Case Studies

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Using Evidence-based Guidelines Produces Significant ROI for Health Plan

Missouri-based Cox HealthPlans was searching for a way to ensure consistent, high-quality care to its members while keeping the cost contained. The company instituted the Milliman Care Guidelines^® to help determine the best medical practices and set the most effective standards of care. In the first year, Cox HealthPlans saved $159,000 by recognizing the appropriate level of care in inpatient and recovery care. Cox later added the Behavioral Health Guidelines and realized a savings of nearly $200,000 in payments for medically unnecessary levels of care in just the first few months.

Active Case Management and Interactive Chronic Care Guideline Software Significantly Reduce Readmit Rates

Seattle-based Group Health Cooperative used the evidence-based Chronic Care Guidelines and software to help increase the efficiency and quality of healthcare delivery, and to provide case-management tools to help nurses address challenging patient needs. Group Health expanded a comprehensive, complex case-management program that enabled them to focus on important issues such as age, gender, cultural and personal differences that most impact how well the patients progress, as well as elicit questions or issues that slow recovery or lead to readmission.