What are the advantages of using the Care Guidelines^® rather than traditional symptom-based criteria?

Milliman Care Guidelines uses a diagnosis-based approach; our products are organized by diagnoses or diagnostic groups such as community-acquired pneumonia or substance abuse disorders. Another approach is traditional symptom-based criteria, organized by manifestations of illness such as symptoms, behaviors or functional deficits. Advantages of a diagnosis-based approach include:

• Outlining disease-specific best practices such as timing of antibiotic therapy for community-acquired pneumonia or surgical procedures.
• Providing disease-specific length of stay benchmarks (Goal Length of Stay).
• Providing greater depth of content employing a larger evidence base.
• Helping to manage recovery delays.
• Promoting consistent, proactive care management, not simply a snapshot.
• Stimulating such questions as:
  • “Is plan of care in place?”
  • “Is the patient making progress toward the goal?”
  • “What additional services does the patient require?”
  •  Not simply “Does the patient meet criteria?”
• Providing users greater depth of content and longitudinal approach to care.