Shannon Brownlee

This session will be a follow up discussion on the opening keynote presentation.

Opal Thomas, RN, MSN, St. Jude Medical Center and Connie Hill, RN, BS, CPHQ, CPUR, Milliman Care Guidelines

St. Jude Medical Center, a division of St. Joseph Health System, and Milliman Care Guidelines worked collaboratively to conduct a five-month project to evaluate the impact of the use of the Care Guidelines and CareWebQI in the delivery of inpatient care at St. Jude Medical Center. We evaluated the impact of utilizing the Care Guidelines and CareWebQI with the modified St. Jude Medical Center medical management processes to better manage patients along the continuum of care, and promote quality by using evidence-based clinical best practices in the care delivered.

Garrett Foulke, MD, MMM, FACP, FCCM, FACPE, Milliman Care Guidelines and Ann O'Neill, RNC, MBA/HCM, Milliman Care Guidelines

This session will review the salient issues uncovered by a major initiative to produce newly designed products that address today's hospital and electronic health record needs. The current status of new products and the Care Guidelines roadmap for the future will be presented.

Frederick Huie, MD, MBA, Horizon BCBS;David Mirkin, MD, Milliman, Inc.

This session will focus on how two large health plans use the Inpatient Hospital Profiler tool. The discussion will include tips on how to use the Inpatient Hospital Profiler tool to enhance the use of the Care Guidelines.

Jane Brock, MD, MSPH, Colorado Foundation for Medical Care

The Colorado Foundation for Medical Care led a small pilot to convene unaffiliated providers from various settings that care for a common group of fee-for-service Medicare beneficiaries, for the purposes of creating new standard processes for care coordination and to support reliable care transitions. The pilot led to a 50% reduction in 30 day hospital readmissions. The pilot has now been expanded to include 14 communities in 14 different states under the CMS's Care Transitions Theme for Quality Improvement Organizations (QIOs). The eventual goal of this work is to enable communities of providers to design intentional care planning and delivery across settings for patients with many medical service needs. There is an obvious potential role for national guidelines to support best practices in delivering multi-setting care.

Penny Moore, CMCE, RPh, SHPS

This presentation will focus on the challenges associated with providing member-centric care plans in an environment where public services are normally organized and delivered in silos.

Paul Smith, MD, University of Wisconsin

In this follow up session, Dr. Smith will review results of a health literacy focus group project he recently completed, promising health literacy practices for ambulatory environments and easily available selected health literacy resources. This will be an interactive session with time for audience questions.

John Ninomiya, PhD, MSc, FSA, MAAA, Louise Bower, BS, RN, Jim Schibanoff, MD, Helen Blumen, MD, MBA, Garrett Foulke, MD, MMM, FACP, FCCM, FACPE and Dorothy Correa, RN, FNP, MSN, Milliman Care Guidelines

This program provides a presentation of the changes in the 13th Edition, along with an opportunity to discuss those changes with the editors.

Lynn Nemiccolo, RN and Tauheedah Avinger, RN, BSN, Milliman Care Guidelines

In this session, you will see what's new with CareWebQI for 2008. You will also have an overview of what is coming next for our interactive software.

Jeff Frater, RN, BSN, CCM, Donna McNamara, BSN, RN, PMP, and Debbie Jepson, RN, CCP, Milliman Care Guidelines

Consistent, appropriate use of the Milliman Care Guidelines is vital to conducting quality Care Management functions. The On Demand Training modules provide comprehensive and interactive training to support retention of new skills, build confidence in the application of the Care Guidelines and support consistent application between users. The Interrater Reliability Tool enables organizations to measure the consistent and appropriate application of the Milliman Care Guidelines. This session will provide an overview of the key features and functions of the Learning Management tool and their application for the delivery of On Demand Training and Interrater Reliability testing.

Kim Motter, RN, BSN, CCM, HHS Health Options

The Geriatric population is increasing rapidly each year. This population brings new challenges for Case Managers while working to increase their quality of life, maximize their level of independence and prevent premature nursing home placement. Within this population there are two distinct groups of individuals who have different needs and different wants. The depression-era geriatrics want only enough services and support to meet their basic needs and they don't want to take services away from others that they believe need the services more than they do. The Baby Boomer generation wants quality services and they want services to keep them in the living style that they have become accustomed to. The goal is simple, person-centered planning that includes disease management, physician-case manager coordinated care and an effective support system.

Jim Schibanoff, MD, Helen Blumen, MD, MBA, Garrett Foulke, MD, MMM, FACP, FCCM, FACPE and Dorothy Correa, RN, FNP, MSN, Milliman Care Guidelines

This session will present topics, examples and prototypes for proposed future Care Guidelines product development and content enhancements and will allow the audience to provide feedback regarding their preferences and suggestions.

Rajesh Godavarthi, CSM, MCP, Maju Kuruvilla, Julie Arotin, MS, RN, CCP, Kevin Wagner, Gary Barnett, Milliman Care Guidelines

A panel of experts from Milliman Care Guidelines will be available to answer any technical, integration, work flow and reporting tools questions related to our Interactive tools.

• Administrators' questions related to CareWebQI features, Security, HL7 interface, and API
• Users seeking advise on creating specific workflows using our interactive tools
• Reporting features: What do you like about current CareWebQI reports? What else are you expecting?
• Common support questions
• Vendor integration questions

Mark Michelman, MD, MBA, Morton Plant Mease Healthcare

The new severity adjusted DRGs will have a significant impact on both hospitals and medical staffs. Crucial to the process is physician documentation or lack thereof. Interventions will be discussed to help bring together the physicians, clinical documentation specialists, and coders, in an effort to come up with the most appropriate MSDRG for the hospital encounter. The implications of poor/inadequate documentation will be discussed.

John Ninomiya, PhD, MSc, FSA, MAAA, Milliman Care Guidelines

This session reviews the data provided in the Care Guidelines to allow the comparison of actual utilization performance with Care Guidelines standards. The Inpatient Utilization Models and the Statistical Companion section of the Inpatient and Surgical Care product will be featured. The role of data analysis in the development and validation of the Care Guidelines will also be discussed.