Clinical Practice Guidelines

Preventive Health Services Guidelines

LifeWise has adopted the United States Preventive Services Task Force (USPSTF) Guide to Clinical Preventive Services. The guideline 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 

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:

The Institute for Clinical Systems Improvement has endorsed with qualification the American Academy of Pediatrics guideline, ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents, and Supplement - March 2014

Source:

Institute for Clinical Systems Improvement

Asthma (Adult and Pediatric)

Guideline:

Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention - 2018

Source:

Global Initiative for Asthma (GINA)

Coronary Artery Disease CAD

Guideline:

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines - July 2014

Source:

American Heart Association, American College of Cardiology

Check out the CV Risk Calculator offered by the American Heart Association and the American College of Cardiology

Chronic Obstructive Pulmonary Disease COPD

Guideline:

Prevention of Acute Exacerbation of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline. 2015 APR

Source:

American College of Physicians (ACP), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), European Respiratory Society (ERS)


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

Guideline:

Practice Guideline for the Treatment of Patients with Major Depressive Disorder

Source:

American Psychiatric Association (APA)


Guideline:

Psychiatric Evaluation of Adults: A Quick Reference Guide

Source:

American Psychiatric Association (APA)

Diabetes

Guideline:

Standards of Medical Care in Diabetes - 2086

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:

Clinical Practice Guidelines in Oncology

Source:

American Society of Clinical Oncology (ASCO)


Guideline:

Clinical Practice Guidelines in Oncology

Source:

National Comprehensive Cancer Network (NCCN)


Guideline:

Clinical Practice Guidelines in Oncology

Source:

American College of Physicians (ACP)

Additional guideline resources are available at the National Guideline Clearinghouse at: http://www.guideline.gov. LifeWise reviews and updates clinical practice guidelines at least every two years.

Resources for Managing Chronic, Non-Cancer Pain

LIfeWise recognizes the challenges many physicians encounter when treating patients who have chronic, non-cancer pain and who are taking controlled substances for pain management. Below are links to various resources and tools for providers to use in managing these patients’ care.

Professional Resources: 

National Resources

Washington

Provider/Patient Pain Management Agreement: