IPRO QIO Uses Milliman Care Guidelines for Medicare Reviews in New York State

Source: Healthcare IT News

IPRO, one of the nation's leading Quality Improvement Organizations (QIOs), has signed a five-year licensing agreement with Milliman Care Guidelines, LLC, A Milliman Company, to use the Care Guidelines for Medicare utilization and quality reviews in the state of New York.

IPRO will use all Care Guidelines products -- Ambulatory Care, Inpatient and Surgical Care, General Recovery Guidelines, Recovery Facility Care, Home Care, Chronic Care Guidelines and Behavioral Health Guidelines -- through Web software to support appropriate quality of clinical care for Medicare beneficiaries.

The Centers for Medicare & Medicaid Services (CMS) contracts with QIOs in each state to conduct Medicare reviews and quality initiatives across a variety of healthcare settings. It does not mandate or endorse the use of any specific criteria set by QIOs.

The Care Guidelines promote quality care by providing healthcare professionals with access to best practice based on annually updated evidence. The Care Guidelines also display Quality Measures approved by CMS, and each inpatient topic includes care planning information highlighting interventions that lead to improved outcomes. Designed for prospective, concurrent, and retrospective reviews, the Care Guidelines enable informed and consistent clinical care decisions, and support the best possible care management using the most current evidence-based medicine.

"The Care Guidelines incorporate CMS Hospital Quality Initiative Core Measures," said

Scott Harris , Milliman Care Guidelines Senior Vice President of Sales and Marketing. "Access to evidence-based clinical tools that improve quality of care enables QIOs to effectively manage their review processes and quality initiatives."