the Care Guidelines and receive training in their use from Milliman clinical consultants. Milliman Care Guidelines is a division of Milliman USA.

The three-year license agreement allows KFMC to use the Care Guidelines to implement the Centers for Medicare & Medicaid Services' (CMS) 7th Scope of Work (SOW), for Medicare reviews. The agreement provides KFMC with electronic access to the Care Guidelines and to training specifically designed for CMS' 7th SOW. The training, to be provided by Milliman's clinical consultants, will prepare the QIO staff to use the Care Guidelines in carrying out their duties in the 7th SOW and to present the Care Guidelines to providers.

The agreement with KHA is the first of its kind between Milliman Care Guidelines and a state hospital association. "We are excited about the opportunity our member hospitals now have to purchase affordable guidelines that enhance their ability to provide quality care," says Deborah Stern, Vice President of Clinical and Quality Services at KHA.

The package includes hands-on training by Milliman clinical consultants with extensive experience working with medical management units of hospitals and health plans. KHA member hospitals receive:

-- Substantial group purchasing discounts of the Care Guidelines

-- Electronic access to the Care Guidelines for the entire staff

-- Training on how to apply the Care Guidelines by Milliman USA

Clinical Healthcare Consultants

The Milliman Care Guidelines are designed for both retrospective and concurrent review, meaning KFMC and KHA member hospitals will be using the same guidelines to determine medical necessity and appropriateness of care. For retrospective review, KFMC staff will use the "Clinical Indications for Admission" section, which is well suited for Medicare and Medicaid admission reviews. KHA member hospitals will use the "Optimal Recovery Course", "Case Management" and "Extended Stay" sections to actively manage patients through to discharge or transition to another level of care.

The Milliman Care Guidelines span the continuum of patient care and describe the best practices for treating common conditions in a variety of care settings. The Care Guidelines offer a description of evidence-based "best practices," to which physicians, hospitals and health plans can refer as patients present with their symptoms.

Written exclusively by a highly experienced team of physicians and nurses, the Care Guidelines are based on the actual practices of clinical care providers throughout the United States and the most current medical literature.

The Care Guidelines are in use by 9 out of the 10 largest commercial insurers and health plans across the nation, along with approximately 70% of the Blue Cross Blue Shield Plans, as well as major hospital groups and physician groups and networks.

Milliman Care Guidelines is a division of Milliman USA, and provides its clinical Care Guidelines to many of the firm's clients in the hospital and insurance industries. Milliman USA, Inc., headquartered in Seattle, serves the full spectrum of business, financial, government and union organizations. Founded in 1947 as Milliman & Robertson, it has 29 offices in the United States as well as offices in London, Bermuda, Hong Kong, Melbourne and Tokyo. It is a founding member of Milliman Global, an international organization serving insurance, employee benefits and healthcare clients worldwide. Milliman USA employs approximately 1,750 people, including a professional staff of over 700 qualified consultants and actuaries. The firm has consulting practices in property and casualty insurance, pensions, employee benefits, healthcare, life insurance and risk management.

To obtain more information, please visit Milliman Care Guidelines website at www.careguidelines.com or call 888/464-4746.

About KFMC

As the federally designated QIO for Kansas, KFMC receives federal funding to work with Kansas health providers to improve the safety and health of Kansans enrolled in Medicare through quality improvement initiatives and other services such as medical case review and consumer education. The purpose is to ensure that care meets professionally recognized standards, to protect beneficiaries by addressing their complaints and concerns, and to protect the integrity of the Medicare Trust Fund and the taxpayer dollars that fund it by ensuring that Medicare pays only for services and items that are reasonable and medically necessary and that are provided in an appropriate setting.