Clinical practice guidelines

Use these resources to find information about specific treatment types and guidelines.

Chronic Disease Management

Asthma

Coronary Artery Disease (CAD)

Congestive Heart Failure (CHF)

Chronic Obstructive Pulmonary (Lung) Disease (COPD)

Diabetes Mellitus (DM)

HIV/AIDS

Hypertension (HTN)

Opioids for Chronic Pain

Preventative Care

Adult Immunizations CDC Guidelines

Adult Preventive Screenings

Perinatal Guidelines

American College of Obstetricians and Gynecologists Clinical Guidelines

Prenatal Care, American Family Physician

Behavioral Health, Mental Health, and Substance Abuse

Alcohol Abuse

Alzheimer’s Disease and Other Dementias

Bipolar Disorder

Major Depressive Disorder

Opioid Use Disorder

Schizophrenia

Tobacco Cessation

Additional Clinical Practice Guidelines

Psychotropic Medication Management

 

Coordination of Community Support for Enrollees in HCBS Waivers

 

Community Re-Integration and Support

 

Long-Term Care (LTC) Residential Condition of Services

 

Population Health Management

Population Health Programs to keep you healthy

For more information on how to use any of the programs listed below just call our Care Management team at 1-866-600-2139 (TTY: 711); You can choose to join or leave the program at any time.

• Diabetes Management -We have a disease management program for members diagnosed with diabetes. Tell us and your doctor if you have diabetes. We’ll work with you to learn more about your condition and put together a plan of care to address any high-risk needs.

• Appropriate Use of Care Settings Inpatient Admission/Discharge – This is a program to ensure that members get the appropriate care when needed. The Care Manager works with high-utilization members and their providers to provide follow-up to those who have an inpatient or discharge alert ensuring that they have access to appropriate care. Your care manager works with you, your doctors and other providers to make sure you receive the right care and services. Our goal is to build a care plan that will help you live a healthier life.

• Acute Care and ED Utilization (Physical and Behavioral Health) – Many illnesses don’t need to be treated at the emergency room. Our Care Management team can provide education and guidance to help all members determine when to contact their physician and when to go to the emergency room. In addition, when a hospitalization is necessary, a care manager will be in contact to help members:

• Schedule follow up appointments

• Obtain prescribed medications

• Understand discharge instructions

• Coordinate any other needed services

• Transition of Care – Prior to discharge, a care manager will contact the member to provide support in discharge planning and post-admission care. Additionally, they will assist in coordination Transition services to another facility or to a home care setting.

• Chronic Condition (Hypertension) Management -Your care manager is here to help you find the care and services you need. You’ll get a call from your care manager soon after you are enrolled. Your care manager works with you, your doctors and other providers to make sure you understand your hypertension and how to best manage it. Our goal is to build a care plan that will help you live a healthier life.