1. IndiciaTM for Utilization Review
Build your business case
Created by Milliman Care Guidelines
For hospital decision-making teams

2. How to Use This Resource
If your organization is considering Indicia for Utilization Review, you may have other team members who are less familiar with the product
We have designed this PowerPoint deck so that you may customize it or use any of its assets in presentations to your team

3. A Word About Content Rights
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4. Indicia for Utilization Review
Designed for providers
Contains the most thoroughly researched, most broadly used care guidelines in the industry
iPad enabled
Supports utilization review efforts
Helps avoid inappropriate admissions

5. Tackles Practical Needs
Admissions
Utilization Review
Easy to look up and interpret criteria
Streamlined user experience for any member of the care team – triage nurse or ED physician alike
Visual go/no-go indication
Mobile access for iPad
PDF, save and print capabilities
Automated admission/discharge indications across various care settings
Can integrate with existing case management or EMR software
Internet-like search capabilities

6. How Indicia would benefit us
Helps ensure focus on patients’ path to health
Supports existing workflow
Helps achieve reimbursement and care management goals
Facilitates conversations with payors about appropriate care

7. Our Organization’s UR Challenges
[What challenges are you experiencing with regard to your existing UR process? Place those here.]

8. Our Plans for Indicia Include
[If you have specific goals or business needs that could be addressed by using Indicia for Utilization Review, include those here.]

9. How It’s Being Used ED Admissions Weekend Admissions
Critical Access Hospital Utilization
Care Transition and Readmission
Ambulatory and Procedural Admissions

10. Example Use Case
Weekend Admissions

11. What Happens in Our Organization at Night or on a Weekend?
Who is responsible for making judgment calls about admission?
Are admissions handled consistently and in accordance with the most up to date, valid criteria used by our payors and CMS?
Is the patient receiving the appropriate level of care?
How is that decision documented?
How is the case manager brought up to speed Monday morning?
How can we ensure we will be reimbursed for this care?

12. What Are the Costs Over the Course of One Weekend?
[EXAMPLE]
Time getting Monday morning staff up to speed
30 minutes per patient
Resources looking up documentation after the fact
Lost reimbursement revenue due to inappropriate admission
$12,000
X 5 patients =
2.5 hours
X 5 patients =
2.5 hours
X 5 bed days
$60,000 =

13. What Are the Costs Over the Course of One Weekend?
[Fill in your own estimates here]
Time getting Monday morning staff up to speed
[How many hours/minutes do you spend per patient?]
Resources looking up documentation after the fact
Lost reimbursement revenue due to inappropriate admission
[Average cost per bed day]
X # patients =
X hours
X # patients =
X hours
X # bed days $X =

14. Selection Criteria: How Indicia Stacks Up
Ease of use
Guidelines lookup and search by any staff member
Clarity of indications
Visual indications for admission
Effective use of time
PDF, save or print the guideline for case manager review on Monday

15. Let’s Walk Through a Typical Admission
A patient presents to the Emergency Department in some respiratory distress
Given the patient's condition the admitting physician thinks she should admit him
The triage nurse is responsible for determining the appropriateness of the admission according to the evidence

16. Easy Guideline Lookup
The Triage Nurse looks up the criteria for hospital admission for a patient with acute exacerbation of Asthma on her iPad.

17. Clear Indication for Admission
The Triage Nurse documents the symptoms and a yellow bar indicates the patient does not need to be admitted.

18. Quick Documentation
The Triage Nurse then views indications for Observation Care, determines he’s a good fit, and documents her decision for the Case Manager by saving a copy of the indications to her department’s shared drive.

19. How will Indicia Benefit Our Organization?
Promoting evidence-based clinical decisions
Improving documentation for utilization review
Improving reimbursement rates by using the same, evidence based best practices used by our health plans
Reducing staff time by x% and saving up to $x in inappropriate admission costs [insert your own figures here]