BCBSNM uses evidence-based clinical guidelines from nationally recognized sources to guide our quality and health management programs. Guidelines are designed to support the decision-making processes in patient care. Recommendations from other national entities may vary.
Clinical practice guidelines (CPGs) distill national recommendations down to clinical guides meant to be more useful for practitioners. Updated at least every two years and reviewed by practicing New Mexico physicians, CPGs are incorporated into our Condition Management Programs. They are meant to serve as general guidelines and are not intended to substitute for clinical judgment in individual cases. At this time, HCSC endorses the AAFP and ACP criteria for defining high blood pressure, which varies from the values provided in other guidelines. Providers are encouraged to make decisions based on their own judgement and most current evidence-based information available. The links below provide information about the CPGs.
- Asthma - Management and Prevention
- Cardiovascular Disease Guidelines
- Chronic Kidney Disease Guidelines
- COPD – Diagnosis, Management and Prevention
- Diabetes Mellitus – Standards of Care
- EPSDT Clinical Practice & Billing Guideline
- HIV Clinical Practice Guidelines
- Heart Failure Guidelines
- Hypertension Guidelines
- Management of Overweight and Obesity in Adults
- Metabolic Syndrome Guidelines
- Sleep Apnea Guidelines
- Tobacco Cessation Guidelines
Shared Decision-Making Aids for all Plans
Shared decision-making is a communications process. It’s a way for providers and patients to make informed health care decisions that align with what matters most to patients. Below are resources to help you involve your patients in shared decision-making.
These evidence-based aids provide information about treatment options, lifestyle changes and outcomes. They don’t replace your guidance but can help your conversations with patients.
Why it’s important: When patients help make decisions about their health care, it can lead to improved patient experience, better outcomes and quality of life.
Mayo Clinic Knowledge and Evaluation Research Unit Care That Fits Tools
- Acute Myocardial Infarction Choice
- Anticoagulation Choice
- Cardiovascular Primary Prevention Choice
- Chest Pain Choice
- Depression Medication Choice
- Diabetes Medication Choice
- Graves’ Disease Treatment Choice
- Head CT Choice
- Osteoporosis Choice
- Percutaneous Coronary Intervention Choice
- Rheumatoid Arthritis Choice
- Smoking Cessation Around the Time of Surgery
- Statin Choice
The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment. References to other third party sources or organizations are not a representation, warranty or endorsement of such organization. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.
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