Руководство поставщика



The purpose of Carelon’s Quality Management Program is to provide a blueprint for planning and deploying quality management throughout the entire organization as well as the provider network. Quality Management includes quality assurance, performance improvement, quality improvement planning activities for clinical care and quality of service.

The Carelon Quality Management Program is based on the principles of Total Quality Management/Continuous Quality Improvement (TQM/CQI), including:

  • Recognition that opportunities for improvement are unlimited
  • Improvement is data driven
  • Reliance on consumer, provider and county input
  • Continual measurement and re-measurement of clinical and non-clinical effectiveness
  • Implementation of programmatic improvements based on such measurements
  • Re-measurement of effectiveness and continuing development and implementation of improvements as appropriate

Объем и цели

The focus of the Quality Management Program is the proactive collection, analysis and reporting of data pertaining to the quality of behavioral health care and services. This includes the development and implementation of systematic improvement efforts across all components of the various delivery systems for all beneficiaries, providers and organizations.

The Quality Management Program will use data to identify areas of concern, schedule appropriate follow-up activities, monitor progress and evaluate the effectiveness of corrective action plans. The results will be communicated to the Pennsylvania HealthChoices appropriate programs, Governing Boards, the Pennsylvania Department of Human Services, the Carelon Corporate Quality Council, the Quality Management / Utilization Management Committees (QM/UMCs), consumers, providers and other stakeholders.