Clinical Guidelines

The following are GEHA’s clinical guidelines for common conditions. These guidelines are intended to inform network providers and health plan members of the health plan’s position on the treatment of certain common conditions. The clinical guidelines represent published guidelines from nationally recognized medical organizations and societies. The guidelines are not intended to be used for medical necessity decision-making, but rather for education on the nationally accepted treatment of certain conditions.

• ADHD in children – Guidance for the diagnosis, evaluation and treatment of ADHD in children.
• Congestive heart failure – A review of the diagnosis, staging and treatment of congestive heart failure.
• Cholesterol management in adults – Guidance for achieving cholesterol reduction in the adult population.
• Chronic obstructive lung disease – Current standards for the diagnosis, treatment and monitoring of COPD.
• Cerebral vascular accident (acute) – Guidance for minimizing injury during a CVA or TIA.
• Diabetes – Current standards for the diagnosis, treatment and monitoring of diabetes mellitus.
• Hepatitis B – Current standards for the diagnosis, staging and treatment of Hepatitis B.
• Hepatitis C – Current standards for the diagnosis, evaluaton and treatment of Hepatitis C.
• HIV – The guideline below provide guidance for primary management of HIV.
• Hypertension – Current medical management, pharmacologic options and goals of care in the treatment of hypertension.
• Ischemic coronary heart disease: stable – Guidelines for adult patients with stable or suspected ischemic heart disease, including new onset ischemia or with stable ischemia.
• Major depression: adult – Guidelines for the diagnosis and management of major depression.
• Acute non-ST elevation myocardial infarction (NSTEMI) – Current standards for the diagnosis, treatment, and procedural and pharmacological intervention during an acute NSTEMI.
• Obesity – Current standards for the medical, surgical and pharmacologic treatment of adult obesity.
• Preventive care guidelines – Recommendations on screening, counseling and preventive medication topics.
• Secondary prevention in coronary artery disease – Guidance for achieving risk reduction in patients with CAD and ASVD.
• Acute ST elevation myocardial infarction (STEMI) – Current standards for the diagnosis, treatment, and procedural and pharmacological intervention during an acute STEMI.