2015 Practice Guidelines
MHP’s Quality Management Committee (QMC) formally adopted nine medical practice guidelines in March 2015. The specific guidelines were chosen based on clinical evidence, professional recommendations and consensus, and member needs.
The selection and review process entailed:
· Review of government positions on health care via authorized sources (e.g., MDH, DHS and HealthyPeople.gov)
· Analysis of MHP’s over/under utilization rates
· Review of current literature pertaining to guidelines and measurement (e.g., ICSI, NCQA HEDIS, MNCM, USPSTF and medical journals)
· Input from MHP’s QMC, including board-certified practitioners and appropriate specialties
· Consensus obtained from the QMC regarding MHP’s decision to adopt the guideline(s)
After considerable review and consensus, the following practice guidelines were adopted for use in 2015. The below tables provide more specifics about the rationale behind the guidelines and products that were affected.
MHP Practice Guideline(Description and Measurement): / Application To:
Medical Preventive Services for Adults
To improve provider compliance with USPSTF and/or ICSI guideline(s) on Preventive Services for Adults and Healthy lifestyles (ages 18 years and older).
HEDIS:
Preventive Care measure / (check appropriate category):
Preventive Care
Chronic Disease
(check all that apply)
Hennepin Health
SNBC / (check all that apply):
Children
Adolescents
Young Adults
Adults 18+
Seniors (65+)
Prenatal Care
Diabetes Management
To monitor and improve compliance with the MN Community Measurement practice guideline for managing members with diabetes (ages 18-75+years). MHP has supported HCMC’s decision to promote a D4 set of measures instead of a D5, removing LDL as a measure.
a. BP Control < 140/90
b. HbA1c < 8%
c. Tobacco-Free
d. Appropriate Aspirin Use
Supporting Guidelines:
-USPSTF Aspirin for Primary Prevention of Cardiovascular Disease
-USPSTF Tobacco Cessation
-USPSTF Screening for High Blood Pressure in Adults
HEDIS: CDC measure
Additional: MN Community Measurement: D5 (D4 without LDL-C Control / (check appropriate category):
Preventive Care
Chronic Disease
(check all that apply)
Hennepin Health
SNBC / (check all that apply):
Children
Adolescents
Young Adults
Adults 18+
Seniors (65+)
Prenatal Care
Hypertension
To improve the on the control and management of blood pressure for adults with hypertension
(ages 18-85 years).
Supporting Guidelines:
-USPSTF Screening for High Blood Pressure in Adults
HEDIS:
CBP measure < 140/90 / (check appropriate category):
Preventive Care
Chronic Disease
(check all that apply)
Hennepin Health
SNBC / (check all that apply):
Children
Adolescents
Young Adults
Adults 18+
Seniors (65+)
Prenatal Care
Advance Care Planning
To improve provider compliance with Federal laws, DHS MN, NCQA, USPSTF and/or ICSI guideline(s) on Advanced Directives for Adults (ages 18 years and older).To monitor and improve care directed towards the safety, comfort, choice and well-being of adults and members with special needs.
HEDIS: Advanced Care Planning (COA)
Supporting Guidelines:
-ICSI Palliative Care, Preventative Service Adults.
MDH, MNBOA,NCQA / (check appropriate category):
Preventive Care
Chronic Disease
(check all that apply)
Hennepin Health
SNBC / (check all that apply):
Young Adults
Adults 18+
Seniors (65+)
Colorectal Cancer Screening
To improve provider compliance with USPSTF and/or ICSI colorectal cancer screening guidelines.
(ages 51-75+ years)
HEDIS:
Colorectal Cancer Screen rate / (check appropriate category):
Preventive Care
Chronic Disease
(check all that apply)
Hennepin Health
SNBC / (check all that apply):
Children
Adolescents
Young Adults
Adults 18+
Seniors (65+)
Prenatal Care
Obesity
To improve provider compliance with USPSTF and/or ICSI obesity clinical practice guidelines.
(ages 18-65 years)
HEDIS :
Adult BMI index / (check appropriate category):
Preventive Care
Chronic Disease
(check all that apply)
Hennepin Health
SNBC / (check all that apply):
Children
Adolescents
Young Adults
Adults
Seniors (65+)
Prenatal Care
Depression, Major, in Adults in Primary Care
To improve provider compliance with USPSTF and/or ICSI guidelines pertaining to the treatment of major depression, in primary care.
(ages 18 years and older)
HEDIS:
Antidepressant Medication Management
-Effective Phase
-Continuation Phase
Additional: MN Community Measurement: Depression Remission and Response at Six months and 12 months
Depression PIP 2014-2017 / (check appropriate category):
Preventive Care
Chronic Disease
(check all that apply)
Hennepin Health
SNBC / (check all that apply):
Children
Adolescents
Young Adults
Adults
Seniors (65+)
Prenatal Care
Alcohol and Drug Dependence
To improve provider compliance with USPSTF and/or ICSI guidelines pertaining to the treatment of Alcohol and Other Drug Dependence.
(ages 18 years and older)
HEDIS: Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
-Initiation of AOD Tx.
-Engagement of AOD Tx. / (check appropriate category):
Preventive Care
Chronic Disease
(check all that apply)
Hennepin Health
SNBC / (check all that apply):
Children
Adolescents
Young Adults
Adults
Seniors (65+)
Prenatal Care
Shared Decision Making (SDM)
To improve provider compliance with USPSTF and/or ICSI guidelines pertaining to the treatment of conditions in primary care.
(ages 18 years and older)
HEDIS:
Supporting Guidelines: ICSI, MNCM,MDH,NCQA, USPTF / check appropriate category):
Preventive Care
Chronic Disease
(check all that apply)
Hennepin Health
SNBC / (check all that apply):
Children
Adolescents
Young Adults
Adults
Seniors (65+)
Prenatal Care
MHP encourages the use of all current and standard guidelines, but also recognizes the importance of providers being able to practice within the scope of their professional knowledge. It is MHP’s intention to continue collaborating with its provider advisors on the annual adoption of clinical practice guidelines. MHP’s ultimate goal is to help members improve their health outcomes and assist providers in delivering the highest quality care. Thank you for taking such great care of our members!