Quality

Dear Colleague:

I am pleased to introduce these Clinical Practice Guidelines to physicians and other practitioners within Arise Health Plan. The primary purpose of the guidelines is to continuously improve the quality of care for Arise Health Plan members affected with the illnesses targeted by these guidelines.

Clinical practice guidelines are designed to assist physicians and other practitioners by providing an analytical framework for the evaluation and treatment of patients with specific clinical circumstances. They are not intended to replace professional judgment or to establish a protocol for patients with a particular condition. A guideline will rarely establish the only approach to a problem.

Practice guidelines have a sound scientific basis, such as clinical literature and expert consensus. The selected guidelines are from nationally recognized organizations and have been reviewed by Advisory Committees.

Practice guidelines are not intended to determine plan benefits and do not reflect coverage. Benefit coverage varies by group and should be verified prior to services being rendered.

As a condition of accreditation, The National Committee for Quality Assurance (NCQA), which is the accrediting organization for managed care plans, requires the adoption of clinical practice guidelines. In addition, guidelines are helpful in demonstrating the quality of care we provide to those who purchase our services.

It is my hope and expectation these guidelines will be helpful to you in the care of your patients.

Sincerely,
Thomas Huffer, M.D.
Medical Director of Quality