SEATTLE, Oct. 5 /PRNewswire/ -- Milliman Care Guidelines(R) announced today that the Iowa Advisory Board for the Iowa Foundation for Medical Care (IFMC), the federally designated Quality Improvement Organization (QIO) for Iowa has approved Milliman Care Guidelines for use by IFMC to screen Medicare and Medicaid cases beginning July 1, 2005.
IFMC will use Ambulatory Care, Inpatient and Surgical Care, Recovery Facility Care, Home Care, General Recovery Guidelines and the Long-term Acute Care Hospital Guidelines (LTACH). IFMC previously used their own criteria to screen Medicare and Medicaid cases.
QIOs are required to establish written criteria or obtain national criteria for non-physician reviewers when screening Medicare and Medicaid cases for referral for physician review. There is no mandate for specific criteria. The Milliman Care Guidelines are available free-of-charge to QIOs, for use in their quality, medical necessity and appropriateness of setting review of Medicare and Medicaid patients.
“We made the decision to use Milliman Care Guidelines because we want to ensure we use both current and evidence-based criteria. Milliman has expertise in criteria development and the ability to update the information annually,” said Sandi Hall, R.N., Program Specialist for Medicare Case Review.
IFMC had discussions with several other QIOs, with multiple stakeholders and with providers, and conducted an in-depth analysis before reaching the decision that Milliman Care Guidelines best meets their needs.
“Milliman Care Guidelines closely reflects the principles of evidence- based medicine, employing the current best evidence. The multiple formats and annotated bibliographies will be extremely useful to assist our staff with appropriately identifying cases where physician reviewer determinations are necessary,” said Peg Mason, Vice President of Government Programs for IFMC.
The Milliman Care Guidelines are designed for both retrospective and concurrent review. Hospitals can use these guidelines in the same way as the IFMC to determine medical necessity and appropriateness of care. The Milliman Care Guidelines span the continuum of patient care and describe the best practices for treating common conditions in a variety of care settings.
“Milliman Care Guidelines is a versatile product that clearly demonstrates evidence-based best practices, recognizes the value of clinical experience of the reviewers, and provides a foundation for both quality improvement and risk management,” said Jim Schibanoff, MD, Editor in Chief for Milliman Care Guidelines.
About Iowa Foundation for Medical Care
IFMC is the federally designated Quality Improvement Organization (QIO) for Iowa and Illinois. The company continues to maintain a leadership role for Centers for Medicare & Medicaid Services (CMS) with pilot projects like public reporting, OASIS and DOQ-IT. IFMC is also a major partner for the State of Iowa Medicaid program. Our diverse health care teams work with doctors, hospitals, home care and nursing home providers, as well as consumers to improve health care quality. Services include Quality improvement (QI) projects; Medical and utilization review programs; Health care provider education and coaching; and Medicare and Medicaid consumer education.
For more than 30 years, Iowa Foundation for Medical Care (IFMC) has been dedicated to health care quality improvement and medical information management. Today, IFMC business units are at the forefront of clinical quality improvement, software design and support, and managed care services. IFMC is headquartered in West Des Moines, Iowa, with satellite offices in Illinois, Maryland, Nevada, and Virginia.
About Milliman Care Guidelines
Milliman Care Guidelines, LLC located in Seattle, WA, is a Milliman Company and provides its Care Guidelines to many of the firm’s clients in the hospital and insurance industries. The Care Guidelines are evidence-based tools that guide care and improve care management across the continuum of care. They reflect current best practices for the actual working environment of today’s healthcare organizations. The Milliman Care Guidelines are used to support the health care of one in three Americans. For further information, visit www.careguidelines.com.
Milliman, whose corporate offices are in Seattle, serves the full spectrum of business, financial, government, and union organizations. Founded in 1947 as Milliman & Robertson, the company has 32 offices in the United States as well as offices in Bermuda, Hong Kong, London, Madrid, Mexico City, Milan, Sao Paulo, Seoul, and Tokyo. Milliman employs approximately 1,850 people, including a professional staff of more than 850 qualified consultants and actuaries. The firm has consulting practices in employee benefits, healthcare, life insurance/financial services, and property and casualty insurance. It is a founding member of Milliman Global, an international organization of consulting firms serving insurance, employee benefits, and healthcare clients worldwide. For further information, visit www.milliman.com.
Milliman Care Guidelines
CONTACT: Scott Harris, Director of Marketing & Sales, Milliman CareGuidelines, +1-206-381-8160, Cell +1-480-203-7268,scott.harris@milliman.com; Jim Loughman, Director, Media Relations & PublicAffairs, Milliman, +1-203-698-0008, jim.loughman@milliman.com
