Clinical Practice Guidelines

UCare’s clinical practice guidelines includes the primary source with a direct link to online content, modifications (if needed) for our unique populations, rationale for modifications and additional references if available.

MEDICAL

UCare, through the Quality Improvement Advisory and Credentialing Committee (QIACC), adopts medical clinical practice guidelines from nationally or locally recognized sources. Sources may include medical specialty societies and other professional organizations. The guidelines are based on reasonable medical evidence or a consensus on clinical treatment patterns by physicians in the selected field of practice.

Asthma, Diagnosis and Management (Approved: September 15, 2022)
Primary Source: Global Initiative for Asthma 

Care of the Older Adult (Approved: September 15, 2022)
Primary Source: American Geriatrics Society

Diabetes, Type 2; Diagnosis and Management (Approved: September 15, 2022)
Primary Source: American Diabetes Association

Management of Heart Failure in Adults (Approved: September 15, 2022)
Primary Source: Journal of the American College of Cardiology (JACC)

Obesity in Adults; Prevention and Management (Approved: September 15, 2022)
Primary Source: American Academy of Family Physicians

Prenatal Care (Approved: September 15, 2022)
Primary Source: American Academy of Family Physicians

Preventive Services for Adults (Approved: September 15, 2022)
Primary Source: American Academy of Family Physicians

Preventive Services for Children and Adolescents (Approved: September 15, 2022)
Primary Source: American Academy of Pediatrics Bright Futures (AAP)

MENTAL HEALTH AND SUBSTANCE USE DISORDER

UCare adopted five mental health and substance use disorder clinical practice guidelines to support good decision-making by patients and clinicians, improve member health outcomes and meet NCQA accreditation standards. Adult guidelines are adopted from American Psychiatric Association (APA). Child and adolescent guidelines are adopted from the Journal of the American Academy of Child Adolescent Psychiatry.

Assessment and Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder  (Approval: September 15, 2022)
Primary Source: American Academy of Child and Adolescent Psychiatry

Assessment and Treatment of Children and Adolescents with Depressive Disorders  (Approval: September 15, 2022)
Primary Source: American Academy of Child and Adolescent Psychiatry

Management of Posttraumatic Stress Disorder and Acute Stress Disorder (Approved: September 15, 2022)
Primary Source: Department of Veterans Affairs and Department of Defense

Treatment of Opioid Use Disorder (Approved: September 15, 2022)
Primary Source: American Society of Addiction Medicine

Treatment of Patients with Major Depressive Disorder  (Approval: September 15, 2022)
Primary Source: American Psychiatric Association

Treatment of Patients with Schizophrenia  (Approval: September 15, 2022)
Primary Source: American Psychiatric Association

Treatment of Patients with Substance Use Disorders (SUD)  (Approval: September 15, 2022)
Primary Source: American Psychiatric Association

PHARMACY

UCare adopts the Minnesota Department of Human Services (DHS) Preferred Drug List guidelines to ensure a more consistent drug benefit for our Medicaid line of business. This clinical practice guideline is developed by Minnesota DHS Drug Formulary Committee.