What Are Milliman Care Guidelines?

Milliman Care Guidelines, or MCG, are clinical guidelines to help providers and health plans make decisions about patient care, according to MCG. These guidelines offer guidance for handling a variety of different medical conditions, including diabetes, heart failure, pneumonia, asthma and chronic obstructive pulmonary disease.

Milliman Care Guidelines help support a qualified physician’s clinical decisions, notes MCG. The guidelines are based on current research with the goal of improving patient outcomes. The guidelines allow the physicians to access current research online or through an interactive software program. Clinical editors develop these guidelines, primarily relying on systematic reviews located in peer-reviewed literature and randomized controlled trials to compose the guidelines. Editors also use observational studies and data from specialized society guidelines and textbooks to create the guidelines. If there is not substantial data available from these sources, MCG uses unpublished sources, including expert opinions and quality improvement projects.

MCG includes 292 inpatient care guidelines as well as 29 general recovery care guidelines. These guidelines cover many types of care, including ambulatory care, neonatal intensive care, inpatient rehabilitation care and home care, reports MCG. The guidelines include information about the level of care, the amount of patient activity and the appropriate interventions necessary for each day a patient stays in a hospital. There are also guidelines useful for situations in which a patient has an extended stay in a hospital or develops a complication or exacerbation of a condition. The guidelines stipulate a goal length of stay for a patient depending on the diagnosis.