Quality Management

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 Tools

  • Coming Soon

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: 

  1. Data collection and analysis 
  2. Identification of best practices 
  3. 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 

Participant Advisory Council

Carelon’s Participant Advisory Council (PAC) strives to reflect the background of the service population and the different geographic regions of the service area.  The purpose of the PAC is to foster improved quality and integrated care, as well as participant satisfaction. The council will provide input into the quality management program and processes related to the development and implementation of services and their delivery to participants.  To accomplish this, the council reports to the Quality Improvement Committee and submits recommendations and provides relevant information to the committee on issues concerning Members.  The Council is one of Carelon Behavioral Health (CBH)’s mechanisms for soliciting participant feedback into the Quality Improvement Program.

The PAC responsibilities include:

  • Identify and recommend opportunities for improvement to the design and delivery of CBH’s programs and services so they meet the needs of participants and their families.  
  • Develop and recommend strategies to ensure that participant treatment is consumer and family-focused. 
  • Receive updates on CBH programs and services and provide feedback to ensure compliance with participants’ rights and responsibilities. 
  • Identify, recommend, and monitor participant satisfaction with their treatment, e.g., organizational provider/practitioner compliance with requirements for family meeting upon discharge.  
  • Provide input from the perspective of consumers and family members, especially as it relates to the accurate and effective measurement of their satisfaction with care.  
  • Review data and other information from CBH and provide reactions and recommendations from the perspective of participants and family members. 
  • Provide input into the development and implementation of CBH initiatives. 

PAC Meeting Calendar

Attend quarterly meetings in person or virtually on the second Wednesday of the month.

  • Upcoming dates: July 9, 2025, and Oct. 8, 2025, from 10 a.m. to 11 a.m.
  • Microsoft Teams Meeting ID: 269 065 039 147
  • Passcode: 7Es9mw3w
  • You may also select this link directly to access.
  • Office Location: 7550 Teague Road, Suite 500, Hanover, MD 21076

Download a printable flyer here.

Provider Quality Management (PQM)

Coming soon

Top Performing Providers Program 

Coming soon

Surveys

2021-2023

If you have any questions or concerns, please reach out to the Carelon Quality Assurance Director.

Email