MCG Selected to Help CMS Contractors Improve Medicare Effectiveness

Access to MCG's Care Guidelines Supports MAC, QIO, FI Mission to Improve Services to Medicare Beneficiaries

SEATTLE and WASHINGTON, July 16, 2013 /PRNewswire/ -- MCG (formerly Milliman Care Guidelines), a leading provider of clinical guidelines to healthcare payor and provider markets, today announced the renewal of a contract to provide Medicare healthcare review contractors access to MCG's comprehensive, evidence-based guidelines. The contractors use clinical guidelines to objectively assess appropriateness of care and help identify opportunities for improving care quality.


Under the agreement – in place since 2010 – MCG provides clinical guidance and software to contractors acting on behalf of the Centers for Medicare & Medicaid Services (CMS). Quality Improvement Organizations (QIOs), Medicare Administrative Contractors (MACs), and Fiscal Intermediaries (FIs) will have access to the newest edition of the care guidelines, including readmission and extended stay risk assessments, care tasks to address identified risks, and patient engagement materials to help patients understand and take charge of their own care.

"Avoidable readmissions cost Medicare billions of dollars a year," said Todd Ketch, executive director of the American Health Quality Association, the trade organization that represents QIOs. "The recent evidence of QIO success in helping reduce readmissions suggests that interventions aimed at improving care transitions and patient engagement can be very effective."

A recent paper in the Journal of the American Medical Association (JAMA) reported that QIO-facilitated activities – including efforts to standardize care transitions and actively engage patients – were linked to declines in rehospitalization rates nearly double those of comparison communities.

 "The findings reported in JAMA earlier this year emphasize the important role CMS contractors play in helping ensure that our healthcare system delivers effective care," said Jon Shreve, chief executive officer of MCG. "We're pleased that MCG has been chosen to support these efforts. We offer QIOs, MACs, and FIs comprehensive clinical guidance derived from ongoing review of research published in JAMA and thousands of other sources."

As part of the agreement, MCG provides training and education at no cost to CMS contractors. QIOs, MACs, and FIs access MCG training onsite, over the Web, and by on demand training modules.  MCG training offers CEUs to meet continuing education requirements for QIO, MAC, and FI staff. MCG also sponsors and participates in Medifest events hosted by the MACs.

About AHQA
The American Health Quality Association represents Quality Improvement Organizations (QIOs) working to improve the quality of health care in communities across America. QIOs share information about best practices with physicians, hospitals, nursing homes, home health agencies, and others. Working together with health care providers, QIOs identify opportunities and provide assistance for improvement. Learn more about AHQA at (

About MCG
MCG, formerly Milliman Care Guidelines, 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 (

Media Contact
Nancy Narraway
Tel +1 206 389 5405
[email protected]


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