Products

The Milliman Care Guidelines^® are evidence-based clinical guidelines that span the continuum of care. They provide best practices criteria and content for healthcare professionals in most healthcare settings, supporting decisions and easing patient transitions between settings. Care Guidelines^® products include:

• CareWebQI ^® – This web-based interactive software captures and reports on real-time clinical data through a consistent point-and-click application and an easy-to-use variance selection. This enables users to identify inappropriate care, and generate reports about variances from evidence-based best practice; physician, facility and resource delays; national quality measures; and more. National Institute of Standards and Technology compliance ensures best security tools. An installable version is also available.
• Auto Authorization – This product streamlines cumbersome prior-authorization processes. As a CareWebQI^® add-on,  Auto Authorization can automate approvals of admissions and procedures, saving time and decreasing administrative costs for both payors and providers.
• Ambulatory Care – Authorize established and emerging outpatient clinical procedures and technologies. The Ambulatory Care product covers diagnostic tests, imaging, rehabilitation services, durable medical equipment, specialty pharmaceuticals, specialty referrals, and more.
• Inpatient and Surgical Care – Anticipate appropriate clinical resources and identify the next steps in proactive care for inpatients. This product provides detailed care pathways, admission and discharge criteria, goal lengths of stay, and other decision-support tools.
• General Recovery Guidelines – Support clinical decision-making when there isn't a guideline for the diagnosis, or when the clinical situation is so complex that a specific guideline doesn't fit. These guidelines and tools expand the Care Guidelines to cover the entire spectrum of conditions and procedures requiring hospital admission, including complex cases.
• Recovery Facility Care – Coordinate plans for moving patients to—and through—recovery facilities to other appropriate care settings. This product provides recovery facility admission, care, and discharge criteria, including complete discharge plans.
• Home Care – Maintain quality and efficiency beyond healthcare facility walls. The Home Care product enables well-defined and coordinated care plans to support patients at home, including therapy visit goals.
• Chronic Care Guidelines – Facilitate outpatient care for chronic or complex diagnoses. These guidelines help direct daily workflow with practical patient care information, presenting clinical content in a case-management framework for 24 chronic conditions.
• Behavioral Health Guidelines – Address specific psychological, behavioral, and pharmacologic therapies. This product covers 15 diagnosis groups at five levels of care to help integrate behavioral health care with other utilization management efforts.

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