Quality Program

eternalHealth is committed to providing the highest quality healthcare and safety for our members by ensuring that our members have access to the healthcare services they need. The goals of our Quality Improvement Strategy are to:

  • Provide our members with access to receiving the highest level of healthcare they need and deserve.
  • Provide ongoing evaluation of our processes and providers to improve quality, safety, and access for our members.
  • Comply with all applicable laws and regulations relevant to our efforts to improve the quality and safety of healthcare for our members.

eternalHealth will accomplish these goals by:

  • Implementing measures and managing the accessibility, and quality of healthcare available to our members.
  • Engaging with providers and other healthcare professionals to improve the quality of healthcare services rendered to our members.
  • Offering our members evidence-based population health programs and services.
  • Supporting our members and their doctors with the information they need to make the best possible decisions.
  • Continuously evaluating and updating our policies and procedures to align with the latest standards for clinical practice.

Quality Improvement Activities

eternalHealth will implement practices and activities to ensure our members will receive the best quality care through services provided by our partners and providers. eternalHealth will evaluate the quality of services and member satisfaction by:

  • Reviewing member satisfaction surveys on services and care received from our internal and external partners.
  • Evaluating how well our network provides coordinated services for our members.
  • Collecting data on overused and underused healthcare services.
  • Promoting member use of preventive care services, to ensure they receive the right service, at the right time, and with the right provider.

eternalHealth will continuously review our provider network to ensure:

  • All members have access and availability to the providers in our network.
  • All providers are being credentialed and recredentialed in a timely and efficient manner.
  • All racial and ethnic disparities are eliminated in both the quality of healthcare services provided and the access to these services.
  • Feedback is sent to our providers based on satisfaction surveys and performance metrics, as it relates to regulatory and organizational goals, in order to promote and support practice improvement.

Meeting Our Quality Improvement Goals

eternalHealth will follow all regulatory quality improvement practices to ensure implementation of best practices to promote the highest quality of care outcomes for our members. These measures will include, but are not limited to:

  • Collection of clinical information from our providers to ensure we are meeting The Centers for Medicare and Medicaid (CMS) Healthcare Effectiveness Data and Information Set (HEDIS) Performance measures.
  • On-going review of our data with our providers to ensure we are providing optimal evidence-based care for our members.
  • Evaluation of the plan’s ability to ensure our members are receiving quality and evidenced-based care.
  • Leveraging our world-class data science capabilities to analyze clinical and claims data.

Case and Disease Management

eternalHealth will collaborate with our providers to provide care and disease management services for our members. This will include:

  • Coordinating with providers to safely transition our hospitalized members back into the community.
  • Educating members on the importance of following up with community-based providers to reduce the need for hospital readmission.
  • Working with members to help them effectively manage common chronic diseases such as hypertension, asthma, and diabetes.
  • Accessing community resources to help members better manage the key social determinants of health (SDH) that may impact their ability to care for themselves and access the right healthcare services.

Quality Improvement Programs for Medications

eternalHealth will implement quality improvement programs which will focus on improving appropriate medication use, such as:

  • Medication-related safety and monitoring solutions that target non-opioid, high-risk drug classes. These solutions focus on preventing polypharmacy and inappropriate use and abuse of controlled substances, including opioids.
  • Targeted strategies for monitoring opioid use with the goals of identifying and working to mitigate any cases of opioid misuse and abuse.
  • A program focused on monitoring and improving adherence with highly effective medications, including oral diabetes medications, cholesterol lowering medications, and blood pressure lowering medications.
  • Reconciliation of members’ medications after being discharged from a hospital or a post-acute care facility, to decrease and prevent medication-related errors and adverse events.
Page Last Updated On: September 27, 2022
This link will leave eternalHealth.com, opening a new window.

Tom Cunniffe

Director of Operations 

Tom Cunniffe comes to eternalHealth with over 20 years of healthcare operations’ experience, having held leadership positions in Call Center, Enrollment, Credentialing, UAT and Reimbursement teams. Tom has worked with Medicaid, Commercial and Medicare lines of business and has consistently built teams who are metrics driven with proven successful outcomes. Making sure our business strives for an efficient, best-in-class customer experience is at the center of Tom’s philosophy.

Tom has a bachelor’s degree from Fordham University and a master’s in business administration from University of Massachusetts at Amherst.

Tom Lawless

Chief Financial Officer

Tom Lawless has spent the past 20+ years building, sustaining, and growing new healthcare-related programs that balance fiscal responsibility & prudence with creativity & innovation, focusing on models of care that are novel, person-centered, and improve the social welfare of those who are served. He is very excited to continue doing so in his role as the Chief Financial Officer of eternalHealth.

Tom comes to eternalHealth from a not-for-profit, member-centric, health insurance cooperative. He helped the company continuously strive toward its dual goals of thriving financially, while keeping members at the very epicenter of its mission and service model. While there, Tom also spearheaded the creation of a brand new private, charitable foundation, which will be meaningfully giving back to those in need in the surrounding communities for years to come. Previously, Tom worked in the finance department of a successful hospice that provided high-quality care to persons experiencing their unique and poignant end-of-life journeys, assuring that the appropriate financing was always available. Tom’s career began as a civil servant in the Wisconsin Medicaid program, where he helped to create a program that expanded the institutional entitlement to care into home and community-based settings. Starting with only a blueprint in hand, the program now serves more than 57,000 frail elders and disabled adults and is considered a national model. Growing into a senior leadership role, Tom was a key architect of an innovative financing model, through which the public and private sectors successfully collaborated to better the lives of persons in great need.

Tom holds undergraduate and graduate degrees from the University of Chicago, with additional graduate work in economics completed at the University Wisconsin-Madison.

This link will leave eternalHealth.com, opening a new window.
This link will leave eternalHealth.com, opening a new window.