Providers

EPSDT / Well-Child Guidelines

Total Physicians, Hospitals & Others

Well-child care and immunizations are an important component of a preventive care program.  Total Health Care supports EPSDT Guidelines and requires that providers schedule the required well-child visits and administer immunizations.  Immunizations must be appropriately documented in the medical record and reported to the Michigan Care Immunization Registry (MCIR) as required by State law.  Vaccines are available through the State of Michigan’s Vaccinations for Children’s Program for those who qualify.

Preventive Health Guidelines

To encourage the appropriate delivery and use of preventive services at appropriate intervals, Total Health Care has adopted and implemented preventive health guidelines for prevention and early detection of illnesses. The use of preventive health guidelines is an essential component to help reduce the incidence of illness, disease, and accidents.  Early detection of potentially serious illnesses may reduce the impact of illness on the member and associated health care costs.  Additionally, use of preventive health guidelines has the potential to reduce unwanted variation in health care outcomes.

Total Health Care will annually measure compliance to these guidelines and associated outcomes.

Clinical Practice Guidelines

Total Health Care adopts Clinical Practice Guidelines that are appropriate to its membership and organization.  Clinical Practice Guidelines are either adopted from nationally recognized organizations, primarily Michigan Quality Improvement Consortium (MQIC), or are developed internally by Total Health Care and are based on scientific literature and reasonable medical evidence.  All Clinical Practice Guidelines are annually reviewed and approved by the Quality Improvement Committee. Utilization Management decision-making criteria is available to practitioners upon request

Use of clinical guidelines assists practitioners in the consistent delivery of acute, chronic and behavioral health care.  These guidelines are not intended to replace clinical judgment nor to be all-inclusive.  It remains the responsibility of the practitioner to individually assess the health status of each patient, and develop the best plan of action to meet the patient’s health care needs.  Guidelines are to be used by the health care practitioners and members collectively, to ensure the best outcome for the members.  THC supports the use of clinical guidelines and will monitor adherence through our Quality Assurance Program.