Clinical Guidelines

Clinical guidelines measure quality across the organization and ensure content is consistent for each condition managed as well as ensuring appropriate practitioner oversight of programs. Evidence-based clinical guidelines are valuable to The Health Plan in analyzing performance, taking action for quality improvement and demonstrating improvement.

Our practice guidelines require a consistent and uniform approach to their development, accomplished through the following objectives:

  1. Ensuring the involvement of the medical directors, the Quality Improvement Committee (QIC), and The Health Plan practitioners
  2. Ensuring the distribution of the guidelines to all applicable practitioners. Our guidelines are on our website for practitioners to access. Practitioners are also notified of their availability.
  3. Ensuring the development of methods for the regular evaluation of the delivery of clinical care consistent with guidelines. Clinical practice guidelines will be researched, adopted, and available to appropriate participating practitioners to ensure the most current clinical practices are in place for the treatment of The Health Plan members. All practice guidelines adopted by The Health Plan are coordinated through the Utilization Management Committee.
     

Clinical Practice Guidelines for Chronic Diseases/Pregnancy-Evidence Based: 


Asthma

 

Coronary Artery Diesease (CAD)

 

Heart Failure (HF)/Cardiomyopathy 

 

Chronic Obstructive Pulmonary Disease (COPD)

 

Diabetes Mellitus

 

Hypertension

 

Pregnancy