Clinical Practice Guidelines

The information below leads you to resources about clinical practice. This information is intended to be a resource for network physicians and other health care professionals. You may find the information helpful in diagnosing, managing or treating a clinical condition.

About the Clinical Practice Guidelines

Clinical Practice Guidelines (link opens in new window)

Humana Behavioral Health has adopted clinical practice guidelines (CPG) from the American Psychiatric Association (APA) and the American Academy of Child and Adolescent Psychiatry (AACAP) to assist practitioners in making decisions regarding appropriate behavioral health care for specific clinical circumstances and to ensure consistency and improve patient care and safety. These evidence-based guidelines are known to be effective in improving health outcomes. Humana Behavioral Health chose practice guidelines for treatment of patients with Bipolar Disorder, Major Depressive Disorder, Substance Use and Schizophrenia as current focus guidelines in the adult population. For adolescents and children, Humana Behavioral Health selected Attention-Deficit/Hyperactivity Disorder (ADHD), Depressive Disorders and Substance Use practice parameters. These guidelines were selected as the diagnoses are the most common among Humana Behavioral Health members.

Random practitioners are selected annually for a review of records to assess if the CPGs are being followed in the treatment of Humana Behavioral Health members. Two elements are selected from each guidelines related to member safety. Corrective actions plans are requested from practitioners scoring below the goal of 85 percent.

For the Bipolar Disorder CPG, Humana Behavioral Health measures performance with the prescription of mood-stabilizing medication and education of the patient or family regarding Bipolar Disorder. Both measures are based on specific recommendations in the guideline. The first is based on numerous recommendations in the CPG for first-line psychopharmacologic treatment. The second is based on recommendations about the importance of educating patients and appropriate family members.

For the Major Depressive Disorder CPG, Humana Behavioral Health measures performance with the completion and revision of a risk assessment and education of the patient or family regarding diagnosis. Both measures are based on specific recommendations identified in the guideline. The first is based on a clear recommendation that an assessment of suicide risk is crucial. The second is based on a recommendation regarding the importance of educating patients and appropriate family members.

For the ADHD practice parameters, Humana Behavioral Health measures performance with the completion of an assessment for co-morbid disorders and referral to a support group such as Children and Adults with Attention Deficit-Hyperactivity Disorder (CHADD). Both measures were based on specific recommendations from the guideline. The first is based on the recommendation that co-morbidity should be assessed due to the high prevalence of co-morbid psychiatric conditions in ADHD patients. The second is based on a recommendation regarding the importance of self-help group support.

For the Substance Use practice guidelines, Humana Behavioral Health measures performance with the completion of an assessment for co-morbid disorders and referral to a support group such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). Both measures are based on specific recommendations in the guideline. The first is based on the recommendation that co-morbidity should be assessed due to the high prevalence of co-morbid psychiatric conditions in substance abuse patients. The second is based on a recommendation regarding the importance of self-help group support as active participation has been correlated with better treatment outcomes.

For the Schizophrenia guideline, Humana Behavioral Health measures performance with the prescription of mood-stabilizing medication and education of the patient or family regarding Schizophrenia. Both measures are based on specific recommendations in the guideline. The first is based on numerous recommendations in the CPG for first-line psychopharmacologic treatment. The second is based on recommendations about the importance of educating patients and appropriate family members.

Clinical Practice Resources

Bipolar Disorder

Attention-Deficit/Hyperactivity Disorder