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Clinical Info

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. 



Clinical Evidence

Asthma - Adult and Child

National Heart, Lung and Blood Institute 2012


Chronic Obstructive Pulmonary Disease (COPD)

U.S. Preventative Services Task Force (USPSTF)

COPD Screening [Note: This will prompt you to download a PDF]

Gold Initiative for Chronic Obstructive Lung Disease (GOLD)

Gold Reports 2018 - Global Initiative for COPD

Diabetes - Adult and Child

American Diabetes Association

ADA Standards of Care

Heart Disease

American College of Cardiology (ACC)

ACC Heart Disease

Heart Failure

American College of Cardiology (ACC)

ACC Heart Failure


National Institute of Health



American College of Cardiology (ACC)

ACC Hypertension

Opioid Prescribing

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

City DOH Prescribing Guidelines

Opioid Use Disorder

American Society of Additional Medicine (ASAM)

ASAM Opioid Use Disorder


Pediatric Lead Levels

U.S. Preventive Services Task Force (USPSTF)
*In the process of being updated

Current Recommendations for Lead Levels in Childhood

Proposed Recommendations for Lead Levels in Childhood

Perinatal Care

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

ACOG Guidelines for Perinatal Care

Sexually Transmitted Infections Centers for Disease Control and Prevention

STD Treatment Guidelines


Smoking Cessation

Agency for Healthcare Research and Quality

Interventions for Tobacco Cessation

Upper Respiratory Infections Centers for Disease Control and Prevention Antibiotic Use
National Center for Biotechnology Information Management of URI in Children

Zika Virus and Pregnancy

Centers for Disease Control and Prevention

Zika and Pregnancy


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 888-991-9023 or 215-991-4350.