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Clinical Care Guidelines

The Health Partners Plans 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. Providers that work with our Pediatric member should also review the EPSDT/Lead Screening page on this website for updates regarding EPSDT screenings and the importance of lead screening.

The grid below demonstrates examples of evidence-based guidelines. 

Condition

Reference

Clinical Evidence

ADHD

American Academy of Pediatrics (AAP)

Diagnosis, Evaluation, and Treatment of ADHD in Children and Adolescents

Asthma - Adult and Child

National Heart, Lung and Blood Institute 2012

Asthma Care Quick Reference

Chronic Obstructive Pulmonary Disease (COPD)

U.S. Preventative Services Task Force (USPSTF)

Chronic Obstructive Pulmonary Disease: Screening

Gold Initiative for Chronic Obstructive Lung Disease (GOLD)

Gold Reports 2020 - Global Initiative for COPD

Diabetes - Adult and Child

American Diabetes Association (ADA)

Standards of Medical Care in Diabetes

E-Cigarette/Vaping

Centers for Disease Control and Prevention (CDC)

E-Cigarette and Vaping Information

Heart Disease

American College of Cardiology (ACC)

2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

Heart Failure

American College of Cardiology

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

Hypertension

American College of Cardiology

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

HIV

U.S. Department of Health and Human Services (HHS)

Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV

Opioid Use Disorder

American Society of Addiction Medicine (ASAM)

National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use

Opioid Prescribing

Philadelphia Department of Public Health/ Department of Behavioral Health and Intellectual disABILITY Services

Opioid Prescribing Guidelines

Centers for Disease Control and Prevention

CDC Guidelines for Prescribing Opioids for Chronic Pain

City of Philadelphia, Department of Public Health

Postoperative Opioid Prescribing Guidelines

City of Philadelphia, Department of Public Health

Postoperative Opioid Prescribing Guidelines: Background for Surgeons

Commonwealth of Pennsylvania

Treating Chronic Non-Cancer Pain

Pediatric Lead Levels

American Academy of Pediatrics (AAP)

Prevention of Childhood Lead Toxicity

Perinatal Care

The American Academy of Pediatrics (AAP) and The American College of Obstetricians and Gynecologists (ACOG)

Guidelines for Perinatal Care, 8th Edition

Sexually Transmitted Infections

Centers for Disease Control and Prevention

2015 Sexually Transmitted Diseases Treatment Guidelines

Smoking Cessation

Centers for Disease Control and Prevention

Cessation Materials for State Tobacco Control Programs

Upper Respiratory Infections

Centers for Disease Control and Prevention

2018 Update: Antibiotic Use in the United States

American Academy of Family Physicians (AAFP)

Respiratory Tract Infections Resources

Zika Virus and Pregnancy

Centers for Disease Control and Prevention

Zika and Pregnancy Basics

These guidelines are reviewed at least annually, and are approved by our Quality Management Committee. To request printed copies of any guidelines, please call our Provider Services Helpline at 1-888-991-9023 or 215-991-4350.