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Clinical Guidelines

Our Quality Management department is responsible for developing and monitoring systems that support our commitment to providing quality care and services to our members. This includes evaluating our performance based on clinical standards.


We encourage our participating providers to take an active role in the ongoing management of member care, particularly members with chronic conditions. We also seek to ensure the coordination of care across specialties and care settings and encourage our practitioners to discuss health conditions with their patients. 

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ADHD

Clinical Practice Guideline for the Diagnosis, Evaluation and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents
American Academy of Pediatrics (AAP)

Asthma - Adult and Child

Asthma Care Quick Reference
National Heart, Lung and Blood Institute

Breast Cancer Screening

Recommendation: Breast Cancer: Screening
U.S. Preventive Services Task Force

Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease: Screening
U.S. Preventive Services Task Force

2023 GOLD Report
Gold Initiative for Chronic Obstructive Lung Disease

Medication Regimens for Managing COPD Exacerbations
National Library of Medicine

Diabetes

Referring Patients to DSMES Centers for Disease Control and Prevention
Centers for Disease Control and Prevention (CDC)

Standards of Care in Diabetes American Diabetes Association
American Diabetes Association

E-Cigarettes/Vaping

Update: Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use Associated Lung Injury
Centers for Disease Control and Prevention (CDC)

Guidance for Healthcare Providers on Evaluating and Tracking Patient Use of E-Cigarettes or ENDS Products
American Lung Association

Heart Attack/STEMI

Guideline on the Assessment of Cardiovascular Risk
American College of Cardiology

Beta-blocker therapy in patients with acute myocardial infarction: not all patients need it
National Institute of Health

Heart Disease

Guideline for the Management of Patients With Chronic Coronary Disease
American College of Cardiology

Heart Failure

Guideline for the Management of Heart Failure
American College of Cardiology

Hepatitis C

Guidance for Testing, Managing and Treating Hepatitis C Virus Infection
Infectious Disease Society of America

HIV

Clinical Guidelines
HIV.gov

Hypertension

Guideline on the Primary Prevention of Cardiovascular Disease
American College of Cardiology

Opioid Use Disorder

National Practice Guideline for the Treatment of Opioid Use Disorder
American Society of Addiction Medicine

Fidelity Guidelines for Opioid Use Disorder
Commonwealth of Pennsylvania

Opioid Prescribing

CDC Clinical Practice Guideline for Prescribing Opioids for Pain
Philadelphia Department of Public Health/ Department of Behavioral Health and Intellectual disABILITY Services

Guidelines for Prescribing Opioids for Chronic Pain
Centers for Disease Control and Prevention

Postoperative Opioid Prescribing Guidelines
Department of Public Health, City of Philadelphia

Postoperative Opioid Prescribing Guidelines: Background for Surgeons
Department of Public Health, City of Philadelphia

Prescribing Guidelines
The Pennsylvania Guidelines on the Prescribing Guidelines of Opioids

Pediatric Lead Levels

Lead Exposure
American Academy of Pediatrics

Perinatal Care

Saferbirth.org
Alliance for Innovation on Maternal Health

Sexually Transmitted Infections

STI Treatment Guidelines Update
Centers for Disease Control and Prevention

Smoking Cessation

Cessation Materials for State Tobacco Control Programs
Centers for Disease Control and Prevention

Upper Respiratory Infections

Appropriate Antibiotic Use
Centers for Disease Control and Prevention

Respiratory Tract Infections Resources
American Academy of Family Physicians

These clinical guidelines are reviewed at least annually and are approved by our Utilization Management Committee. To request printed copies of any guidelines, please call our Provider Services Helpline
at
1-888-991-9023.