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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 accept
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SOURCE Milliman Care Guidelines
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