CareFirst BlueCross BlueShield Community Health Plan Maryland (CareFirst CHPMD) is committed to providing the best possible healthcare to all of its members. CareFirst CHPMD has an active Quality Improvement Program (QIP) that monitors the quality of care and service provided to its members. The Quality Improvement Program (QIP) is integrated throughout the health plan and is governed by a committee structure composed of doctors, nurses and other non-clinicians. These committees regularly measure performance and recommend improvements for all health plan functions.
CareFirst CHPMD continuously evaluates its Quality Improvement Program (QIP) using nationally recognized measures such as The Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers & Systems (CAHPS). These measures help CareFirst CHPMD determine if members are receiving the care they need and are satisfied with that care. These measures allow CareFirst CHPMD to assess the overall health status of its members to ensure all members remain healthy and well.
Using the results of these measures, CareFirst CHPMD annually sets goals and objectives for its Quality Improvement Program (QIP). At the end of every year, CareFirst CHPMD reviews its Quality Improvement Program (QIP) to identify both achievements as well as opportunities for improvement from the previous year.
Click on the below drop down buttons to find out more about specific sections of our Quality Improvement Program (QIP).
NCQA Accreditation: CareFirst CHPMD has been certified by the National Committee for Quality Assurance (NCQA). This organization sets high quality standards for Health Plans across the nation.
Qlarant Quality Review: CareFirst CHPMD undergoes an annual audit by a Quality Review Organization selected by the Maryland Department of Health (MDH). In addition to the annual review, Qlarant provides ongoing monitoring and feedback about the quality of care provided by CareFirst CHPMD.
CareFirst CHMPD Health Equity Accredited
We are pleased to announce that CareFirst CHPMD has successfully achieved NCQA Health Equity Accreditation for the MD Medicaid LOB from NCQA for the next three years.
What does this mean for CareFirst?
It means that the CareFirst CHPMD team has successfully demonstrated our commitment across core health equity industry standards. This accreditation is also a key milestone in-line with CareFirst’s strategic goals.
What does this mean for CareFirst CHPMD Members?
NCQA Accreditation: CareFirst CHPMD has been certified by the National Committee for Quality Assurance (NCQA). This organization sets high quality standards for Health Plans across the nation.
Each year, CareFirst CHPMD asks members what they think about their care. This is done through a survey called CAHPS®1, which stands for Consumer Assessment of Healthcare Providers and Systems. The Maryland Department of Health runs this survey every year.
You may get the survey in the mail or by phone. Your answers help us understand what is working well and what needs to be better. CareFirst CHPMD may also send other surveys during the year.
Below are the results from the 2025 CAHPS® survey. The results are shown for adults and children. They are compared to:
- Our 2024 results.
- Other Medicaid health plans in Maryland.
The numbers show the percent of members who gave a positive answer.
Adult Member Satisfaction Results
What the results show:
- Most adult members said it was easy to get needed care.
- Many members felt doctors communicated well.
- Scores for getting care quickly and overall ratings were a little lower than last year.
- Some scores were still higher than or close to other Medicaid plans in Maryland.
1 CAHPS (Consumer Assessment of Healthcare Providers and Systems) is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ, a U.S. federal agency within the Department of Health and Human Services.
Child Member Satisfaction Results
What the results show:
- Most parents said their children received needed care.
- Many parents rated their child’s doctor and specialist positively.
- Communication with doctors scored very high.
- Some areas were slightly lower than last year but still close to other plans.
Our Commitment to Members
CareFirst CHPMD is committed to making care better for our members. We review survey results carefully and look for ways to improve. When we find areas that need work, we take action to make changes as quickly as possible.
More Information
You can view the State of Maryland 2025 Executive Summary Report on Member Satisfaction to learn more about CAHPS® results for all Health Choice Medicaid Plans in Maryland.
The goal of the Health Education Program is to empower its members with information on how to take control of their health. The information we gather in our Quality Improvement Program helps us to understand the members we serve, and allows CareFirst CHPMD to take action to provide up-to-date, easy-to-use health education services to our members. Examples of Health Education services provided by CareFirst CHPMD include the regular mailings, newsletters, web-site postings, a 24-hour nurse advice line, community events and population health programs including case management.
The goal of the Outreach Program is to help members get the care and services they need at the right time and the right location. CareFirst CHPMD outreaches to you to let you know which wellness services would be beneficial to you and helps you access those services. Outreach always comes with education on how to stay healthy. CareFirst CHPMD reaches out to members in different ways such as by phone, letter, text messages and personal contact.
CareFirst CHPMD strives to build health care systems that consider members’ ethnic backgrounds, age, gender, lifestyles, language, disabilities, reading levels, religion and areas where they live. CareFirst CHPMD believes that members experience better health outcomes and results when care is delivered in their own language and their cultural background is considered. Providing interpreter services free of charge and building a diverse network of participating providers are two examples of how CareFirst CHPMD takes actions to provide culturally competent care. All CareFirst CHPMD staff are experienced and trained in recognizing cultural differences and their impact on health care.
Providing safe medical care and preventing complications is a priority. Our Quality Program includes multiple methods to ensure safe and effective medical care is provided to our members. CareFirst CHPMD only contracts with well-qualified providers that meet high quality standards. Once providers are contracted their performance is monitored to promote safety and reduce complications. This includes reviewing certain high risk medical procedures or medications to confirm they are necessary, tracking health outcomes and investigating quality of care complaints from members.
For more information on CareFirst CHPMD’s Quality Improvement Program please contact Member Services and ask to speak with the Quality Improvement Department about our Quality Improvement Program or email QualityMD@CareFirst.com.