We are committed to supporting our providers in the care of our members by making clinical best practice references available.

 

Clinical Practice Guidelines

We have adopted the recommendations of the following organizations as our practice guidelines. With permission from these organizations, BlueChoice HealthPlan has created direct links from our website to these guidelines.

BlueChoice HealthPlan's Quality Medical Advisory Panel (QMAP) reviews and adopts all guidelines at least annually and more frequently if necessary to review new scientific evidence or national standards as they are published.

While we review the guidelines annually, you should not construe them as a legal or required standard of care, or as an indication they will always apply in every medical situation. These are recommendations only, and do not guarantee any medical results or indicate coverage for such services by any given plan or policy.

We hope these guidelines will be a convenient resource in helping you care for your patients.

 

Asthma

National Institutes of Health: National Heart, Lung and Blood Institute (NHLBI)
Guidelines for the Diagnosis and Management of Asthma (EPR-3 Report 2007) (2007)
NHLBI Guidelines Asthma Care Quick Reference Guide (2012)

 

Back Pain


Behavioral Health

Attention Deficit Hyperactivity Disorder

American Academy of Pediatrics (AAP)
Clinical Practice Guideline for the Diagnosis, Evaluation and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2011)
Clinical Practice Guideline: Diagnosis and Evaluation of the Child with Attention-Deficit/Hyperactivity Disorder (PEDIATRICS Vol. 105 No. 5 May 2000, pp. 1158-1170)
Clinical Practice Guideline: Treatment of the School-Aged Child With Attention-Deficit/Hyperactivity Disorder (PEDIATRICS Vol. 108 No. 4 October 2001, pp. 1033-1044)


Bright Futures at Georgetown
Bright Futures in Practice: Mental Health — Volume II, Tool Kit

 

Cancer (Supportive Care in Oncology)

National Comprehensive Cancer Network (NCCN)
National Comprehensive Cancer Network Clinical Practice Guidelines 


Chronic Kidney Disease

National Kidney Foundation (NKF)
Kidney Disease Quality Outcomes Initiative (KDQOI) Clinical Practice Guidelines 


Chronic Obstructive Pulmonary Disease (COPD)

 

Congestive Heart Failure (CHF)

American College of Cardiology Foundation (ACCF) and American Heart Association (AHA)
2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure

 

Coronary Artery Disease (CAD)

American College of Cardiology Foundation (ACCF) and American Heart Association (AHA)
2013 ACC and AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults (2013)  
2012 ACCF and AHA Focused Update of the Guideline for the Management of Patients With Unstable Angina/Non – ST-Elevation Myocardial Infarction (Updating the 2007 Guideline and Replacing the 2011 Focused Update) (2012)

American Heart Association
Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women — 2011 Update: A Guideline from the American Heart Association (2011)

American Heart Association (AHA) and American College of Cardiology Foundation (ACCF)
AHA and ACCF Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2011 Update: A Guideline from the American Heart Association and the American College of Cardiology Foundation (2011)

 


Diabetes

American Diabetes Association (ADA)
Standards of Medical Care in Diabetes (2018)


High Blood Cholesterol

American College of Cardiology (ACC) and American Heart Association (AHA)
2013 ACC and AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults (2013)
 

National Institutes of Health: National Heart, Lung and Blood Institute
Third Report of the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (updated 2004)
 

Hypertension (High Blood Pressure)

National Institutes of Health: National Heart, Lung and Blood Institute
2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC8) (2014) 

American Heart Association 
Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease: A Scientific Statement From the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention (2007)


Immunization Guidelines

Center for Disease Control and Prevention
Immunization Schedules

 

Maternity and Perinatal Guidelines

US Preventive Services Task Force
Screening for Depression in Adults (2016)

 

American Congress of Obstetricians and Gynecologists
Guidelines for Perinatal Care, Seventh Edition (2012)

 

Metabolic Syndrome

American Heart Association/National Heart, Lung and Blood Institute 
Diagnosis and Management of the Metabolic Syndrome (2005)

 

Migraine

American Academy of Neurology
Clinical Practice Guidelines
Practice Parameter: Evidence-Based Guidelines for Migraine Headache (2000)

 

International Headache Society
International Classification of Headache Disorders, Third Edition (ICHD-3) (2013)

 

Obesity and Overweight: Adults

Office of Disease Prevention and Health Promotion
2015 – 2020 Dietary Guidelines for Americans (2016)

American Heart Association and American College of Cardiology
Guideline for the Management of Overweight and Obesity in Adults (2013)

National Institutes of Health: National Heart, Lung, and Blood Institute
The Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults (2000)
Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults (1998)


Obesity and Overweight: Children

Endocrine Society
Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline

Office of Disease Prevention and Health Promotion 
2015 – 2020 Dietary Guidelines for Americans (2016)

National Institutes of Health: National Heart, Lung and Blood Institute
Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk and Reduction in Children and Adolescents (Summary Report) (2012)

 

Physical Activity Guidelines

U.S. Department of Health and Human Services
2008 Physical Activity Guidelines for Americans (2008)
Physical Activity Guidelines for Americans Midcourse Report: Strategies To Increase Physical Activity Among Youth (2012)

 

Prediabetes

American Diabetes Association 
Standards of Medical Care in Diabetes (2018)

 

Preventive Guidelines 

U.S Preventive Services Task Force (USPSTF)
The Guide to Clinical Preventive Services (2014)

 

American Academy of Family Physicians
Summary of Recommendations for Clinical Preventive Services (2017)

 

Tobacco Cessation Guidelines

Agency for Healthcare Research and Quality (AHRQ)
Clinical Guidelines for Prescribing Pharmacotherapy for Smoking Cessation

 

Preventive Health Guidelines

We have adopted the recommendations of the U.S. Department of Health and Human Services through the Public Health Service, the Office of Public Health and Science, and the Office of Disease Prevention and Health Promotion as our preventive health guidelines for adults, children and adolescents. With permission from these organizations, BlueChoice HealthPlan has created direct links from our Web site to these guidelines.

While we review the guidelines annually, you should not construe them as a legal or required standard of care, or as an indication they will always apply in every medical situation. These are recommendations only, and do not guarantee any medical results or indicate coverage for such services by any given plan or policy.

We hope these guidelines will be a convenient resource in helping you care for your patients.

 

Preventive Health Guidelines for Children and Adolescents

Centers for Disease Control and Prevention, Vaccines and Immunizations Information

 

These resources are provided by independent organizations that provide health information you may find helpful. Some of these links lead to third-party websites. Those parties are solely responsible for the contents and privacy policies on their sites.