Blog
New Website Gives Clients Access to Latest Benchmarks and Data
June 21, 2010
We receive many inquires from clients regarding the data that our products include: the diagnosis and procedure codes assigned to our guidelines, lists of the guidelines themselves, the statistical data we use to validate parts of our guidelines, and our benchmarks for system-wide health care utilization. For our 14th Edition, we've made this data more accessible and convenient to use through our new Benchmarks and Data website.
The Benchmarks and Data website includes links to all of our existing data and benchmarking information, such as the utilization models and Statistical Companion analyses. These are now provided in Microsoft® Excel® (.xls) format for downloading and easier viewing, and also are available via the Table of Contents pages of our individual products. In addition, we've provided comprehensive list of guidelines, and full, downloadable tables of the ICD-9 and CPT-4 codes linked to each of our guidelines.
This information is now totally web-based, so that you can access updates and new features as soon as they are available. The initial release of the 14th Edition already contains several new data features, including the Potentially Ambulatory Procedures analysis, which provides information on the use of ambulatory vs. inpatient alternatives for our Inpatient and Surgical Care product; and our Behavioral Health Guidelines product's utilization models, providing utilization rates by guideline and level of care under well-managed and loosely-managed scenarios.
The Benchmarks and Data website may be accessed via our Web or CareWebQI® software options. In Web software, select the "My Products" link from the gray navigation bar at the top of the screen, and select the "Benchmarks and Data" link at the bottom of the page. Clients using CareWebQI have access to this website as well - see your CareWebQI administrator for logon information, or call Milliman Care Guidelines technical support, toll free, 888 464.4746, Option 1.
Group Health Cooperative Reduces Readmits with Active Clinical Care Tools and Nurse Care Manager Training
April 06, 2010
Seattle-based Group Health Cooperative provides services for urban and rural populations in Washington and Idaho, including patients with complex or comorbid conditions. As experienced case managers retired, general-practice nurses had to effectively manage patient care workflow, a specialist job for which they weren't trained.
To address these challenges, Group Health developed a comprehensive, complex-case management program for its rural patients, then expanded and adapted the program to cover all patients.
Using national, evidence-based clinical guidelines and powerful software, the Group Health program allowed new nurse case managers to focus on patient-recovery steps that would most impact how well patients progressed, helping the nurses to uncover issues that might slow recovery or lead to readmission.
Group Health gave all nurse case managers interactive software with the clinical guidelines, ensuring that evidence-based care would guide patient recovery. These tools enabled general-practice nurses to become case managers, helping them to quickly build detailed care plans to manage any case.
With these case management tools, a nurse could pay attention to the patient, being alert to possible patient misunderstanding, while the guidelines provided national standards for efficient and effective care. Backed by these broadly accepted guidelines, Group Health's new nurse case managers can help patients move through each step of the care continuum, and reduce readmit rates for its nearly 600,000 members.
Assessing and Addressing Patients' Health Literacy Challenges
February 12, 2010
Most patients are not this open about their inability to understand health education materials because they don't understand the risks of their health literacy deficit. Health literacy is defined in Healthy People 20101 as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." Patients often fail to adhere to medical or dietary recommendations because of their poor health literacy. And when providers are unaware of this problem, they are unlikely to teach their patients in ways that empower those patients to successfully manage their health problems.
Inadequate health literacy is a widespread problem. In a large national study conducted in 20032, 14% of adults were determined to be at the lowest level of health literacy (below basic), and 22% were at the next lowest level (basic). Although the majority of participants in this study in the "below basic" level of health literacy had not completed high school, 3% of this group had a bachelor's degree.
Providers should assess the health literacy level of each patient and provide education that is appropriate for that level. It is unlikely that patients will admit that they don't understand health information, so the provider should look for clues, such as patients promising to read education materials when they get home, never having their reading glasses with them, or leaving a lot of blanks on an intake form. When working with patients on the phone, clinicians may be able to identify health literacy deficits if patients frequently put someone else on the phone to speak for them, they avoid reviewing health topics, or if they continue to repeat incorrect medical information even after proper instruction.
What can providers do?
Ensure Consistent Clinical Decision Making
January 15, 2010
Every day, healthcare organizations are challenged regarding the clinical decisions they make. They face an increased number of requirements from government, regulatory accrediting agencies and employer groups. Objective proof that decisions are consistent and supportable is imperative, making interrater reliability -- the degree of agreement among clinical decision-makers -- critical.
There are a wide variety of approaches that organizations can use to support interrater reliability, and objectively validate its presence: using nationally recognized standards of care and clinical guidelines; providing easy access to staff training; and testing how staff members use the standards in place. National organizations such as NCQA and URAC offer programs and services to help organizations assess their quality of care and their clinical decision-making processes.
With the diversity of workplace settings, offering multiple training options is a key to ensuring that staff members participate, regardless of their schedule. Consider on-site or regional training, peer training, and web-based training options. All training activity must be tracked, reportable and result in measurable action plans. Evaluating the outcome once training has been completed, and measuring progress and results are vital.
Once training is complete, organizations can begin to track their interrater reliability. The best solutions test staff using realistic clinical situations against set standards, and provide both detailed and high-level reporting by individual user, group and across the organization. Healthcare standards change as new treatments, medications and alternatives are identified. Access to ongoing training and testing helps to maintain consistent clinical decisions.
Milliman Care Guidelines offers nationally-recognized guidelines, a comprehensive set of training options and an Interrater Reliability Tool to support the evaluation process.
Providing Our Clients with Efficiencies through Auto Authorization
December 15, 2009
A recurring theme in the healthcare industry over the past several years has been that of “creating efficiency.” Efficiency, of course, includes the lofty goal of eliminating waste in care delivery – whether that waste is unnecessary or redundant care, avoidable complications, errors or lack of care coordination. Certainly, we believe the Care Guidelines have a large role to play in that effort.
However, this struggle to find efficiencies extends to the administrative realm. How can we perform the transactions, reviews and other duties required through less expensive, but equally effective means?
This kind of efficiency can come in several forms: medical management systems, electronic health records, CPOE, etc. All are worthy investments, if done correctly, but there is another that has woven its way in and out of our industry’s dialog over the past decade, and is worth considering: “auto authorization.”
Auto authorization is a software tool – typically accessed through a web portal – that offers real-time, self-service access to member eligibility and medical necessity authorization. It creates administrative efficiencies for both payors and providers.
This blog’s purpose is to provide our clients with insight regarding a variety of issues they face. On occasion, however, we may use it to share exciting news, such as our current development of auto authorization software that will be available to our clients in 2010. This software will be released as an additional module within our highly-successful existing interactive software, CareWebQI®. We look forward to its development in the coming months and sharing its progress with our clients!
