Tag Archives: Penny Edlund

Pursuing health plan accreditation considerations

Health insurance markets in the United States are evolving with an increased emphasis on achieving the Triple Aim of improved patient experience of care, reduced healthcare costs, and improved population health. For health plans, that comes with an increased focus on quality standards and outcomes, and recognition that investment in quality accreditation is becoming essential to business success.

A growing number of state Medicaid contracts are requiring a focus on quality outcomes and quality accreditation by recognized accrediting organizations. One of these organizations, the National Committee for Quality Assurance (NCQA) continues to gain significance as Medicare and Medicaid increase quality requirements tied to NCQA. Regardless of the accrediting organization, achieving accreditation typically requires a significant commitment of time and resources, and follows a similar process.

In this paper, Milliman’s Barbara Culley, Penny Edlund, and Maureen Tressel Lewis provide information about the pursuit of quality accreditation as an essential investment that can have a positive impact on multiple health plan priorities, including quality of care, member satisfaction, and market viability.

How can medical management teams help enhance their health plan’s COVID-19 response?

The COVID-19 pandemic has the potential to significantly disrupt and challenge the healthcare delivery system, including health payers. It also presents opportunities for payers to leverage internal resources and deliver value for their provider partners and customers.

Traditionally, the U.S. healthcare system is bifurcated into two major types of organizations: those that deliver healthcare services and those that finance or fund the delivery of healthcare services. There are a few areas where there has been some convergence of these key functions. In particular, the introduction of risk contracts has moved provider organizations closer to the financing end of things and the growth of medical management has moved some payers closer to care delivery.

In this brief, Milliman’s Penny Edlund and Maureen Tressel Lewis highlight some areas where a health plan’s medical management team may contribute to the COVID-19 response.