Our Quality Improvement Program

The goal of CareFirst’s Quality Improvement (QI) Program is to constantly improve the quality and safety of clinical care, including behavioral health care, and the quality of services provided to our members. CareFirst works to provide access to health care that meets The Institute of Medicine's aims of being "safe, timely, effective, efficient, equitable and patient-centered."

The quality process supports ongoing efforts to improve clinical care and services through activities such as:

  • Assessment and improvement of clinical care
  • Safe clinical practices
  • Measuring quality of services and satisfaction
  • Efficient use of resources
  • Interventions to provide accessible, efficient, quality health care for every member

The QI Program’s objectives are to:

  • Support and promote all aspects of the CareFirst Patient-Centered Medical Home (PCMH) Program in order to improve quality of care, safety, access, efficiency, coordination and service.
  • Establish partnerships with clinicians and organizations to put into action interventions that address the identified health and service needs of our membership and that are likely to improve desired health outcomes.
  • Provide data that encourages clinicians to practice evidence-based medicine and make informed choices when making referrals.
  • Maintain a systematic process to continuously identify, measure, assess, monitor and improve the quality, safety and efficiency of clinical care and quality of service.
  • Assess the cultural, ethnic and language needs of our members and consider such diversity when analyzing data and implementing interventions to reduce health care disparities.
  • Monitor and oversee the performance of delegated functions of certain vendors and large provider groups.
  • Develop and maintain a high quality network of health care providers.
  • Operate a QI Program that meets federal, state and local public health goals, and requirements of plan sponsors, regulators and accrediting bodies.
  • Address health needs of the communities we serve.
  • Support quality improvement principles throughout CareFirst, acting as a resource in process improvement.

CareFirst recognizes that large racial and ethnic health disparities exist and that communities are becoming more diverse. Racial, ethnic and cultural background influence a member’s view of health care and its results. CareFirst uses member race, ethnic and language data to find where disparities exist, and we use the information in quality improvement efforts.