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CIMRO of Nebraska Uses Milliman Care Guidelines(R) for Nebraska Medicare Reviews

Use of Clinical Guidelines and Software Improves Quality Review Process

SEATTLE, March 17 /PRNewswire/ -- CIMRO of Nebraska, the Medicare Quality Improvement Organization (QIO) for Nebraska, recently signed a five-year licensing agreement with Milliman Care Guidelines, LLC, A Milliman Company, to use the Care Guidelines for Medicare utilization and quality reviews in Nebraska. The Care Guidelines replace criteria sets that CIMRO of Nebraska adapted from those in the public domain.

CIMRO of Nebraska will use all Care Guidelines products -- Ambulatory Care, Inpatient and Surgical Care, General Recovery Guidelines, Recovery Facility Care, Home Care, Chronic Care Guidelines and Behavioral Health Guidelines -- through Web software to support utilization review, as well as quality of clinical care for Medicare beneficiaries.

The Centers for Medicare & Medicaid Services (CMS) contracts with QIOs in each state to conduct various reviews and quality initiatives. CMS does not mandate or endorse the use of any specific criteria set by QIOs or hospitals. Twelve QIOs now license the Care Guidelines.

The Care Guidelines promote quality care by providing healthcare professionals with access to best practices based on annually updated evidence. The Care Guidelines also display quality measures used by CMS, and each inpatient guideline topic lists key care elements and hospital care planning information highlighting interventions that offer the highest probability for improving outcomes.

Designed for prospective, concurrent and retrospective reviews, among other care management activities, the Care Guidelines enable informed and consistent clinical care decisions and support the best possible care management using current evidence-based medicine.

"Several factors led us to adopt nationally developed criteria to improve quality and assure proper care to Nebraska Medicare beneficiaries," said Tina Georgy, CIMRO of Nebraska Chief Executive Officer. "In addition to changes in CMS operations, it became more important than ever for QIOs to adhere to guidelines based on the latest evidence found in medical literature. We now have that with the Care Guidelines."

Scott Harris, Milliman Care Guidelines Senior Vice President of Sales and Marketing, added, "The Care Guidelines incorporate quality measures from the Hospital Quality Alliance (CMS Core Measures). These measures, and other evidence-based clinical tools included in the Care Guidelines to improve quality of care, enable QIOs to effectively manage their review processes and quality initiatives."


CIMRO of Nebraska is a not-for-profit quality improvement organization. CIMRO of Nebraska's network of experts includes physician reviewers, registered nurses, allied health professionals, case managers, and data and research analysts. CIMRO of Nebraska works with healthcare providers to improve the quality of care for Nebraska Medicare beneficiaries.

About Milliman Care Guidelines

Milliman Care Guidelines, LLC, A Milliman Company, is located in Seattle, and independently develops and produces evidence-based clinical guidelines and software used by more than 1,000 clients, including hospitals, providers and health plans. Covering the continuum of care, the seven-product Care Guidelines series is updated annually by an experienced team of clinicians and are used to support the care of more than one in three Americans. For more information, visit

About Milliman

Milliman Care Guidelines is a wholly owned subsidiary of Milliman, Inc., which is among the world's largest independent actuarial and consulting firms. Founded in Seattle in 1947 as Milliman & Robertson, the company now has 49 offices in key locations worldwide. Milliman employs more than 2,000 people, with a professional staff of more than 1,000 qualified consultants and actuaries, including specialists ranging from clinicians to economists. The firm has consulting practices in healthcare, employee benefits, property and casualty insurance, life insurance and financial services. Milliman serves the full spectrum of business, financial, government, union, education and non-profit organizations. For more information, visit

SOURCE Milliman Care Guidelines
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