Milliman Care Guidelines® are annually updated, evidence-based clinical guidelines that span the continuum of care, including chronic care and behavioral health management. Providing much more than authorization criteria, they drive high-quality care through such tools as care pathway tables, flagged quality measures, and integrated medical evidence.

The current best evidence is optimal only when easily used by healthcare professionals to make decisions about the care of individual patients. To that end, Care Guidelines are incorporated into easy-to-use software. From Web-based applications, to interactive software producing real-time management reports, to handheld versions, Care Guidelines software makes the current best evidence readily available for use where it matters—at the point of care.

Interactive care management tool provides real-time variance reporting

Care Guidelines are incorporated into either client-hosted or Web-based software that readily interfaces with many medical management and clinical information systems. Interactive version CareWebQI® enables quality improvement and cost efficiency through targeting and reducing inappropriate care. This progressive workflow tool not only identifies potential gaps in care, but also provides information about why variances are occurring—and thus, how they can be reduced. Users can easily identify variances through the point-and-click interface. Then, through tools such as variance reports, CareWebQI provides real-time clinical data in terms that management can act upon.

Delivering evidence-based knowledge at the point of care

Our team of doctors, nurses, and other clinicians has reviewed more than 100,000 abstracts, articles, and other sources of evidence and chosen more than 14,000 unique citations. We use the findings to build evidence-based authorization criteria, care pathways, and other care management tools. These decision-support resources enable payors, care providers, and facilities to efficiently and consistently make care decisions grounded in rigorous, up-to-date research. They also assist clients in evaluating current practices and finding opportunities to improve both quality of care and care management.