Premera 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. Immunizations are part of USPSTF recommendations for Preventive Health Services, and Premera recommends the Centers for Disease Control & Prevention (CDC) and Advisory Committee on Immunization Practices (ACIP) for an up-to-date Immunization 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. These resources are available below.
Preventive Health – Guide to Clinical Preventive Services for Adults
Preventive Health – Guide to Clinical Preventive Services for Children/Adolescents
Premera 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. Premera adopts evidence-based national guidelines for treatment of conditions addressed by Premera disease management, quality and pharmacy programs. Performance on key guidelines is measured and analyzed annually. Premera’s adoption of the following guidelines does not guarantee benefit coverage for services and is not an authorization of payment for specific procedures. Members’ benefits can be verified online at premera.com/provider.
Guidelines are reviewed and approved for adoption at least every two years by Premera’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 Premera.
Standards of Medical Care in Diabetes – 2012
Guiding Principles for Diabetes Care: For Health Care Professionals
U.S. Department of Health and Human Services (HHS)/National Diabetes Education Program (NDEP)
Heart Failure (HF)
Guidelines for the Diagnosis and Management of Heart Failure in the Adult
American College of Cardiology (ACC)/American Heart Association (AHA)
Chronic Obstructive Pulmonary Disease (COPD)
American College of Physicians (ACP)/American College of Chest Physicians (ACCP)/American Thoracic Society (ATS); European Respiratory Society (ERS)
Global Initiative for Chronic Obstructive Lung Disease (GOLD)
Asthma (Adult and Pediatric)
Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma
National Heart, Lung and Blood Institute (NHLBI)
Institute for Clinical Systems Improvement (ICSI)
Practice Guideline for the Treatment of Patients with Major Depressive Disorder
American Psychiatric Association (APA)
Major Depression in Adults in Primary Care
ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents
American Academy of Pediatrics (AAP)
American Society of Clinical Oncology (ASCO)
Additional guideline resources are available at the National Guideline Clearinghouse at: www.guideline.gov. Premera reviews and updates clinical practice guidelines at least every two years.
Premera 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.
Washington State Department of health
Provider/Patient Pain Management Agreement: