Latest news with #MargaretE.O'Kane
Yahoo
01-07-2025
- Business
- Yahoo
MedImpact Achieves NCQA UM Accreditation Three-Year Renewal
SAN DIEGO, July 01, 2025--(BUSINESS WIRE)--MedImpact, the nation's largest independent pharmacy benefit and health solutions company, announced today that it has earned a three-year reaccreditation in Utilization Management from the National Committee for Quality Assurance (NCQA). This marks MedImpact's fourth consecutive NCQA UM Accreditation. "Achieving NCQA Utilization Management Accreditation demonstrates that MedImpact has the systems, processes, and personnel in place to conduct utilization management in accordance with the strictest quality standards," stated Margaret E. O'Kane, President, NCQA. NCQA is an independent, nonprofit organization dedicated to improving healthcare quality through voluntary, objective, and evidence-based evaluations. NCQA accreditation is a key critical differentiator for pharmacy benefit managers (PBMs) seeking to partner with health plans, managed care organizations, and accountable care organizations. "For more than 35 years, MedImpact has ensured timely access to medications and supported improved health outcomes by putting our clients and members at the center of care," said Denise Burns, Chief Operations Officer at MedImpact. "NCQA represents the gold standard in healthcare quality, and this recognition reflects our continued commitment to clinical excellence, responsible utilization, and delivering connected care that supports both quality and affordability." MedImpact continues to lead the way in clinical innovation, investing heavily in a world-class clinical team, and delivering personalized care solutions. This forward-thinking approach drives effective utilization management, high-touch member engagement, and low year-over-year cost trend. Today, MedImpact supports more than 55 million consumers globally, including many of the nation's most recognizable health plans and self-insured employers. "MedImpact's successful NCQA UM Accreditation renewal and continued URAC PBM Accreditation validate the integrity of our clinical programs and operational excellence, reinforce our commitment to uphold the highest standards of quality and transparency, and reaffirm our position as a trusted healthcare leader," Burns said. NCQA has reviewed and accredited MedImpact's Utilization Management functions only. For complete details on the scope of this review, visit About MedImpact MedImpact Healthcare Systems, Inc., based in San Diego, is the nation's largest independent health solutions, technology, and pharmacy benefit management provider. For 35 years, MedImpact has partnered with commercial and government healthcare payers to improve member health, manage pharmacy benefits, and reduce drug costs. The company serves more than 55 million consumers globally and processes over $40 billion in pharmacy transactions annually. To learn more, visit us online, follow us on LinkedIn, or contact us at info@ About NCQA NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA's Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in healthcare. NCQA's website ( contains information to help consumers, employers and others make more informed health care choices. NCQA can be found online at on X (Twitter) @ncqa, on Facebook at and on LinkedIn at View source version on Contacts Jennifer Krolljkroll@ Sign in to access your portfolio
Associated Press
09-04-2025
- Health
- Associated Press
NCQA Issues Health Care Recommendations for the Trump Administration
Proposal outlines vision for evolving the quality measurement ecosystem to support patient-centered, cost-effective, integrated care WASHINGTON, D.C., WASHINGTON, D.C. / ACCESS Newswire / April 9, 2025 / The National Committee for Quality Assurance (NCQA) today released recommendations for the Trump Administration and the 119th Congress to build a more transparent, integrated and interoperable health care system. The National Committee for Quality Assurance: Recommendations for the Trump Administration outlines a vision for evolving the current U.S. quality measurement ecosystem to support patient-driven, cost-effective, integrated care and highlights three key themes: alleviate chronic disease burden; create a digital health infrastructure to support health care innovation; and address the behavioral health crisis. 'For 35 years, NCQA has worked to improve health care quality through measurement, transparency, and accountability,' said NCQA President Margaret E. O'Kane. 'We believe that advancements in quality measurement, care integration and interoperability are needed to create a more efficient and accountable health care system and urge the new administration to prioritize innovative care and payment models that align incentives with improved patient outcomes.' Optimize Value-Based Care & Alternative Payment Models to Alleviate Chronic Disease The U.S. health care system is fragmented and difficult to navigate, making decision-making both time-consuming and expensive. This issue is pronounced for the 133 million Americans living with chronic disease. While digital health technologies have the potential to improve communication, coordination, and care management, without appropriate integration and standardization, care may become even more fragmented. To address these issues, NCQA recommends that the administration expands the U.S. Department of Health and Human Services (HHS) commitment to ensure that all Medicare beneficiaries are in value-based arrangements by 2030. Additionally, the Center for Medicare and Medicaid Innovation's (CMMI) new leadership create models that prioritize integration through technology and dynamic care plans, the Centers for Medicare and Medicaid Services (CMS) should introduce Medicare Advantage Star Ratings metrics that promotes standardized data exchange, and HHS should prioritize more effective use of patient-generated data, including person-reported outcomes measures. Create a Lasting Digital Health Infrastructure to Support Health Care Innovation While the availability of electronic health data has grown, the use and exchange of such data to foster health care innovation is impeded by misaligned policy incentives and payment programs. Stronger support from the administration, through government payment programs, can drive industry implementation, accelerate data exchange and stimulate innovation. To address these issues, NCQA recommends that HHS expedites adoption of a digital quality measures (dQM) reporting architecture, develops a comprehensive health care data quality framework that supports a digital health data exchange ecosystem, and accelerates alignment with the CMS Universal Foundation across HHS quality reporting and value-based payment programs. Address the Behavioral Health Crisis More than 20% of American adults live with mental illness, and recent estimates place the resulting economic strain at over $280 billion. To address this crisis, we must strengthen efforts by increasing funding for fundamental quality improvement, establish national standards, and advance technology. To address these issues, NCQA recommends that the administration work with Congress to incentivize behavioral health provider adoption of certified EHRs, expand access to medication for opioid use disorder as first-line, evidence-based treatment, and support states in evaluating prevention, treatment and recovery efforts through development, collection and reporting of opioid use disorder quality measures. Additionally, NCQA recommends that the administration instructs HHS to fund creation of a quality measures framework for substance use disorder care, require independent accreditation for SAMHSA's Certified Community Behavioral Health Centers certification, and urges the administration to collaborate with Congress to finalize policies that ensure telehealth and virtual care become permanent fixtures of American health care. 'The U.S. health care system faces numerous challenges including high costs, access to care, and varying degrees of quality of care,' said NCQA Vice President Federal Affairs Eric Musser. 'By leveraging NCQA's expertise, evidence-based practices, and resources, the new administration could make significant strides in addressing the systemic issues within the U.S. healthcare system, ultimately leading to a more efficient use of resources, and better health outcomes for all Americans. We look forward to working with the new administration to realize our common goals.' NCQA is eager to collaborate with the Trump administration as it drives innovation and works to create a more cohesive, less fragmented experience for all stakeholders across the American health care ecosystem. Read NCQA's complete recommendation to the Trump administration: NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA Accredits and Certifies a wide range of health care organizations. It also Recognizes clinicians and practices in key areas of performance. NCQA's Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA's website ( contains information to help consumers, employers and others make informed health care choices. NCQA can also be found at X @ncqa and on LinkedIn. # # #
