Clinical Practice Guidelines are evidence-based statements and recommendations designed to assist clinicians by providing an analytical framework for the evaluation and treatment of patients. While they should be followed in most cases, there is an understanding that, depending on the patient, setting, circumstances, or other factors, care can and should be tailored to fit individual needs.
Clinical guidelines are based on the most current scientific evidence, and are adopted or adapted from standards published by recognized sources. Each guideline is reviewed and updated by Health Plan staff and approved annually by the plans’ Quality Monitoring Committee.
These guidelines are not a statement of benefits. Individual coverage will need to be verified by the Plan.
- ADHD Guideline
Adopted from the American Academy of Pediatrics: Reviewed March 2017. Next review March 2018.
- Assessment and Management to Reduce Cardiovascular Risk
Adopted from the American Heart Association February 2017. Next review February 2018. The American Heart Association is a national voluntary health agency to help reduce disability and death from cardiovascular diseases and stroke.
- Management Heart Failure Adopted from the American Heart Association February 2017. Next review February 2018. The American Heart Association is a national voluntary health agency to help reduce disability and death from cardiovascular diseases and stroke.
- Depression Guideline Adults in Primary Care
Adopted the Institute for Clinical Systems Improvement, Inc. (ICSI) Health Care Guideline " Adult Depression in Primary Care Seventeenth Edition March 2016"
Guideline reviewed March 2017. Next review March 2018
- Prenatal Management Guideline
- Adopted from the New York State Department of Health (NYS DOH)
Guideline reviewed February 2017. Next review February 2018
- Preventive Care of Adults Ages 19 and Older: Practice Guidelines:
Reviewed March 2017. Next scheduled review March 2018.
Adopted from the U.S. Preventive Services Task Force (USPSTF)
Recommendations for Adults
Excellus has adopted the following exceptions to the USPSTF recommendations: