Navigation Links
NMMRA QIO Uses Milliman Care Guidelines(R) for New Mexico Medicare and Medicaid Reviews
Date:3/24/2009

Evidence-Based Clinical Guidelines and Software Improve Quality Review Process

SEATTLE, March 24 /PRNewswire/ -- New Mexico Medical Review Association (NMMRA), a Quality Improvement Organization (QIO), has 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 -- as well as Medicaid quality reviews -- in New Mexico.

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

NMMRA 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 evaluate appropriate care for Medicare and Medicaid beneficiaries. The Care Guidelines identify benchmark patient care and recovery stages to enhance healthcare services delivery, resource management and patient outcomes. This approach can reduce unnecessary variation in healthcare delivery and health care disparities in the community.

The Care Guidelines provide healthcare professionals with evidence-based clinical guidelines at the point of care. They also support prospective, concurrent, and retrospective reviews; proactive care management; discharge planning; patient education, and quality initiatives. The Care Guidelines also incorporate quality measures from national organizations, including the Hospital Quality Alliance (HQA), NCQA and the Joint Commission.

"By law, we review Medicare cases to determine if the services meet medically acceptable standards of care, are medically necessary, and are delivered in the most appropriate setting," said Dan Jaco, NMMRA Chief Executive Officer. "Using the Care Guidelines helps us in that analysis. Competing for the CMS 9th Statement of Work was challenging, and we are pleased to be able to continue our work in helping New Mexico beneficiaries receive the best available medical care. We believe that using the Care Guidelines will enable us to meet our Medicare and Medicaid review requirements and will continue to make us competitive for future contracts," Jaco added.

Scott Harris, Milliman Care Guidelines Senior Vice President of Sales and Marketing, commented, "The Care Guidelines combine rigorously screened, evidence-based clinical information with key elements of quality programs such as HQA's hospital quality measures. These quality-focused measures, and other clinical tools included in the Care Guidelines, enable QIOs to effectively manage their review processes and quality initiatives."

About NMMRA

The not-for-profit New Mexico Medical Review Association (NMMRA) has been the state's premier independent health care consulting organization since 1984. NMMRA is the federally contracted Medicare QIO for New Mexico and state-contracted Medicaid External Quality Review Organization (EQRO). It is widely recognized for providing education and training, technical assistance, quality of care review, and project management expertise to a variety of audiences in a number of areas. In addition to its federal and state contracts, NMMRA also assists organizations outside of New Mexico in quality improvement initiatives, working with providers, beneficiaries, consumers, payors and others to improve care.

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 www.careguidelines.com.

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 nonprofit organizations. For more information, visit www.milliman.com.


'/>"/>
SOURCE Milliman Care Guidelines
Copyright©2009 PR Newswire.
All rights reserved

Related medicine news :

1. Emprise 7000 Storage System, with ICON Manager and Virtual View Integration, Helps Milliman Care Guidelines Simplify Storage Management
2. CIMRO of Nebraska Uses Milliman Care Guidelines(R) for Nebraska Medicare Reviews
3. IPRO QIO Uses Milliman Care Guidelines(R) for Medicare Reviews in New York State
4. Recovery Audit Contractor HealthDataInsights Licenses Milliman Care Guidelines(R)
5. Milliman Care Guidelines(R) Replaces Multiple Guideline Sets for Wisconsin QIO
6. Milliman Survey Indicates Lower Health Insurance Rate Increases
7. ICMA-RC Announces New Service for Clients; Milliman, Inc. to Offer Actuarial Services for GASB 45 Reporting
8. Milliman Announces Encore Webinar on Practical Uses of Lifestyle-Based Analytics (LBA) in Risk Selection
9. Milliman Says 2008 Medical Cost for American Family of Four Exceeds $15,600
10. Milliman Expert Addresses Practical Applications of Lifestyle-Based Analytics in Risk Selection
11. Milliman Survey Confirms Continued Dominance of Guarantees in Variable Annuity Retirement Income Products
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/20/2017)... , ... February 20, 2017 , ... ... check-in, a cloud-based self-service technology that runs on the Posiflex XT-series of touch ... 1076 during HIMSS17 in Orlando, Florida. The terminal provider Posiflex is ...
(Date:2/20/2017)... Sunapee, NH (PRWEB) , ... February 20, 2017 , ... ReportingMD, a Population Health Software ... rapid growth of the company. The new location will triple the size of the ... location for the town of Sunapee, NH. , “We are excited to expand ...
(Date:2/20/2017)... Tampa, FL (PRWEB) , ... February 20, 2017 ... ... $20,000 gift from Constellation Brands to purchase a new ultrasound-enhanced thrombolysis machine, a ... ultrasonic waves. The gift was facilitated by the Pepin Family Foundation. , “We ...
(Date:2/19/2017)... ... 2017 , ... Orbita, Inc., a leading provider ... Healthwise ® at HIMSS 2017 to showcase a breakthrough in remote ... technology and services, will demonstrate a voice-powered knowedge assistant based on Orbita ...
(Date:2/18/2017)... ... , ... Park Cities Pet Sitter President, Joette White, has been featured on ... The episode, which was posted this week, features a 30-minute interview of White ... Cities Pet Sitter’s being awarded the 2017 National Association of Professional Pet Sitter’s Business ...
Breaking Medicine News(10 mins):
(Date:2/20/2017)... ORLANDO, Fla. , Feb. 20, 2017   ... will migrate its Amadeus precision medicine platform ... Health,s software currently manages over 110 million patient records ... approach to developing cloud-based, big data solutions built on ... Director of Healthcare and Life Sciences. "The AWS Cloud ...
(Date:2/20/2017)... Research and Markets has announced the addition of the ... report to their offering. ... An increasing number of patients suffering ... tension free repair procedures and increasing demand for minimally invasive ... market. However, Inconsistent reimbursement and the high cost of hernia ...
(Date:2/20/2017)... 20, 2017 According to a new market research ... powder), Device Type (Metered dose, Dry Powder, Nebulizer)), Canister (Plain, Coated), End ... The market is projected to reach USD 52.37 Billion by 2021 from ... forecast period. Continue Reading ... ...
Breaking Medicine Technology: