Payors

Seven of the eight largest US health plans use the evidence-based Milliman Care Guidelines^® to help reduce inappropriate care and control its associated costs. They rely on integrated, diagnosis-specific references, footnotes and abstracts that are all accessible and documentable within a user's workflow. Equip your staff with the tools needed to drive higher-quality care and review the use of medical resources:

• Employ proactive care using care pathways – Rather than working from a "snapshot" of a patient on a given day or using admission criteria for subsequent days of a patient's stay, the Care Guidelines^® employ care pathways to support continuing, proactive management of patients.
• Assess high-cost and emerging technologies – Use detailed indications and evidence summaries to support management of areas such as genetic testing, specialty pharmaceuticals, imaging, diagnostic testing, DME and more.
• Track and report on variances from best practice – CareWebQI helps improve quality and cost efficiency by 1) documenting users' interactions with criteria; 2) identifying variances and potential gaps in care; 3) and using reports to reduce these variances.
• Manage chronic membership – The Chronic Care Guidelines provide a robust framework for care management of chronic, complex or multi-diagnosis members also is a set of patient education materials.
• Support complex and complicated patients – The General Recovery Guidelines provide expanded decision support for management of members with comorbidities, multiple illnesses, or unclear diagnoses.
• Automate prior authorizations – Auto Authorization decreases administrative costs and time by automating provider requests and payor approvals for many procedures via automated, easy-to-use "check box" authorization requests.