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. 

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. 

Select each measure above to learn more.

HEDIS ROADSHOW TRAINING SERIES  

Carelon invites you to join the upcoming HEDIS Roadshow Training Series, featuring five events scheduled across October, November, and December. This series is designed to provide behavioral health professionals with the essential knowledge and tools to enhance quality improvement and optimize patient care in mental health and substance use treatment settings. 

You can register for individual sessions or the entire series here: Webinar series registration link 

Learn more about each training below

Mental Health – Higher Level of Care: October 21, 12:30 – 2 p.m. 

HLOC MH: Enhancing Mental Health Care through Quality Metrics

Join our series to refine your expertise, drive quality improvements, and deliver exceptional mental health care that reflects the latest standards in health care excellence.

  • Purpose: This Advanced HEDIS Training Series is specifically designed for Higher Level of Care Mental Health Providers who are committed to elevating the quality of mental health services. We focus on critical HEDIS measures like Follow-Up After Hospitalization for Mental Illness (FUH), Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA), and Initiation and Engagement of Alcohol and Other Drug Use or Dependence Treatment (IET). The series aims to empower mental health professionals to integrate these metrics into clinical practice effectively, ensuring that patients receive comprehensive, continuous, and coordinated care.
  • Audience: This training is tailored for psychiatrists, clinical psychologists, mental health nurses, social workers, and other professionals working in higher-level care settings such as inpatient, residential, or intensive outpatient programs. It is particularly beneficial for those involved in quality improvement, case management, and the oversight of mental health service delivery and outcomes.
  • Expected Learning Outcomes:
    • In-Depth Measure Analysis: Acquire an advanced understanding of FUH, SAA, and IET measures, including their definitions, objectives, and the role they play in enhancing the quality of mental healthcare.
    • Strategies for Improved Patient Outcomes: Learn evidence-based strategies for facilitating timely follow-up, ensuring medication adherence, and encouraging ongoing patient engagement in treatment programs, specifically geared to higher levels of care.
    • Clinical Application and Best Practices: Gain insights into practical applications and best practices for implementing these HEDIS measures in clinical settings, addressing barriers to care and optimizing patient follow-up and engagement.
    • Data Utilization and Improvement Techniques: Develop skills in data analysis and reporting to monitor performance on these measures, identify areas for improvement, and apply targeted interventions to enhance care delivery.
    • Interprofessional Collaboration: Strengthen the ability to collaborate with interdisciplinary teams to provide integrated and coordinated care, maximizing resources for effective patient management across various mental health services.
    • HEDIS Measurement and Compliance Insights: Understand the technical specifications and measurement standards related to HEDIS measures, helping your organization meet numerator compliance and achieve quality benchmarks.

SUD – Higher Level of Care: November 4, 12:30 – 2 p.m.

HLOC SUD: Elevating Substance Use Disorder Care with Quality Metrics

Participate in this series to deep dive into quality metrics, enhancing the care and support provided to individuals undergoing treatment for substance use disorders in higher-level care settings.

  • Purpose: This Advanced HEDIS Training Series is designed for professionals providing Higher Level of Care in Substance Use Disorder (SUD) treatment settings. The series focuses on key HEDIS measures including Follow-Up After High-Intensity Care for Substance Use Disorder (FUI) and Initiation and Engagement of Alcohol and Other Drug Use or Dependence Treatment (IET). The training aims to empower service providers to effectively incorporate these measures to ensure improved patient follow-up, treatment initiation, and sustained engagement, ultimately leading to superior patient outcomes.
  • Audience: This training is well-suited for SUD treatment professionals working in residential treatment centers, inpatient facilities, and intensive outpatient programs. It targets addiction specialists, counselors, clinical directors, and case managers involved in quality improvement and the oversight of SUD services.

Expected Learning Outcomes:

  • Comprehensive Measure Understanding: Develop an advanced comprehension of the FUI and IET HEDIS measures, focusing on their purpose, methodology, and impact on the quality of SUD care and patient recovery.
  • Effective Follow-Up and Engagement Techniques: Learn evidence-based methods to ensure successful follow-up after high-intensity care and enhance patient initiation and engagement in treatment programs, specifically for higher levels of care.
  • Clinical Integration and Best Practices: Discover practical approaches for integrating these HEDIS measures into clinical workflows to ensure seamless transitions from high-intensity care settings to ongoing treatment and support.
  • Performance Monitoring and Data Utilization: Acquire skills in collecting and analyzing data on FUI and IET measures, using insights to drive quality improvements and tailor interventions to patient needs.
  • Coordination and Continuity of Care: Build skills in coordinating care efforts across interdisciplinary teams to promote continuity and robust support systems for recovery in patients receiving higher-level care.
  • HEDIS Measurement and Compliance: Gain knowledge about the technical specifications and measurement standards linked to HEDIS measures, helping your organization meet numerator compliance and achieve quality benchmarks.

SUD – Lower Levels of Care: November 18, 12:30 – 2 p.m. 

LLOC SUD: Strengthening Substance Use Disorder Care at Lower Levels

Join this series to refine your skills, contribute to the quality enhancement of SUD services, and support better outcomes for individuals in recovery at the community level.

  • Purpose: This comprehensive HEDIS Training Series is tailored for professionals providing Lower Levels of Care in Substance Use Disorder (SUD) treatment settings. The series emphasizes crucial HEDIS measures such as Follow-Up After High-Intensity Care for Substance Use Disorder (FUI) and Initiation and Engagement of Alcohol and Other Drug Use or Dependence Treatment (IET). The training aims to equip providers with strategies to enhance patient follow-up, treatment initiation, and sustained engagement, thereby improving the quality and effectiveness of SUD services in outpatient and community-based settings.
  • Audience: This training is ideal for SUD treatment professionals working in outpatient clinics, community mental health centers, and other lower-intensity care settings. It is geared toward addiction counselors, therapists, social workers, program coordinators, and anyone involved in the delivery and improvement of SUD treatment services.

Expected Learning Outcomes:

  • Understanding Key HEDIS Measures: Develop a comprehensive understanding of FUI and IET measures. For FUI, focus on the percentage of acute inpatient hospitalizations, residential treatment, or withdrawal management visits for a diagnosis of substance use disorder among individuals aged 13 and older that lead to a follow-up visit or service. Learn how these measures apply to lower-level care settings and their role in enhancing the continuum of care.
  • Enhancing Follow-Up and Treatment Engagement: Acquire strategies to ensure effective follow-up after high-intensity care and increase initiation and engagement in SUD treatment programs, specifically within lower-level care environments.
  • Integration of Best Practices: Discover practical methods for integrating these measures into daily clinical operations, focusing on overcoming specific barriers present in lower-intensity care settings.
  • Data and Performance Evaluation: Develop the capability to utilize data effectively for monitoring performance on these measures, identifying improvement opportunities, and implementing evidence-based interventions.
  • Collaborative Care Approaches: Strengthen skills in coordinating with broader healthcare teams and community resources to provide integrated and holistic care for patients, enhancing support systems for recovery.
  • HEDIS Measurement and Compliance: Acquire essential knowledge about technical specifications and quality and measurement standards related to HEDIS measures, helping your organization align with industry best practices, achieve numerator compliance and quality benchmarks.

Mental Health – Lower Levels of Care: December 2, 12:30 – 2 p.m. 

Enhancing Mental Health Care at Lower Levels of Care

Participate in this series to elevate your practice, improve mental health care quality, and achieve better patient outcomes within your community.

  • Purpose: This HEDIS Training Series is specifically designed for mental health providers operating in lower levels of care. The series focuses on vital HEDIS measures such as Follow-Up After Hospitalization for Mental Illness (FUH), Initiation and Engagement of Alcohol and Other Drug Use or Dependence Treatment (IET), and Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA). The training aims to equip providers with the knowledge and tools necessary to improve patient follow-up, treatment initiation, medication adherence, and overall quality of care in outpatient and community-based mental health settings.
  • Audience: This program is tailored for mental health professionals working in outpatient clinics, community mental health centers, and other lower-intensity care settings. It is ideal for therapists, counselors, social workers, case managers, and program coordinators involved in mental health service delivery and quality improvement.

Expected Learning Outcomes:

  • Understanding Key HEDIS Measures: Develop a comprehensive understanding of FUH, IET, and SAA measures, and learn how they can be effectively applied to enhance mental health services in lower-level care settings.
  • Improving Follow-Up and Engagement: Acquire strategies to ensure timely follow-up after mental health hospitalizations and boost initiation and engagement in mental health and substance use treatment programs.
  • Ensuring Medication Adherence: Learn techniques to support adherence to antipsychotic medications, addressing common challenges in outpatient and community-based mental health environments.
  • Best Practices Integration: Discover practical methods for incorporating these measures into daily clinical operations, focusing on overcoming specific barriers present in lower-level care settings.
  • Data-Driven Improvement: Enhance skills in data collection and analysis to monitor performance on these measures, identify areas for improvement, and implement targeted quality interventions.
  • Collaborative Care and Systems Coordination: Strengthen teamwork and coordination with interdisciplinary teams and community resources, promoting comprehensive and continuous care for mental health patients.
  • HEDIS Measurement and Compliance: Acquire essential knowledge about technical specifications and quality and measurement standards related to HEDIS measures, helping your organization align with industry best practices, achieve numerator compliance and quality benchmarks.

Clinical/Quality Q&A: December 16, 12:30 – 2 p.m

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.

Click here to nominate a participant!

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 meetings virtually on the second Wednesday of the first month of each quarter.

  • Q4 2025 Participant Advisory Council Meeting
  • Date and time: Wednesday, October 8, 2025 10:00 AM | (UTC-04:00) Eastern Time (US & Canada)
  • Registraton link

Download a printable flier!

Provider Quality Management (PQM)

Provider Quality Management offers collaboration with providers to not only enhance performance, but improve quality outcomes for Maryland Medicaid participants. PQMs work to build collaborative relationships with providers, drive discussions on clinical and quality improvements, identify best practices, and promote innovative quality interventions.

We are looking for providers who want to stay informed of Carelon Maryland’s quality improvement initiatives and to support improved participant outcomes. If you would like to become a Quality Partner, please complete the form below: