UnitedHealthcare received the second annual Richard L. Doyle Award for Innovation and Leadership in Health Care from Milliman Care Guidelines for working collaboratively with physicians and other health professionals to identify and employ best practices to prevent complications from major bowel surgery.
Milliman presented the award to UnitedHealthcare today at an awards ceremony in La Jolla, Calif.
Milliman is a national organization that publishes evidence-based clinical guidelines used by more than 1,800 clients, including 1,000 hospitals, and supporting the care of more than two-thirds of health plan participants nationwide. An in-house staff of clinician writers develop and annually update the Milliman Care Guidelines® based on the latest clinical evidence, which was used as the foundation for UnitedHealthcare’s award-winning program that addressed an unacceptably high level of preventable complications related to bowel surgery.
Working collaboratively with gastrointestinal (GI) surgeons and other hospital-based clinical staff across the country over an 18-month period, best practices were identified and implemented in areas such as nutrition and diet, activity level and indicators of return to normal bowel function. UnitedHealthcare augmented this expertise and resources with its industry-leading technology and data resources.
The program’s success was demonstrated by faster recovery times for patients, resulting in a 50-percent decrease in avoidable hospital days and a decrease in GI surgery-related hospital readmissions. This decrease helped lower the risk of post-surgery complications by up to 60 percent and produced inpatient cost savings of approximately $7.4 million over the 18 months.
“UnitedHealthcare clearly demonstrated that programs that focus on the patient and are based on proven scientific evidence can improve health care quality and safety,” said James M. Schibanoff, M.D., Editor-in-Chief of the Milliman Care Guidelines.
Patients are at greater risk for avoidable complications the longer they remain in the hospital, according to many studies. In fact, every hospital day is linked to a 6-percent increase in risk for complications, with the potential of negatively affecting patient health and adding unnecessary health care costs. As a result, a shorter length of stay in a hospital environment can significantly reduce the possibility of complications.
“The Richard L. Doyle Award recognizes what can be achieved when health plans and physicians work together to improve the health of our patients,” said Sam Ho, M.D., UnitedHealthcare executive vice president and chief medical officer. “This program illustrates how better information can lead to better health results. We’re honored to receive this recognition and look forward to applying these best practices to enhance the quality of care in other clinical programs.”
UnitedHealthcare’s program was selected for the Richard L. Doyle Award by a panel of external judges representing various organizations that are national leaders in promoting health care quality and patient safety standards. The award recognizes health care-related organizations that are at the forefront of using evidence-based clinical guidelines and technology to advance the delivery of optimal health care.
About Milliman Care Guidelines
Milliman Care Guidelines LLC, A Milliman Company (www.careguidelines.com), located in Seattle, Wash., independently develops and produces evidence-based clinical guidelines and software. These products are used by more than 1,800 clients, including 1,000 hospitals, seven of the eight largest U.S. health plans, and 25 Centers for Medicare and Medicaid audit contractors to support the care of a majority of Americans. Covering the continuum of care, the seven-product Care Guidelines series is updated annually by an experienced team of clinicians. Milliman Care Guidelines is a wholly owned subsidiary of Milliman, Inc. (www.milliman.com), which is among the world’s largest independent actuarial and consulting firms. The company has 52 offices in key locations worldwide, providing a full spectrum of health care, employee benefits, property and casualty insurance, life insurance, and financial services. Milliman serves the full spectrum of businesses, financial, government, union, education, and nonprofit organizations.
UnitedHealthcare (www.unitedhealthcare.com) provides a full spectrum of consumer-oriented health benefit plans and services to individuals, public sector employers and businesses of all sizes, including more than half of the Fortune 100 companies. The company organizes access to quality, affordable health care services on behalf of approximately 25 million individual consumers, contracting directly with more than 600,000 physicians and care professionals and 5,000 hospitals to offer them broad, convenient access to services nationwide. UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified Fortune 50 health and well-being company.
About The Richard L. Doyle Award for Innovation and Leadership in Healthcare
Named for Richard L. Doyle, M.D., founder of the Milliman Care Guidelines, the award was developed to recognize Milliman Care Guidelines clients who are health care leaders and innovators -- those using the Care Guidelines to advance the delivery of optimal healthcare.
Dr. Doyle was hospital chief-of-staff when he began creating clinical guidelines in the 1980s to help improve health care efficiency and quality at Mercy Hospital in San Diego. He later joined Milliman and, in 1990, published the first set of what was to become the Milliman Care Guidelines.
Judges for this award were independent health care quality experts, not currently associated with Milliman Care Guidelines. They were Richard L. Doyle, M.D., retired founder of Milliman Care Guidelines; Liza Greenberg, RN, MPH, president of Health Project Consulting; Leah Binder, MA, MGA, chief executive officer of Leapfrog Group; Michelle Phipps, RN, PhD, director of standards development for URAC; and Michael Millenson, president of Health Quality Advisors.
Applicants were judged on how well their projects supported the Milliman Care Guidelines vision of advancing the delivery of optimal health care, as well as the level of innovation, impacts on other departments or geographic areas, quantifiable progress, and support from hospital or health plan leadership. Judges looked for improvements in health care quality or patient safety; patient or member satisfaction; staff efficiency, productivity or satisfaction; provider or payor satisfaction or communication; external agency satisfaction; and health care costs.