The landmark report from the Institute of Medicine (IOM), “Crossing the Quality Chasm: A New Health System for the 21st Century,” called for our nation’s health care system to be more patient-centered and more systems oriented. It also stressed the need for health care delivery to be more focused on chronic care, more evidence-based, and more reliant on best practices.
Health plans have long embraced this approach to health care, utilizing best practices and clinical guidelines to help physicians and other providers ensure they are providing the most appropriate treatments and care to patients. As medicine is constantly evolving—advances in technology and new research can lead to changes both minor and significant—the definition of best practices and clinical guidelines must also evolve.
Health plans use a variety of nationally recognized proprietary products (i.e. Interqual, Milliman & Robertson) that collect and constantly update guideline criteria. All health plans provide the clinical guidelines and treatment protocols for particular diseases or conditions to those consumers who request this information.