What are the Milliman Care Guidelines® and who uses them?
A series that spans the continuum of patient care, the Care Guidelines describe the best practices for treating common conditions in a variety of care settings.
The Care Guidelines are written by an experienced editorial staff of physicians, nurses and other healthcare professionals, and represent a compilation of best practices drawn from the current best medical evidence. The purpose of these clinical tools, which are updated on a regular basis, is to assist healthcare professionals in providing quality care by reducing the underuse, overuse and misuse of medical resources. This reduction is accomplished by:
- Describing the right care, at the right time, at the right place
- Avoiding delays in care
- Incorporating nationally-recognized quality measures
- Providing planning tools to coordinate care and anticipate patients’ needs
- Providing patient education tools
Written in a clear, direct style, the Care Guidelines are, quite simply, guidelines for providing the right care, at the right time and in the right setting. They are not a prescription, a decision tree or a set of rules for the practice of medicine. Based on medical literature and the actual practice of physicians across the United States, the Care Guidelines are a picture of what is possible and – most importantly– what is actually being done.
The Care Guidelines are used by more than 1,000 hospitals, physician groups, health plans and other healthcare managers. They are so broadly-accepted that the Care Guidelines are used to support the care of one in three Americans.
The Care Guidelines are used most effectively when they are reviewed by local physicians and care managers and adapted, as necessary, depending on the availability of local healthcare resources. We believe physicians need to understand, have input into and accept guidelines to achieve optimal results.
For some conditions, the Care Guidelines assume that certain infrastructure, including pre- and post-hospital care services, are available in the local healthcare delivery system to achieve the Care Guidelines’ Goal Lengths of Stay. If services such as home healthcare or skilled nursing facilities are not available, longer in-hospital stays may be required. Use of the Care Guidelines often helps identify needed outpatient care services not available in a system or community.