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NMMRA QIO Uses Milliman Care Guidelines(R) for New Mexico Medicare and Medicaid Reviews

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."


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

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

SOURCE Milliman Care Guidelines
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