Clinical Practice Guidelines

Preventive health guidelines

LifeWise has adopted the United States Preventive Services Task Force (USPSTF) Guide to Clinical Preventive Services. The guide is evidence-based, relying on current scientific studies. Vaccinations are part of USPSTF recommendations for Preventive Health Services, and LifeWise recommends the Centers for Disease Control & Prevention (CDC) and Advisory Committee on Immunization Practices (ACIP) for an up-to-date vaccination schedule. USPSTF "A" and "B" grade services, in addition to content from other recognized sources, have been selected and formatted in two quick reference guides for provider use.

• Preventive Health - Guide to Clinical Preventive Services for Adults

• Preventive Health - Guide to Clinical Preventive Services for Children/Adolescents

Healthcare Effectiveness Data and Information Set (HEDIS)

HEDIS is a set of nationally recognized performance measures developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS is used by over 90% of US health plans to measure quality of care, access to care, and satisfaction with care.

If screenings are done in your office, documenting and coding these thoroughly helps assess quality care for HEDIS measurements and allows us to assess appropriate programs to assist members with health conditions. The more accurate claims are coded, the less medical record reviews are needed for HEDIS measurements.

Please view our Quality and Coding Tools page for best practices across a variety of HEDIS measures and to ensure you are sending complete and accurate claims.

For more information about HEDIS, visit ncqa.org/hedis.

Clinical practice guidelines

LifeWise adopts clinical practice guidelines for the provision of non-preventive acute and chronic services relevant to its member population and for preventive and non-preventive behavioral health services. Evidence-based guidelines from recognized sources are designed to guide practitioner and member decisions about appropriate healthcare for specific clinical circumstances. LifeWise adopts evidence-based national guidelines for treatment of conditions addressed by LifeWise disease management, quality and pharmacy programs. Performance on key guidelines is measured and analyzed annually.

LifeWise's adoption of the following guidelines does not guarantee benefit coverage for services and is not an authorization of payment for specific procedures.

Guidelines are reviewed and approved for adoption at least every two years by LifeWise's Clinical Quality Improvement Committee. The committee's composition reflects a variety of medical and behavioral health specialties, as well as geographic regions served by LifeWise.

ADHD

Guideline:
ClinicalPractice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents - October2019

Source:
The American Academy of Pediatrics

Asthma (Adult and Pediatric)

Guideline:
2019 GINA Report, Global Strategy for Asthma Management and Prevention

Source:
Global Initiative for Asthma (GINA)

Coronary Artery Disease (CAD)

Guidelines:
2013 ACC/AHA Guideline on the Lifestyle Management to Reduce Cardiovascular Risk

2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk

Source:
American Heart Association, American College of Cardiology

Chronic Obstructive Pulmonary Disease (COPD)

Guideline:
Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Updated January 2017

Source:
Global Initiative for Chronic Obstructive Lung Disease (GOLD)

Depression

Guidelines:
Practice Guideline for the Treatment of Patients with Major Depressive Disorder

Psychiatric Evaluation of Adults: A Quick Reference Guide

Source:
American Psychiatric Association (APA)

Diabetes

Guideline:
Standards of Medical Care in Diabetes - 2020

Source:
American Diabetes Association (ADA)

Heart Failure (HF)

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

Source:
American College of Cardiology Foundation (ACCF), American Heart Association (AHA)

Oncology

Guideline:
Guideline, Tools and Resources

Source:
American Society of Clinical Oncology (ASCO)

Guideline:
NCCN Guidelines and Clinical Resources

Source:
National Comprehensive Cancer Network (NCCN)

Guideline:
Clinical Guidelines and Recommendations

Source:
American College of Physicians (ACP)