Milliman Care Guidelines Now Offered Without Charge To Quality Improvement Organizations.

Business Editors

SEATTLE--(BUSINESS WIRE)--Jan. 20, 2004

Industry-leading Guidelines Made Available For Both

Medicare & Medicaid Reviews

Milliman Care Guidelines, a division of Milliman USA, today announced that it is providing its Milliman Care Guidelines(R) to Quality Improvement Organizations (QIOs) free-of-charge. This program will give QIOs access to Milliman's evidence-based medical criteria, for use in their quality and appropriateness reviews of Medicare and Medicaid patients, including Long Term Acute Care Hospital admissions. QIOs are contracted by the Centers for Medicare & Medicaid Services (CMS) to conduct these reviews.

CMS recently confirmed that it does not mandate or endorse the use of any specific criteria set by QIOs or hospitals, and CMS has removed the reference to the specific criteria from the QIO manual. The free program means that QIOs will now have access to the criteria used by most commercial insurers, which will help streamline the quality and appropriateness reviews in hospitals.

"Now that CMS has confirmed the QIOs' ability to choose the criteria they think best serves their needs, we have moved quickly to give QIOs access to this leading tool," said Scott Harris, Marketing and Sales Director for Milliman Care Guidelines. "Milliman's Care Guidelines surpass CMS requirements, and our free program opens much broader access to the evidence-based clinical tools that can improve the quality of care provided."

The Kansas QIO, Kansas Foundation for Medical Care (KFMC), has been using the Milliman Care Guidelines since summer 2002 for both Medicare and Medicaid reviews. "Our previous screening criteria limited our review to evaluating a patient's need for inpatient care at a particular moment in time," said KFMC review staff Toni Pierson, RN and Diane Dudley. "With the Care Guidelines we look at the patient's entire continuum of care, thereby improving our ability to evaluate a hospitalization based upon the patient as a whole, rather than fragments of clinical information.

Milliman's Care Guidelines are designed for both retrospective and concurrent review, meaning both QIOs and hospitals can use them to determine appropriateness of admission and appropriateness of inpatient care. The "Optimal Recovery Course" identifies key care elements and milestones in patient recovery to ensure that the safest and most appropriate care is being given. Hospitals also use the "Case Management" and "Extended Stay" sections to help them actively manage patients through to discharge or transition to another level of care. Further, instead of juggling between two sets of criteria/guidelines, one for government funded patients and another for commercial patients, hospitals can streamline their process with Care Guidelines for both.

When their state QIO chose to use the Care Guidelines for Medicare and Medicaid reviews, the Kansas Hospital Association (KHA) made the Care Guidelines available to their members. "We wanted to provide our member hospitals with current and affordable quality/utilization guidelines," said Deborah Stern, RN, JD, vice president clinical & quality services at Kansas Hospital Association. "Our members are appreciative of the detailed, yet easy to use tools, and appear quite satisfied with their investment."

The Milliman Care Guidelines span the continuum of patient care providing access to evidence-based knowledge and best practices relevant to patients in a broad range of care settings. This not only assists with decisions for each setting, but also facilitates coordination of care and smooth patient transitions. Designed to be used in conjunction with health care professionals' clinical judgment, the Care Guidelines enable more informed and consistent clinical care decisions and promote the best possible care management. Among the most important features of the Care Guidelines are the benchmarks they provide to help care givers establish appropriate, patient-specific goals.

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.

About KHA

KHA is a voluntary non-profit organization existing to provide leadership and services to member hospitals. In broader terms, KHA is the lead organization in a group of companies and affiliates that provides a wide array of services to the hospitals of Kansas and the Midwest region.

The hospitals of Kansas founded the Kansas Hospital Association (KHA) in 1910 to improve hospital care through the exchange of knowledge and ideas. Over the years, the Association has provided its membership with opportunities to share information, receive continuing education and develop approaches to legislative and regulatory reforms.