{"id":5877,"date":"2019-05-28T13:02:04","date_gmt":"2019-05-28T17:02:04","guid":{"rendered":"https:\/\/www.healthadvocate.com\/site\/?p=4520"},"modified":"2020-01-14T17:00:59","modified_gmt":"2020-01-14T22:00:59","slug":"why-clinical-guidelines-are-critical-to-standardize-care-and-improve-outcomes","status":"publish","type":"post","link":"https:\/\/www.healthadvocate.com\/site\/article\/why-clinical-guidelines-are-critical-to-standardize-care-and-improve-outcomes","title":{"rendered":"Why clinical guidelines are critical to standardize care and improve outcomes"},"content":{"rendered":"\n

By Jocelyn\nSivalingam, M.D., F.A.C.P. | BenefitsPRO<\/strong><\/p>\n\n\n\n

As\nemployers or benefits consultants, it is critical to ensure that your health\nplan, advocacy or decision support providers, and other partners that depend on\nthis information to guide their practices and decisions understand and follow\ncurrent, relevant guidelines.<\/em><\/p>\n\n\n\n

Employees\nand their family members frequently face tough questions about their health\ncare: How do I know when it\u2019s time to get a mammogram<\/strong><\/a>?\nWhen does my child need a vision screening? Is thyroid screening something I\nshould get? If I have high blood pressure or diabetes, what is the best\ntreatment for me?<\/p>\n\n\n\n

For\nthe providers who care for them, the key question is: How do we implement appropriate,\nscience-backed treatments for our patients, testing where needed, but avoiding\npotentially harmful or unnecessary (and expensive) care? The answer is to seek\nguidance from and use clinical guidelines \u2014along with existing clinical skills\n\u2014 wisely.<\/p>\n\n\n\n

Establishing clinical guidelines<\/strong><\/p>\n\n\n\n

Clinical\nguidelines are sets of science-based recommendations, designed to optimize care\nfor patients in areas such as screening and testing, diagnosis, and treatment.\nThey are developed after a critical review by experts of current scientific\ndata and additional evidence to help inform clinical decisions across a\nspectrum of specialties.<\/p>\n\n\n\n

Based\nupon this process, guidelines are then released by a number of sources and\ncollaborations, including academic and non-profit health care entities,\ngovernment organizations, and medical specialty organizations.<\/p>\n\n\n\n

From\npreventive care to treatment protocols for chronic conditions, guidelines\nprovide a framework health care providers use with patients to help guide care.\nHowever, it is important to note that clinical guidelines are not rigid\nsubstitutes for professional judgment, and not all patient care can be\nencompassed within guidelines.<\/p>\n\n\n\n

The impact on health care and benefits<\/strong><\/p>\n\n\n\n

Clinical\nguidelines are used in myriad ways across the health care spectrum, and\nproviders are not the only ones who utilize them. Insurers may also use\nguidelines to develop coverage policies for specific procedures, services, and\ntreatment, which can affect the care your covered population receives.<\/p>\n\n\n\n

To\nillustrate a key example of an intended impact of guidelines on health plan\ncoverage, consider those issued by the U.S. Preventive Services Task Force\n(USPSTF), whose A and B level recommendations comprise the preventive services\nnow covered at no cost under the mandate of the\nAffordable Care Act<\/strong><\/a>.<\/p>\n\n\n\n

As\nanother example, the National Committee for Quality Assurance (NCQA), which\naccredits health plans and improves the quality of care through its\nevidence-based measures, uses the American Heart Association guidelines when\ncreating its quality rules for treating\nhigh cholesterol with statin drugs<\/strong><\/a>.<\/p>\n\n\n\n

Other\nexamples exist among commercial coverage policies. For example, some cancer\ndrug reimbursement policies use components from nationally recognized\nguidelines for cancer care.<\/p>\n\n\n\n

The importance of up-to-date guidelines<\/strong><\/p>\n\n\n\n

Because\nscience is rapidly changing, guidelines are often updated, leading insurers to\nrevisit their policies to decide if they will change how services and\nmedications are covered for their members. Providers and health systems may\nmodify processes of patient care in response to major changes in guidelines\nand\/or resultant changes in payer reimbursement.<\/p>\n\n\n\n

Not\nall guidelines are updated on a set schedule, making it even more important for\nproviders and organizations that rely on guidelines to stay on top of changing\ninformation, as it can have a direct impact on how they work. Attending\nconferences, visiting the recently established ECRI\nGuidelines Trust\u2122<\/strong><\/a> , and regularly reviewing relevant\nprofessional association websites and journals can help ensure needed\nguidelines are current. Lack of current information can affect care decisions\nand potential outcomes for patients. Those who have access to the most\nup-to-date, evidence-based information are able to work together to make\nwell-informed healthcare decisions.<\/p>\n\n\n\n

The value of clinical guidelines for\nemployers<\/strong><\/p>\n\n\n\n

As\nemployers or benefits consultants, it is critical to ensure that your health\nplan, advocacy or decision support providers, and other partners that depend on\nthis information to guide their practices and decisions understand and follow\ncurrent, relevant guidelines.<\/p>\n\n\n\n

Further,\nby combining information from relevant guidelines and data from biometric\nscreenings, health risk assessments, claims and other sources, it is possible\nfor clinical advocacy and other decision support providers to identify\nemployees with gaps in care and generate targeted communications (through a\nmember website and\/or mobile app) to help them take action to improve their health.<\/p>\n\n\n\n

Clinical\nguidelines are science distilled into practical recommendations meant to be\napplied to most patients for quality health care. By maintaining current,\nrelevant guidelines, organizations and providers who work with your covered\npopulation can ensure that all parties have the key information they need to\nmake the best decisions for their health.<\/p>\n\n\n\n

About the author<\/strong><\/p>\n\n\n\n

Jocelyn Sivalingam, M.D., F.A.C.P., is a Medical Director with West\u2019s Health Advocate Solutions, a company that provides health and well-being solutions for over 12,500 organizations using clinical guidelines to inform preventive screening recommendations as well as ongoing disease management. Dr. Sivalingam is board-certified in Infectious Diseases and leads the Clinical Guidelines working group at Health Advocate. She also serves as a key leader of clinical operations for the Chronic Care Solutions program and provides clinical expertise across a number of areas at Health Advocate.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

As employers or benefits consultants, it is critical to ensure that your health plan, advocacy or decision support providers, and other partners that depend on this information to guide their practices and decisions understand and follow current, relevant guidelines.<\/p>\n","protected":false},"author":11,"featured_media":1030,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[5],"tags":[154,56,46,150],"class_list":["post-5877","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-article","tag-clinical-guidelines","tag-health-advocacy","tag-health-advocate","tag-jocelyn-sivalingam"],"acf":[],"yoast_head":"\r\nWhy clinical guidelines are critical to standardize care and improve outcomes | 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