NMMRA QIO Uses Milliman Care Guidelines(R) for New Mexico Medicare and Medicaid Reviews

NMMRA QIO Uses Milliman Care Guidelines(R) for New Mexico Medicare and
Medicaid Reviews

Evidence-Based Clinical Guidelines and Software Improve Quality Review Process

SEATTLE, March 24 /PRNewswire/ -- New Mexico Medical Review Association
(NMMRA), a Quality Improvement Organization (QIO), 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 -- as
well as Medicaid quality reviews -- in New Mexico.

The Centers for Medicare & Medicaid Services (CMS) contracts with QIOs in each
state to conduct various reviews and quality initiatives. It does not mandate
or endorse the use of any specific criteria set by QIOs or hospitals. Twelve
QIOs now license the Care Guidelines.

NMMRA 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 evaluate appropriate care for Medicare and Medicaid beneficiaries.
The Care Guidelines identify benchmark patient care and recovery stages to
enhance healthcare services delivery, resource management and patient
outcomes. This approach can reduce unnecessary variation in healthcare
delivery and health care disparities in the community.

The Care Guidelines provide healthcare professionals with evidence-based
clinical guidelines at the point of care. They also support prospective,
concurrent, and retrospective reviews; proactive care management; discharge
planning; patient education, and quality initiatives. The Care Guidelines
also incorporate quality measures from national organizations, including the
Hospital Quality Alliance (HQA), NCQA and the Joint Commission.

"By law, we review Medicare cases to determine if the services meet medically
acceptable standards of care, are medically necessary, and are delivered in
the most appropriate setting," said Dan Jaco, NMMRA Chief Executive Officer.
"Using the Care Guidelines helps us in that analysis. Competing for the CMS
9th Statement of Work was challenging, and we are pleased to be able to
continue our work in helping New Mexico beneficiaries receive the best
available medical care. We believe that using the Care Guidelines will enable
us to meet our Medicare and Medicaid review requirements and will continue to
make us competitive for future contracts," Jaco added.

Scott Harris, Milliman Care Guidelines Senior Vice President of Sales and
Marketing, commented, "The Care Guidelines combine rigorously screened,
evidence-based clinical information with key elements of quality programs such
as HQA's hospital quality measures. These quality-focused measures, and other
clinical tools included in the Care Guidelines, enable QIOs to effectively
manage their review processes and quality initiatives."

About NMMRA

The not-for-profit New Mexico Medical Review Association (NMMRA) has been the
state's premier independent health care consulting organization since 1984.
NMMRA is the federally contracted Medicare QIO for New Mexico and
state-contracted Medicaid External Quality Review Organization (EQRO). It is
widely recognized for providing education and training, technical assistance,
quality of care review, and project management expertise to a variety of
audiences in a number of areas. In addition to its federal and state
contracts, NMMRA also assists organizations outside of New Mexico in quality
improvement initiatives, working with providers, beneficiaries, consumers,
payors and others to improve care.

About Milliman Care Guidelines

Milliman Care Guidelines, LLC, A Milliman Company, is located in Seattle, and
independently develops and produces evidence-based clinical guidelines and
software used by more than 1,000 clients, including hospitals, providers and
health plans. Covering the continuum of care, the seven-product Care
Guidelines series is updated annually by an experienced team of clinicians and
are used to support the care of more than one in three Americans. For more
information, visit www.careguidelines.com.

About Milliman

Milliman Care Guidelines is a wholly owned subsidiary of Milliman, Inc., which
is among the world's largest independent actuarial and consulting firms.
Founded in Seattle in 1947 as Milliman & Robertson, the company now has 49
offices in key locations worldwide. Milliman employs more than 2,000 people,
with a professional staff of more than 1,000 qualified consultants and
actuaries, including specialists ranging from clinicians to economists. The
firm has consulting practices in healthcare, employee benefits, property and
casualty insurance, life insurance and financial services. Milliman serves
the full spectrum of business, financial, government, union, education and
nonprofit organizations. For more information, visit www.milliman.com.

SOURCE Milliman Care Guidelines

Scott Harris, Senior Vice President of Sales and Marketing, Milliman Care
Guidelines, +1-206-381-8160, or Cell, +1-480-203-7268,
scott.harris@milliman.com