2012 Doyle Award Winner Announced

Share Article

Milliman Care Guidelines Recognizes Capital District Physicians’ Health Plan, Inc. for Innovation in Effective Health Care

Milliman Care Guidelines today named Capital District Physicians’ Health Plan, Inc. (CDPHP®) as a winner of the 2012 Richard L. Doyle Award for Innovation and Leadership in Healthcare.

The Doyle Award, given to one payor and one provider every year, recognizes organizations that use Milliman Care Guidelines products in exceptional ways to achieve the objective of optimal care.

Using clinical criteria and decision support software from Milliman Care Guidelines, this health plan transitioned from retrospective, paper-based utilization review to an electronic, real-time system. With the time savings experienced, CDPHP was able to devote more attention to quality improvement projects and better deliver effective care. Serving upstate New York, CDPHP has nearly 400,000 members and a provider network of 10,000.

According to Irene Grey, manager of inpatient programs for CDPHP, prior to the project, getting records back to their office and scanned often took days and sometimes weeks.

“Now, with real-time access to the latest clinical information on our hospitalized members, we are able to identify their reasons for admission, services arranged after discharge, and agencies involved, resulting in accurate real-time assessments and meaningful reductions in readmissions,” said Grey.

Prior to their new utilization management process, a case that required review and action by a medical director typically took half an hour. After implementation, such a review required less than 10 minutes. CDPHP estimates that its medical directors have been freed up to devote two and a half hours a day to quality improvement projects, including a collaborative initiative with area practices and facilities to reduce unnecessary readmissions and emergency department visits.

CDPHP uses the Milliman Care Guidelines CareWebQI® decision support software to discover hidden inefficiencies within its provider network, such as 30-day readmissions. For example, Grey said, “Previously, if a patient was discharged from Hospital A and readmitted to Hospital B within days, Hospital A might never know that the patient was readmitted, let alone why. With CareWebQI, we can track that information and help the two hospitals coordinate.”

Milliman Care Guidelines will present the Doyle Award to CDPHP on October 2 at its annual Client Forum in San Antonio. For more information, visit http://conference.milliman.com/2012CF/about.php

About CDPHP
Established in 1984, CDPHP is a physician-founded, member-focused and community-based not-for-profit health plan that offers high-quality affordable health insurance plans to members in 24 counties throughout New York. CDPHP is also on Facebook, Twitter, and LinkedIn.

About Milliman Care Guidelines
Milliman Care Guidelines LLC, A Milliman Company, independently develops and produces evidence-based clinical guidelines and software used by more than 2,200 clients including 1,200 hospitals and seven of the eight largest U.S. health plans. Updated annually by an experienced team of clinicians, the care guidelines support the care management of a majority of Americans. For more information, visit http://www.careguidelines.com.

About Milliman
Milliman Care Guidelines is a wholly owned subsidiary of Milliman, Inc. Milliman is among the world’s largest providers of actuarial and related products and services. The firm has consulting practices in life insurance and financial services, property & casualty insurance, healthcare, and employee benefits. Founded in 1947, Milliman is an independent firm with offices in major cities around the globe. For further information, visit http://www.milliman.com.

About The Richard L. Doyle Award for Innovation and Leadership in Healthcare
The Doyle Award was developed to recognize organizations making innovative use of the care guidelines to help deliver effective healthcare.

Dr. Doyle, the care guidelines founding editor, was a hospital chief-of-staff when he began creating clinical guidelines in the 1980s to help improve healthcare efficiency and quality at Mercy Hospital in San Diego. He later joined Milliman & Robertson and in 1990 published the first set of what was to become the care guidelines.

Judges for this award are independent healthcare quality experts, not currently associated with Milliman Care Guidelines. Applicants were judged on how well their projects supported the Milliman Care Guidelines mission to help drive effective care. Judges looked for improvements in healthcare quality and patient safety; patient/member satisfaction; staff efficiency, productivity and satisfaction; internal/external communication; and effective use of resources.

Share article on social media or email:

View article via:

Pdf Print