Clinical Practice Guidelines

The Alliance uses clinical practice guidelines to help providers make decisions about appropriate care for specific clinical circumstances. These clinical practice guidelines are also used by the Alliance in related programs such as disease and population management.

Practice guidelines are developed from scientific evidence or a consensus of health care professionals in the particular field. The Alliance’s Health Care Quality Committee (HCQC) reviews and adopts practice guidelines that define standards of practice as they pertain to improving health care quality for major diseases/diagnoses.

Practice guidelines are reviewed and updated at least every two years and more frequently when updates are released by the issuing entity. The Alliance monitors compliance and member outcomes related these clinical guidelines for quality improvement initiatives.

These clinical practice guidelines are intended to assist providers in clinical decision-making and attempt to define clinical practices that apply to most patients in most circumstances.

The guidelines are not intended to replace clinical judgment but are provided to assist Alliance providers with making decisions about a range of clinical conditions. The treating practitioner should make the ultimate decision in determining the appropriate treatment for each patient.

Adopted Guidelines

Preventive Care Guidelines

The Alliance requires that all network and delegate providers follow the most current Preventive Care Guidelines.

These guidelines were approved by the Alliance Health Care Quality Committee (May 2019).

Other Clinical Resources and Supporting Tools

The following resources and tools are also available to providers:

U.S. Preventive Services Task Force (USPSTF) Recommendations 

Recommendations for screening tests, counseling, immunizations, and preventive medication.

If you would like to request a paper copy of the Clinical Practice Guidelines we adopted, please call Provider Services at (510) 747-4510.