Clinical Connections
Clinical news
and trends
What we’re watching in the ever-evolving healthcare landscape.
Medicine advances rapidly. At Carelon Medical Benefits Management, we understand emerging science and real-world clinical practice and apply what’s been proven effective to benefit health plan members. Our team of specialized clinicians, medical librarians, and evidence researchers conduct rigorous, robust evidence surveillance. We collect and analyze data from thousands of studies, guidelines, and the many millions of case reviews we conduct each year. Our research informs the clinical criteria embedded into our automated platform and fuels the logic of our review process, creating an efficient experience that’s also clinically credible. This commitment to clinical best practices is the foundation of our business.
Evidence in action
The most interesting articles encountered during our literature surveillance.
ASCO Annual Meeting
The American Society of Clinical Oncology (ASCO) held its annual meeting June 3-7, 2022, in Chicago, Illinois, with the theme “Advancing Equitable Cancer Care Through Innovation.” Several thousand studies...
New and updated Appropriateness Criteria from the American College of Radiology
In May 2022, the American College of Radiology (ACR) published several new and updated Appropriateness Criteria. The following new Criteria were published: Pelvic Floor Dysfunction in Females Osteomyelitis or...
Genomic sequencing of solid tumors to guide cancer therapy
Genetic testing is a rapidly growing area in which technology can outpace the understanding of its appropriate use. In the area of tumor genetics, this is especially true. An increasing number of cancer...
The impact of low-value cardiovascular care
In a scientific statement released for publication, the American Heart Association Council on Quality of Care and Outcomes Research examines the issue of low-value cardiovascular care, including a discussion...
Same day discharge following joint replacement surgery
A recent study published in the Journal of Bone & Joint Surgery examined same-day discharge following total joint replacement in patients considered to be at increased risk for adverse events. ((Reddy NC,...
New guidance for evaluation of chest pain
The American Heart Association and American College of Cardiology recently released a comprehensive guideline for evaluation and diagnosis of chest pain.((Gulati M, Levy PD, Mukherjee D, et al. 2021...
Management of stable coronary artery disease
Coronary artery disease (CAD) is a common condition which exists across a spectrum ranging from asymptomatic, subclinical disease to acute, life-threatening events. Between these extremes is a large...
Colorectal cancer screening
On May 18th, 2021, the U.S. Preventive Services Task Force (USPSTF) issued a revised recommendation statement on screening for colorectal cancer. ((US Preventive Services Task Force. Screening for Colorectal...
Trends in cancer incidence and mortality
A cross sectional study published in the JAMA Open Network in April 2021 examines U.S. population-based cancer statistics and census data to predict trends in cancer incidence and mortality over the next 20...
PET radiotracers in prostate cancer
The FDA recently approved two new radiotracers for use in prostate cancer. Gallium (Ga)-68 prostate-specific membrane antigen (PSMA) was the first, approved in December of 2020. PSMA is a protein unique to...
On the horizon
Current issues with far-reaching impact.
FDA approval of Pluvicto
On March 23, 2022, the FDA approved the therapeutic radiopharmaceutical agent Pluvicto™ (lutetium Lu 177 vipivotide tetraxetan, also known as 177Lu-PSMA-617) for treatment of metastatic prostate cancer...
Evaluation and treatment of gastroesophageal reflux disease
The American College of Gastroenterology recently published a clinical practice guideline for the evaluation and treatment of gastroesophageal reflux disease (GERD).((Katz PO, Dunbar KB, Schnoll-Sussman FH,...
Updated CMS Lung Cancer Screening recommendations
In March 2021, the U.S. Preventative Services Task Force (USPSTF) updated their guidelines for lung cancer screening with low-dose CT (LDCT).((Centers for Medicare & Medicaid Services. Screening for lung...
LiverMultiScan and cone-beam breast CT CPT codes
Carelon has received several questions regarding upcoming codes for LiverMultiScan (LMS) – CPT 0648T/0649T and Cone-beam breast CT (CBCT) – CPT 0633T-0638T. Additional information and rationale is provided...
AHRQ Technology Assessment: CPAP for treatment of obstructive sleep apnea
The Agency for Healthcare Research and Quality (AHRQ) is preparing to publish a technology assessment of continuous positive airway pressure (CPAP) for treatment of obstructive sleep apnea (OSA ).((Agency for...
Breast MRI as an adjunct to mammography for cancer screening
The DENSE trial (Dense Tissue and Early Breast Neoplasm Screening) is an ongoing study designed to help define the role of breast MRI in screening women with dense breast tissue. In an article published in...
Evaluating the role of coronary CT angiography in initial assessment of CAD
The American College of Cardiology (ACC) is expected to update its recommendations for evaluation of chest pain to include coronary CT angiography (CCTA) as a first line study. If this happens, it will...
Breast cancer screening recommendations
In January 2021, the U.S. Preventive Services Task Force (USPSTF) began the process of updating its recommendations for breast cancer screening. The announcement and call for public comment on the research...
Behind the scenes
Get to know some of the great people in our clinical team.
Evidence assessment
The Carelon Guideline Development team conducts a systematic evidence review to inform both new guidelines and annual updates. A key component of the process is an assessment of the collected evidence by a...
CT contrast shortage
On May 9, 2022, the United States Food and Drug Administration added Omnipaque™ and Visipaque™ to their drug shortage list due to the shutdown of a GE Healthcare plant in Shanghai. Though the plant has since...
myNEXUS
myNEXUS delivers integrated clinical support services for approximately 3.5 million Medicare Advantage members across 23 states through their comprehensive home benefit management program for payors. myNEXUS...
Search function and archives added to AIM guidelines
Carelon recently launched enhancements to Carelon guidelines.* Developed based on client, reviewer and provider feedback, the guidelines now have many requested features including the following: Relevance...
Evidence review process
Carelon clinical appropriateness guidelines are developed using a robust evidentiary review process. A team of clinicians and medical librarians conduct literature review using structured search...
Oncology Pathways
The Carelon Oncology Pathways Program provides information to providers on high quality, cost-effective treatment options through the publication of optimal regimens used in the practice of medical oncology....
Knowledge Services
All guideline development work performed at Carelon begins with the Knowledge Services team. This team of graduate level professionals includes a methodologist and a group of experienced medical librarians...
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