Health Care Links
Clinical Practice Guidelines
CareSource approves and adopts evidence-based nationally accepted standards and clinical practice guidelines to help inform and guide the provision of clinical care to members. CPGs are identified through member review of member population demographics and state/national priorities. Review occurs every two years by our Provider Advisory Committee and CPGs are updated as necessary.
The use of these guidelines allows CareSource to measure their impact on member health outcomes. Review and approval of the guidelines are completed by the Market CareSource Provider Advisory Committee (PAC) and the CareSource Enterprise PAC. The Quality Enterprise Committee (QEC) are notified of guideline approval. CareSource identifies guideline topics through analysis of member population demographics and national or state priorities. Guidelines may include, but are not limited to:
- Behavioral health (e.g., depression)
- Adult health (e.g., hypertension and diabetes)
- Population health (e.g., obesity and tobacco cessation)
Guidelines may be promoted to providers through one or more of the following: newsletters, our website, direct mailings, provider manual, and through focused meetings with CareSource Provider Engagement Specialists. A broad range of wellness, preventive health and chronic disease management tools are also available on the CareSource member website, newsletters or upon request.
If you would like more information on CareSource quality improvement, please call Provider Services.
Clinical Practice Guidelines
| Health Condition | Clinical Guideline |
|---|---|
| Asthma | At-A Glance Guide-Asthma Management Guidelines (2020 Focused Updates) |
| Blood Cholesterol | 2018 Guideline on the Management of Blood Cholesterol: Executive Summary The American Heart Association, American College of Cardiology, American Association of Cardiovascular & Pulmonary Rehabilitation, American Academy of Physician Assistants, Association of Black Cardiologists, American College of Preventive Medicine, et al. The American Heart Association is a national voluntary health agency to help reduce disability and death from cardiovascular diseases and stroke. |
| Chronic Obstructive Pulmonary Disease (COPD) | Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease 2024 Report Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) |
| Coronary Artery Disease | 2019 ACC/AHA Guideline on Primary Prevention of Cardiovascular Disease: Executive Summary American College of Cardiology and American Heart Association Task Force on Clinical Practice Guidelines The American Heart Association is a national voluntary health agency to help reduce disability and death from cardiovascular diseases and stroke. |
| Dental Health | ADA® Center for Evidence-Based Dentistry™ Clinical Practice Guidelines The American Dental Association (ADA) ADA is a registered trademark of the American Dental Association and ADA.org is a service mark of the American Dental Association. Links may be made to ADA.org provided the links do not use trademarks or service marks of the American Dental Association or its affiliated entities. |
| Diabetes | Standards of Medical Care in Diabetes – 2024 American Diabetes Association |
| Geriatric Medicine | Geriatric Medicine Clinical Recommendations & Guidelines American Academy of Family Physicians (AAFP) |
| Heart Failure | |
| HIV/AIDS | HIV Guidelines and Recommendations Centers for Disease Control and Prevention CDC.gov is your online source for credible health information and is the official web site of the Centers for Disease Control and Prevention (CDC) |
| Hepatitis C Virus |
Hepatitis C Virus Infection Care Pathway A Report from the American Gastroenterological Association Institute HCV Care Pathway Work Group |
| Hypertension | 2020 International Society of Hypertension Global Hypertension Practice Guidelines American Heart Association The American Heart Association is a national voluntary health agency to help reduce disability and death from cardiovascular diseases and stroke. |
| Infant Mortality | Infant Mortality: What is CDC Doing? Centers for Disease Control & Prevention |
| Kidney Disease |
2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease Kidney Disease Outcomes Quality Initiative (KDOQI)
U.S. Commentary on the 2012 Kidney Disease: Improving Global Initiatives (KDIGO) Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD) |
| Lead Toxicity | Prevention of Childhood Lead Toxicity The American Academy of Pediatrics, Council on Environmental Health The mission of the American Academy of Pediatrics is to attain optimal physical, mental and social health and well-being for all infants, children, adolescents and young adults. |
| Interpregnancy Care |
Obstetric Care Consensus, Interpregnancy Care The American College of Obstetricians and Gynecologists The American College of Obstetricians and Gynecologists is a membership organization dedicated to the advancement of women’s health care through continuing medical education, research and practice. |
| Maternal Care |
Obstetric Care Consensus, Levels of Maternal Care The American College of Obstetricians and Gynecologists |
| Maternal Health |
Avoidance of Nonmedically Indicated Early-Term Deliveries and Associated Neonatal Morbidities The American College of Obstetricians and Gynecologists, ACOG Committee Opinion |
| Postpartum Care |
ACOG Committee Opinion, Optimizing Postpartum Care The American College of Obstetrics and Gynecologists The American College of Obstetrics and Gynecologists |
| Sickle Cell Disease | Evidence-Based Management of Sickle Cell Disease, Expert Panel Report, 2014 National Heart, Lung and Blood Institute (NHLBI) |
| Sickle Cell Disease: Pediatric | Management of Children with Sickle Cell Disease: A Comprehensive Review of the Literature American Academy of Pediatrics |
Preventive Health Guidelines
| Health Condition | Clinical Guideline |
|---|---|
| 0-18 Years of Age Immunization Schedule | Recommended Child & Adolescent Immunization Schedule for Ages 18 Years or Younger Centers for Disease Control and Prevention |
| ≥ 19 Years of Age Immunization Schedule | Recommended Adult Immunization Schedule for Ages 19 or Older, United States Centers for Disease Control and Prevention |
| Periodicity Schedule | Bright Futures Periodicity Schedule American Academy of Pediatrics |
| Recommendations for Preventive Pediatric Care: 0-21 Years of Age | 2023 Recommendations for Preventive Pediatric Care American Academy of Pediatrics |
| USPSTF: A & B Recommendations | U.S. Preventive Services Task Force Recommendations U.S. Preventive Services Task Force |
| Vision Screening (Adult) | Comprehensive Adult Eye & Vision Examination American Optometric Association |
| Vision Screening (Pediatric) |
Comprehensive Pediatric Eye and Vision Examination American Optometric Association |
Other Health Resources
| Health Condition | Clinical Guideline |
|---|---|
| ADHD: Pediatrics | Treatment of ADHD Centers for Disease Control and Prevention |
| Cancer Care | National Comprehensive Cancer Network® site The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 of the world’s leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. |
| Cardiovascular Health and Risk Reduction in Children & Adolescents | Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, published October 2012 National Heart, Lung & Blood Institute |
| Contraceptive Use: U.S. Medical Eligibility Criteria | US Medical Eligibility Criteria (US MEC) for Contraceptive Use 2016-Present Centers for Disease Control and Prevention |
| DiabetesPro® | American Diabetes Association, Professional Education Portal |
| Domestic Violence | Intimate Partner Violence Centers for Disease Control & Prevention |
| Infant Mortality | Infant Mortality Rates by State National Center for Health Statistics |
| LactMed® Drugs & Lactation Database | Drugs and Lactation Database, National Library of Medicine, 2006-(Present) National Library of Medicine |
| Maternal Mortality | Reproductive Health, Maternal Mortality Centers for Disease Control and Prevention |
MedlinePlus® | U.S. National Library of Medicine site U.S. National Library of Medicine MedlinePlus directs you to information to help answer health questions. MedlinePlus brings together authoritative information from NLM, the National Institutes of Health (NIH), and other government agencies and health-related organizations. MedlinePlus also contains extensive information about drugs and supplements, an illustrated medical encyclopedia, the latest health news, and surgery videos. |
| Preconception & Prenatal Care | Pre-Pregnancy Care and Prenatal Care Resources, Resources for Researchers and Health Care Providers Eunice Kennedy Shriver National Institute of Child & Human Development |
| Pregnancy: Safer Medication Use | Treating for Two: Medicine and Pregnancy Centers for Disease Control and Prevention |
| Perinatal Quality Collaborative | West Virginia Perinatal Partnership |
Behavioral Health Guidelines
| Health Condition | Clinical Guideline |
|---|---|
| ADHD | Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents American Academy of Pediatrics |
| Autism | Identification, Evaluation, and Management of Children With Autism Spectrum Disorder American Academy of Pediatrics |
| Dementia | Dementia Care Practice Recommendations & Dementia Care Practice Recommendations, 2018 Alzheimer’s Association The Alzheimer’s Association is not responsible for information or advice provided by others, including information or advice provided by others, including information on websites that link to Association sites and on third party sites to which the Association links. Please direct any questions to weblink@alz.org |
| Depression | Management of Major Depressive Disorder (MMD) (2022) Veteran’s Affairs/Department of Defense Clinical Practice Guidelines |
| Depression Adolescent | |
| Opioid Use Disorder | The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder, 2020 Focused Update The American Society of Addiction Medicine |
Behavioral Health Resources
| Health Condition | Clinical Guideline |
|---|---|
| Depression Screening Tool: PHQ-9 | Patient Health Questionnaire-9 |
| Depression Screening Tool: PHQ-9 (Spanish) | Cuestionario Sobre La Salud Del Paciente – 9 |
| Depression Screening Tool: Pregnancy/Postpartum |
Edinburgh Postnatal Depression Scale The 10-question Edinburgh Postnatal Depression Scale (EPDS) is a valuable and efficient way of identifying patients at risk for “perinatal” depression. |
| Opioid Tool Kit | Opioid Tool Kit |
Mental Health and Substance Use Disorders Practitioner Training
| Source | Practitioner Training Description |
|---|---|
| SAMHSA – Substance Abuse and Mental Health Services Administration | Practitioner Training: SAMHSA’s practitioner training offers tools, training, and technical assistance to practitioners in the fields of mental health and substance use disorders. |
| MHFA – Mental Health First Aid | https://www.mentalhealthfirstaid.org/ |