Clinical Practice Guidelines

Clinical Practice Guidelines

McLaren Health Plan utilizes Clinical Practice Guidelines to assist practitioners and members to make decisions about appropriate health care for specific clinical circumstances including acute, chronic, and behavioral health services.

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.

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. See side tab for listing. Call Customer Service at (888) 327-0671 if you would like a copy of any guideline.

> Last Updated 01/09/2018

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