The purpose of the Carelon 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:
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 Committees (QMC’s), consumers, providers and other stakeholders.