Emmalou is CCA Health California’s Director of Health Plan Quality
From a young age, Emmalou knew she wanted to help people, so it was no surprise that she trained to become a nurse. While she’s no longer at the bedside caring for individuals, what she does today impacts the health of many.
In her current role at CCA, Emmalou is the Director of Health Plan Quality for our members in California. Her focus is to make sure that members receive the best care possible. Her role includes ensuring the health plan complies with federal and local regulations. She also identifies areas for improvement and oversees quality and member safety initiatives.
“My goal is to provide members with needed services to improve their health and well-being. Then they can live longer, healthier lives,” she says.
She explains the goal of quality management is better health outcomes for members. Also, it is to improve the member experience and lower the cost of care. Her work involves looking at data to identify specific areas for improvement. “It’s about striving to improve the care our members receive,” she notes.
She explains, “We motivate our members to take care of themselves. We encourage them to go for annual wellness visits. We also let members know about recommended screenings. Those include mammograms to detect breast cancer and colonoscopy for colon cancer.”
She adds, “We want to help our members manage diabetes, high blood pressure, and cholesterol. It’s also important they get recommended eye exams and take medications as prescribed. Quality Management programs help us do all that.”
Emmalou comments that she is also focused on health equity. “I want our members to get a fair opportunity to achieve their best health. They should receive the high-quality care they deserve. We value our members’ differences and we focus on delivering respectful care. That’s why quality management is such a crucial part of delivering healthcare.”
When asked what she enjoys about her job, Emmalou says, “I love the work I do. I have a unique background of clinical experience combined with analytical skills. When I look at numbers, they’re not just data points to me – there are people behind those numbers.”
Emmalou is quick to point out something she doesn’t take for granted. “The member experience is crucial for us. How members perceive their health plan and providers must be a priority. Are our members getting their needs met? Are they getting the care they need quickly and easily; in the setting they prefer?”
“Our priority at CCA is to ensure our members get the care they deserve,” Emmalou explains. “Our quality improvement efforts include outreach to and education for our members. We can encourage them to go for their screenings and get their check-ups. We can also help them change their behaviors to live a healthier lifestyle.”
Emmalou joined CCA a year ago. Her experience includes roles with health plans and outpatient clinics. She also worked for a children’s hospital in Texas. “My role here at CCA focuses on Medicare members, and I am familiar with the special needs of that group. I am also the daughter of parents who are aging. I knew I wanted to make a difference in the lives of older adults,” she says.
Her first job in quality management was for a health plan in New York, assigned to member outreach. It was that job that made her realize the value of quality management. “I realized that helping to improve quality is where I can really help people,” says Emmalou.
Emmalou is quick to respond when asked to recount a member story in her career. She recalls reaching out to a member to remind her of a mammogram. She says that conversation was eye-opening.
“This individual had a list of reasons for not wanting to get a mammogram. She didn’t have time and her friends told her it hurt. She also said she didn’t have transportation and she had no family history of breast cancer.”
Emmalou remembers spending time talking about the importance of mammograms with the member. She let her know the health plan would provide transportation if she needed it. She says, “She did go for that mammogram. It turns out she had early-stage breast cancer. Without the screening, she might not have known about that cancer until it was too late.”
When asked why she believes CCA is different, she says that its focus is caring for members. “Everyone here at CCA has that passion to help people. I haven’t done bedside nursing in a few years, but I still have that member-centric focus,” she says. “I don’t care for just one member at a time, but what I do impacts a whole group of members. That’s the “population health” concept and that’s what keeps me going. If I can influence our members to go for a walk or a screening or take their medications, it’s all worth it.”
She sums it up by saying, “Our role is to ensure that our members are living a healthy, happy life. We do what we can to make that happen. That might mean a reminder postcard, an article in our newsletter, or a phone call or visit. If we do quality management well, everything else will follow,” she says.
Emmalou finds her role at CCA personally rewarding and satisfying. She comments, “I love this job because it is my contribution to the world.” She gets a bit emotional as she thinks about it.
She adds, “If I can change or impact one person’s life through that kind of outreach then I’ve done my job well. It’s worth going into quality management to save that one person’s life.”