Department & Division News

APWU Health Plan Gains Accreditation

(This article first appeared in the May-June 2017 issue of The American Postal Worker magazine.)

By Health Plan Director John Marcotte

Office of Personnel Management (OPM) recognizes comprehensive Health Plan Accreditation provided by the Accreditation Association for Ambulatory Health Care. All Federal Employee Health Benefit (FEHB) plans are expected to meet this OPM requirement by April 2017.

In September 2016, the APWU Health Plan successfully completed the Health Plan Accreditation. This achievement shows the APWU Health Plan’s commitment and overall dedication to quality. It also improves patient experience for our members.

What is Accreditation?

Health Plan Accreditation helps employers and consumers identify health plans based on quality and value.

What are the components of Health Plan Accreditation?

1. Standards – An evaluation of the health plan’s structure and processes to maintain and improve quality. The health plan must provide documented evidence through the use of policies, reports, materials and records that foster successful outcomes.

2. Performance measures – An evaluation of the health plan’s performance on process and outcomes in clinical care, as well as member experience of care, to determine quality and value. The assessment of these performance measures lets APWU Health Plan members know how well your doctor is managing your care, if you are receiving the required tests and treatments necessary to get well and if you are obtaining appropriate follow up appointments to ensure you remain healthy.

Accreditation Assesses Quality

The APWU Health Plan wants its members to understand what “Quality” means to overall health and well-being. This allows our members the opportunity to partner with the APWU Health Plan to ensure that our quality program initiatives meet your needs. Examples include:

  • Living with Illness - The health plan has activities for members managing chronic illness. What this means to you: The APWU Health Plan has programs in place to help manage chronic conditions. One example is for members who have been diagnosed with diabetes. They can access care at 100 percent, which means you pay nothing for in-network office visits, generic medication and insulin through the Health Management Programs (terms and conditions apply).
  • Access and Service - Health plan members have access to needed care and favorable patient experience. What this means to you: The APWU Health Plan continuously assesses how quickly our members can access care, how members rate their personal physician and if there are enough primary care physicians and specialists to serve all members.
  • Customer Satisfaction - Health plan members have access to Membership Services for answers to questions regarding health benefits and claims payment. What this means to you: The APWU Health Plan strives to ensure that all claims are processed accurately and timely. Members also have the opportunity to file an appeal regarding submitted claims. All appeals will receive a written notification within the specified time frame based on the type of appeal.

Delegation Oversight

The APWU Health Plan contracts with: Cigna, United HealthCare, Beacon Health Plan (Behavioral Health), VI Equicare and ExpressScripts (Pharmacy) to provide health services to all members. Our contracted relationships with these vendors also ensure we provide adequate oversight and have accountability for our health care services.

Our vendors are accredited or certified, which means they, too, undergo a rigorous accreditation assessment and implement their own quality improvement program. The APWU Health Plan continuously reviews our vendors’ quality and provides recommendations to meet the health care needs of our members.

Our accreditation status ensures we will continue to distinguish ourselves amongst our competitors.