Clinical Care Guidelines
The Jefferson Health Plans/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.
|
Condition |
Reference |
Clinical Evidence |
|---|---|---|
|
ADHD |
American Academy of Pediatrics (AAP) |
|
|
Asthma - Adult and Child |
National Heart, Lung and Blood Institute 2012 |
|
|
Chronic Obstructive Pulmonary Disease (COPD) |
U.S. Preventative Services Task Force (USPSTF) |
|
|
Gold Initiative for Chronic Obstructive Lung Disease (GOLD) |
||
|
National Library of Medicine: Respiratory Care - Medication Regimens for Managing COPD Exacerbations |
||
|
Diabetes - Adult and Child |
American Diabetes Association (ADA) |
|
|
E-Cigarette/Vaping |
CDC |
|
|
Heart Disease |
ACC |
|
|
ACC |
|
|
|
National Library of Medicine |
Beta-blocker therapy in patients with acute myocardial infarction: not all patients need it |
|
|
Heart Failure |
AAC |
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure |
|
ACC |
2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure |
|
|
Hypertension |
AAC |
2020 International Society of Hypertension Global Hypertension Practice Guideline |
|
Hepatitis C
Hepatitis C Virus Infection in Adolescents and Adults: Screening |
Infectious Disease Society of America (IDSA) U.S. Preventative Services Task Force |
Clinical Guidance for Treatment of Hepatitis C (idsociety.org)
|
|
HIV |
HIV.gov |
|
|
Opioid Use Disorder |
American Society of Addiction Medicine (ASAM) |
www.asam.org/quality-care/clinical-guidelines/national-practice-guideline |
|
Opioid Prescribing |
||
|
Centers for Disease Control and Prevention |
||
|
City of Philadelphia, Department of Public Health |
||
|
Commonwealth of Pennsylvania |
||
|
Pediatric Lead Levels |
AAP | |
|
Perinatal Care |
The American College of Obstetricians and Gynecologists (ACOG) | |
| The American College of Obstetricians and Gynecologists (ACOG) | ||
| American Academy of Family Physicians | ||
|
Sexually Transmitted Infections |
CDC |
|
|
Smoking Cessation |
CDC |
|
|
Upper Respiratory Infections |
CDC |
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.
