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 members should also review the EPSDT/Bright Futures and Lead Screening pages for updates regarding EPSDT screenings and the importance of lead screening.

Updates to ADHD and COPD Guidelines

HPP has provided new guidelines on ADHS and COPD. These guidelines are shown below.

Condition	Reference	Clinical Evidence
ADHD	American Academy of Pediatrics (AAP)	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)	2023 GOLD Report
	National Library of Medicine: Respiratory Care - Medication Regimens for Managing COPD Exacerbations	Medication Regimens for Managing COPD Exacerbations
Diabetes - Adult and Child	American Diabetes Association (ADA)	Standards of Care in Diabetes
Diabetes Self-Management	Centers for Disease Control and Prevention (CDC)	Managing Diabetes
E-Cigarette/Vaping	CDC	E-Cigarette and Vaping Information
Heart Attack/STEMI	American College of Cardiology (ACC)	ACC/AHA Guideline on the Assessment of Cardiovascular Risk
Heart Disease	ACC	2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease
Heart Failure	AAC	2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure
Hypertension	AAC	2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease
HIV	HIV.gov	Clinical Guidelines
Opioid Use Disorder	American Society of Addiction Medicine (ASAM)	www.asam.org/quality-care/clinical-guidelines/national-practice-guideline
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	AAP	Lead Exposure
Perinatal Care	AAP and The American College of Obstetricians and Gynecologists (ACOG)	www.acog.org/clinical/clinical-guidance/clinical-practice-guideline
Sexually Transmitted Infections	CDC	STI Treatment Guidelines Update
Smoking Cessation	CDC	Cessation Materials for State Tobacco Control Programs
Upper Respiratory Infections	CDC	Appropriate Antibiotic Use
Upper Respiratory Infections	American Academy of Family Physicians (AAFP)	Respiratory Tract Infections Resources
Zika Virus and Pregnancy	CDC	Zika and Pregnancy Basics

These 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 or 215-991-4350.

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Clinical Care Guidelines

Updates to ADHD and COPD Guidelines