Guidelines

To help provide our members with consistent, high-quality care that uses services and resources effectively, we have chosen certain clinical guidelines to help our providers. These include treatment protocols for specific conditions, as well as preventive health measures.

These guidelines are intended to clarify standards and expectations. They should not:

  • Take precedence over your responsibility to provide treatment based on the member’s individual needs
  • Substitute as orders for treatment of a member
  • Guarantee coverage or payment for the type or level of care proposed or provided

Asthma

National Heart, Lung and Blood Institute (NHLBI) - Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (2012)

 

Alcohol Use

 

National Institute on Alcohol Abuse and Alcoholism (NIAAA),  

Attention - Deficit/Hyperactivity Disorder
American Academy of Pediatrics (AAP): Diagnosis, Evaluation and Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in Children and Adolescents (2019).

Chronic Kidney Disease
Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease

Chronic Obstructive Pulmonary Disease
Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2019).

Chronic Pain

Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain (2016)

Coronary Artery Disease 

2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease

 

Congestive Heart Failure

2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure

2013 ACCF/AHA – Heart Failure Guideline

Hypertension (HTN)

JAMA-April 2018: The 2017 American College of Cardiology/American Heart Association Clinical Practice Guideline for High Blood Pressure in Adults

American College of Cardiology-   2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

Diabetes

American Diabetes Association (ADA): Standards of Medical Care in Diabetes (2020)

Major Depression Disorder

Management of Major Depressive Disorder (MDD) (2016)

Macarthur Depression Toolkit


HIV/AIDS 

Tobacco Cessation