Introduction
Quality care is our top priority. Through data collection, measurement, network management, and analysis, opportunities for improvement in care and services are regularly identified and addressed. Data collected for quality improvement activities are frequently related to key indicators of quality that include high-risk diagnoses or services to special populations, or access to care. Carelon’s quality improvement team ensures that the data collected to assess performance and/or outcomes are valid, reliable, and comparable over time.
Review the most up-to-date quality assurance documents that outline reports and findings, quality standards and best practices, as well as continuous improvement strategies. These resources will help you maintain high standards of care and ensure compliance with Medicaid requirements.
Audit Tools and Findings
- Audit Definitions Tool SUD Level 1 OP TEMPLATE 03.2021
- Audit Quality Tool SUD Level 1 OP TEMPLATE 03.2021
- Audit Definitions Tool SUD Level 2.1 IOP TEMPLATE 03.2021
- Audit Quality Tool SUD Level 2.1 IOP TEMPLATE 03.2021
- Audit Definitions Tool SUD Level 2.5 PHP TEMPLATE 03.2021
- Audit Quality Tool SUD Level 2.5 PHP TEMPLATE 03.2021
- Audit Definitions Tool SUD Level 3.1 TEMPLATE 05.2021
- Audit Quality Tool SUD Level 3.1 TEMPLATE 03.2021
- Audit Definitions Tool SUD Level 3.3 TEMPLATE 03.2021
- Audit Quality Tool SUD Level 3.3 TEMPLATE 03.2021
- Audit Definitions Tool SUD Level 3.5 TEMPLATE 03.2021
- Audit Quality Tool SUD Level 3.5 TEMPLATE 03.2021
- Audit Definitions Tool SUD OTP TEMPLATE 03.2021
- Audit Quality Tool SUD OTP TEMPLATE 03.2021
Healthcare Effectiveness Data and Information Set (HEDIS®)
Carelon’s Quality Management Program is committed to promoting quality improvement in our care and services in order to help the people we serve live their lives to the fullest potential. To achieve this mission, Carelon provides ongoing support around three pillars of quality improvement:
- Data collection and analysis
- Identification of best practices
- Implementation of quality improvement activities
Carelon monitors the quality of its behavioral health services using Healthcare Effectiveness Data and Information Set (HEDIS®) performance measures. HEDIS ® measures are used by over 90 percent of America’s health plans and allow standardized comparisons of utilization and the effectiveness, accessibility and availability of care.
- Initiation and engagement in alcohol and other drug dependence treatment (IET)
- Follow-up after hospitalization for mental Illness (FUH)
- Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA)
- Antidepressant medication management (AMM)
Reporting
Carelon Maryland demonstrates the strength of its programs and services through high-quality reporting. Check out these Carelon Behavioral Health documents for more information.
- Data Briefs *COMING SOON
- Utilization Reports *COMING SOON
- Program Evaluations *COMING SOON
Provider Quality Management (PQM)
Coming soon
Top Performing Providers Program
Coming soon
Surveys
If you have any questions or concerns, please reach out to the Carelon Quality Assurance Director.
Email