Clinical Practice Guidelines
McLaren Health Plan's disease management programs are based on the MQIC Clinical Practice Guidelines.
McLaren Health Plan's Chief Medical Officer (CMO) oversees the development of the guidelines and the Quality Improvement Committee (QIC) has final approval responsibility.
McLaren Health Plan's disease management programs are based on the Clinical Practice Guidelines.
It is the policy of McLaren Health Plan that Clinical Practice Guidelines are relevant to the population and are developed, distributed, and reviewed in a consistent manner. The Chief Medical Officer (CMO) oversees the development of the guidelines and the Quality Improvement Committee (QIC) has final approval responsibility.
To promote consistency across Michigan's health plans, approval is based on the activities of the Michigan Quality Improvement Consortium (MQIC) who uses a collaborative approach to establish and implement a core set of evidence-based Clinical Practice Guidelines with performance measures. MQIC membership includes physicians, health plans, researchers, quality improvement experts, and specialty societies. New and revised guidelines are developed through MQIC’s collaborative efforts, using evidence-based practice guidelines from recognized sources. Clinical practice guidelines are reviewed and updated every 2 years, or more often when new scientific evidence or national standards become available prior to the 2-year review date. MQIC completes this research and development of many Clinical Practice Guidelines, and approves for distribution. MQIC sources are listed at the bottom of each guideline. These guidelines are then presented to our QIC for MHP approval.
Carelon has several clinical appropriateness guidelines and cancer treatment pathways available on their website. Guidelines are available by category. Categories include: radiology, sleep, rehabilitation, radiation oncology, new and emerging interventions, cardiology, musculoskeletal, genetic testing, cancer treatment pathways and guidelines, and general.
Learn more: https://guidelines.carelonmedicalbenefitsmanagement.com/
The American Academy of Pediatrics provides patient care guidelines on their website for the following pediatric conditions:
- Autism Spectrum Disorder
- Biological Terrorism and Agents
- Cerebral Palsy
- Child Trafficking and Exploitation
- Children with Medical Complexity
- Epilepsy: National Coordinating Center for Epilepsy
- Foster Care
- Fragile X Syndrome
- Immigrant Child Health
- Lead Exposure
- LGBTQ+ Health and Wellness
- National Center for a System of Services for Children and Youth with Special Health Care Needs
- Native American Child Health
- Poverty and Child Health
- Spina Bifida
To view a full list of patient care guidelines visit: https://www.aap.org/en/patient-care/
McLaren Health Plan’s disease management programs are based on the Clinical Practice Guidelines when appropriate. Member education materials, Utilization Management processes and criteria, and Disease Management programs are reviewed to assure consistency with clinical practice guidelines.
Clinical Practice Guidelines that are approved by McLaren Health Plan are distributed to practitioners through new provider orientation packets, newsletters, and individual mailings to appropriate providers. In addition, the website maintains the most current version of each guideline. Call Customer Service at (888) 327-0671 if you would like a copy of any guideline.
Confidentially
McLaren Health Advantage guarantees its members the right to privacy of information. All information relating to or identifying specific patients shall be kept strictly confidential. Each McLaren Health Advantage participating provider is responsible for maintaining the confidentiality of medical, social and economic information contained on the member’s medical record. Storage of medical and confidential files should be done in a physically secure location during non-working hours.
Last Updated 01/09/2018