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QUALITY MANAGEMENT PROGRAM PURPOSE AND SCOPE

目的

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:

• 认识到改进的机会是无限的
• 改进是数据驱动的
• 依赖消费者、提供者和县的投入
• 临床和非临床有效性的持续测量和重新测量
• 基于此类测量的程序改进的实施
• 重新衡量有效性，并酌情继续开发和实施改进

范围和目标

质量管理计划的重点是主动收集、分析和报告与行为医疗保健和服务质量有关的数据。这包括为所有受益人、提供者和组织在各种交付系统的所有组成部分制定和实施系统的改进工作。

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.