Inside Health Care: Presented by NCQA

In this episode of Quality Matters, Julie Seibert, Assistant Vice President of Behavioral Health at NCQA, joins host Andy Reynolds to explore the rise of—and the relationship between—two trends in behavioral health: measurement-informed care and peer support. Julie breaks down how these strategies improve outcomes, engage patients and close gaps in access and accountability.Listen to this episode to discover: How Measurement-Informed Care Engages Patients: Learn how measurement-informed care supports patient engagement and treatment adjustments in behavioral health. We explore the importance of ongoing assessment, tracking symptoms and outcomes and empowering patients to understand their journey. Friction and Fuel for New Approaches: We unpack historical challenges to measurement-informed care. These include the omission of behavioral health from key legislation and the costs of EHR integration. We also discuss how NCQA depression measures and person-centered outcome measures relate to measurement-informed care.Benefitting From Peers' Lived Experience: We discuss how people who have been through mental health or substance use treatment can provide non-clinical support to help others navigate the system, subvert stigma and fill care gaps.This discussion is a valuable resource for providers, policy leaders and others who care about improving access, engagement and outcomes in behavioral health.Key Quote:"Measurement-based care has been around for a long time and only 20% of behavioral health providers adopted it.Traditionally, these are trained clinicians. And in the course of a session with a patient, probably in the back of their mind, they're evaluating whether an individual is improving or has worsening function.Payers would like some numerical or standardized way of seeing the clinician's clinical judgment. Measurement-informed care offers that."Julie SeibertTime Stamps:(03:04) Who's Behind Measurement-Informed Care(05:08) HEDIS and Measurement-Informed Care(08:13) Person-Centered Outcome Measures in Behavioral Health(09:58) The Power of Peer Support Specialists(11:57) Addressing Workforce Shortages(15:37) Why States Support Peer Support(16:32) Peer Support's Connection to Measurement-Informed CareDive Deeper:Blog: How Peer Support Can Help Close the Gaps in Behavioral HealthcareBlog: Measurement-Based Care in Behavioral HealthQuality Matters Episode 13: Getting Clear About Behavioral HealthConnect with Julie Seibert

In this episode of Quality Talks With Peggy O'Kane, NCQA President Peggy O'Kane sits down with Dr. Rita Redberg, a cardiology pioneer and fierce advocate for evidence-based care. Dr. Redberg, who famously served as Editor-in-Chief of JAMA Internal Medicine for 14 years, shares her "Less is More" philosophy — a perspective that challenges the view that "more" care is always better.Join Peggy and Rita as they explore:The Problem with "More": Why a health care culture focused on technology and volume over patient needs leads to runaway costs and poor results.The Stent Story: How a widely adopted procedure in cardiology gained traction without initial evidence of patient benefit, and the uphill battle to integrate rigorous clinical trials.Mary Caldwell's Odyssey: A cautionary tale illustrating the dangerous cascade of unnecessary testing and interventions, based on a desire for reassurance rather than clinical need.Re-evaluating Statins: Rita's unconventional view on the use of statins in asymptomatic people. She advocates lifestyle changes over medication when the evidence of benefit is thin.Rebuilding Trust: How the fee-for-service payment model erodes the patient-doctor relationship and how regulatory reforms can shift incentives towards patient wellbeing.Rita reminds us that health care quality isn't about more tests or interventions. It's about thoughtful, patient-centered decisions and a commitment to "first, do no harm." This episode is a must-listen for anyone curious about improving health outcomes and reducing waste in health care.Key Quote:Most statins are prescribed for people that have not already had a heart attack or have established coronary disease. In that higher risk group, there is some benefit to taking statins. It's not huge but there is some benefit.But most people I see, and most people taking statins, are not in that category. They're healthy people that want to prevent a heart attack and want to live longer. They definitely are not going to feel better. Rita Redberg, MDTime Stamps:(02:09) Misconceptions in Medicine(10:01) Mary Caldwell: A Cautionary Tale(13:35) Choosing Wisely Campaign: A Step Towards Better Care(16:32) Debating the Use of Statins(21:31) Trust, Incentives and the High Cost of US Care(27:05) Technology, Teams and Trust Links:JAMA Internal Medicine “Less is More”Choosing WiselyConnect with Rita

In this episode of Quality Matters, Tonya Winders, President and CEO of the Global Allergy and Airways Patient Platform (GAAPP), joins host Andy Reynolds to unpack the diagnosis and care gaps that plague asthma treatment—from delayed access to spirometry, to underuse of biologics. Tonya explains what high-quality, patient-centered asthma care requires, and what health care leaders can do to close that gap.Tonya also discusses: Why a definitive diagnosis of asthma isn't necessarily the norm.What the “three-legged stool” of asthma care looks like.Why patient-centricity is essential for chronic disease management.How new treatments like biologics are changing what's possible in asthma treatment.This podcast is a must-listen for anyone working to redesign care delivery and improve outcomes for patients with chronic respiratory illness.Key Quote:“We are finding in that moderate to severe category, when they are diagnosed accurately and get appropriate access to targeted treatments, about one in three go into a clinical remission, where they have no exacerbations, no symptoms, no hospital, no ER, no oral corticosteroids, no use of short acting bronchodilator. This is something that, I have to tell you, I never dreamt would come in my career. So, it's very exciting, especially for those that have had the opportunity to access these miracle drugs—that's the term they use, miracle drugs—that have changed their lives and given them the freedom to breathe.”Tonya WindersTime Stamps:(04:00) Diagnostic Delays: Spirometry and Systemic Barriers(05:44) How Age and Comorbidities Obscure Asthma(08:00)  Challenges of Misdiagnosis and Access to Specialists(10:28) The Three Legs of Effective Asthma Care(18:20) NCQA's Measurement Strategy for AsthmaLinks:NCQA White Paper: Improving Outcomes for People with AsthmaConnect with Tonya Winders

In this debut episode of Quality Talks With Peggy O'Kane, Founder and President of NCQA, Peggy is joined by Dr. Sachin Jain, CEO of SCAN Group and SCAN Health Plan, to explore a provocative question: Why isn't health care better at getting better?Measuring—Not Missing—What Matters: Anxieties about access and affordability plague everyday people. But quality measurement's focus is elsewhere. Is health care chasing the wrong metrics and missing the big picture? The Complacency Crisis: Sachin says the core issue is a reluctance to embrace real reform, noting the industry's tendency to want improvement without being willing to change fundamental practices. He calls for a bolder approach. Rethinking Medicare & Medicare Advantage: Sachin challenges rosy view of traditional Medicare, and describes how a legal battle over a flawed Medicare Advantage star rating raised questions about how measuring quality affects care. Simplifying for Impact: Sachin proposes focusing on three or four areas, emphasizing patient experience, ease of access and basic care for common conditions. He urges cost transparency, simpler administrative processes and renewed competition.Key Quote:“ If we all just took care of our own part of the ecosystem, we'd get 20, 30% better. But instead, the most industry talking points are about, ‘Hey, we don't get paid enough for what we do.' Everyone who's making money claims that they're losing money on X, Y, or Z lines of business. Everyone complains about regulatory capture, so there's just a bit of having normalized the abnormal. And I think that that's the thing we have to undo if we're going to actually make the kinds of forward progress that we're hoping to make as an industry.”-Sachin Jain, MDTime Stamps:(01:44) Inspired by Our Mentors in Health Care(04:27) How Does Health Care Get Better?(7:28) The Trap of Toxic Positivity (11:34) Misplaced Nostalgia for Traditional Medicare(18:05) The Stars Program Controversy(22:13) Simplifying Health Care MeasurementLinks:Connect with Sachin Learn More About SCANConnect with PeggyLearn More About NCQA

Why isn't health care better at getting better? Join Peggy O'Kane, founder and outgoing president of NCQA, as Quality Talks tackles this critical question. This engaging, limited-series podcast brings together health care's most innovative thinkers and doers to explore powerful ideas and real solutions needed to transform care. If you're ready to reimagine costs, quality and care delivery, tune in to discover the future.

In the second episode of our special series on recommendations to the Trump administration, Quality Matters host Andy Reynolds welcomes Ryan Howells, Principal at Leavitt Partners, for an illuminating discussion on transforming digital quality and data exchange..Ryan shares fresh ideas from the Leavitt Partners roadmap to reshape digital health infrastructure by embracing scalable, internet-based standards and dismantling policy barriers. At the core of this conversation is that effective data exchange must be powered not only by modern standards, but by trust among people and institutions. Ryan's suggestions include:·   Implementing APIs at scale to reduce manual processes and administrative waste. The same APIs that power everyday apps can streamline data exchange between payers and providers, replacing faxes, phone calls and redundant forms.·   Certifying data exchange—not just software functionality. Instead of dictating how systems are built, federal policy should focus on certifying APIs, allowing EHR vendors the flexibility to innovate while helping ensure that data flows freely.·   Establishing “tables of trust.” Regional collaboration among payers, providers and government agencies can test new digital infrastructure in real-world settings and be the model for national expansion.Digital quality transformation will require more than just tech upgrades—we must rethink relationships, trust and policy levers. Listen to this episode to learn how the Trump administration could support a data-driven revolution in health care quality.Key Quote:“I've been doing this for a long time, almost 30 years. But when I go into my doctor's office and I still have to fill out a clipboard with a piece of paper on it with information I know they already have, it is painful. The best representation of whether we are making progress is, I don't want to ever go into a doctor's office and fill out a clipboard. If I could just not fill out my health history, my demographic information, whether information should be sent to my doctor—if all that is just in the doctor's system—I would say we have made progress. Because at that point it will be real to the individual. Think about it in terms of digitizing all of the health care data and making sure it is with the right person, at the right time, in the right place to make the right decisions. When that happens, we'll know we've made significant progress.” Ryan Howells Time Stamps:(02:27) Why Implementing Health Care APIs is Hard(05:32) Tables of Trust: A Case Study from Utah(07:03) Scaling Trust and Interoperability(13:12) Eliminating Manual Processes (18:23) Solving Diverse Use Cases (19:36) Encouraging Early Adoption of APIsLinks:NCQA Recommendations to the Trump Administration Leavitt Partners Recommendations: “Kill the Clipboard!”Connect with Ryan Howells

One-hundred days into the second Trump administration, Quality Matters host Andy Reynolds welcomes Eric Musser, Vice President of Federal Affairs at NCQA, for an insightful discussion about NCQA's recommendations to the Trump administration for improving health care quality.Eric shares ideas to shape a strong quality future for value-based care, digital health infrastructure and behavioral health.The conversation focuses on value-based care models that prioritize care integration to prevent or alleviate chronic illness. Eric identifies fragmentation's threats to care delivery and data management—problems NCQA's recommendations aim to address.Specific suggestions include:Expanding the commitment the first Trump administration made to getting all Medicare beneficiaries in value-based care arrangements by 2030. This ambitious goal requires big changes in policy and practice, but could lead to better outcomes and more efficient care delivery.Creating innovative care models that leverage technology and dynamic care plans. These models would use advanced technologies like AI to integrate patient data more quickly and effectively. Dynamic care plans would allow for real-time updates based on patient data from various sources, including remote monitoring.Prioritizing patient-generated data and patient-reported outcomes. This approach focuses on incorporating patients' experiences and goals into their care plans. The aim is to improve patient engagement and ensure care matches what matters to patients, particularly those with chronic conditions.Promoting standardized data exchange in Medicare Advantage programs. This recommendation addresses the need for better data sharing between plans, providers and patients. This would mean dismantling data silos and creating more comprehensive, real-time views of patient populations.There is tremendous potential for the Trump administration to improve health care quality. Listen to this episode to find out how.Key Quote:“ We know the Trump administration has a patients first agenda. They put the consumer first in the way they think about quality and payment. There is a desire in the measurement space to have more measures centered around patients' goals. That's a person-reported outcome or a patient-centered outcome, as we call it here at NCQA. You want to make sure that the patient gets that strong clinical care. But the experience to ensure that they want to come back for that clinical care is also extremely important. So person-reported outcomes are about enhancing the experience of patients as they work with their care team. This is important for folks with chronic conditions, behavioral health. Having those goals that are patient-centric–like walking down the stairs, getting to church–are all ways which improve health and then get that buy-in to the care plan that we're seeking to support.”-Eric MusserTime Stamps:(01:22) Opportunities in the First 100 Days of a New Administration(05:30) Deep Dive: Value-Based Care and Care Integration (07:12) Fixing Two Kinds of Fragmentation(10:49) Four Operational How-Tos Links:NCQA's Recommendations to the Trump AdministrationListen to Eric's Episode on Data SharingConnect with Eric 

In this special edition of Quality Matters, we explore what three powerful conversations have taught us about one of health care's most pressing and perplexing questions: What do we know about the economics of care in America, and how can we make substantial, sustainable improvements? We look back at previous episodes of Quality Matters to reflect. We begin with health economist Sanjula Jain, who challenges conventional thinking around value-based care and urges a shift toward a more intuitive concept: “value for money.” With real-world examples (think hotels and Costco), she explains why the US health economy needs stability, and what it would take to rebuild trust and deliver real value to patients.Next, Brittany Cunningham, of Vanderbilt University Medical Center, shares how My Health Bundles help employers rein in costs while improving patient experience and provider satisfaction. Her team's approach flips the traditional payment model on its head—designing care first and payment second.And obstetrician Tiffany Inglis, of Elevance Health, takes us inside a groundbreaking program that pairs OB/GYNs with dedicated practice consultants. The result? Dramatic improvement in maternal health outcomes that could affect a staggering 12% of the nation's births.Each voice in this episode offers fresh, actionable insight. Together, they offer a roadmap toward a more sustainable—and humane—health care economy. Key Quote:“ Value for money is the ultimate consumer of the service is going to determine that value based off what they are paying. Value-based payment, it's different because value-based payment is ultimately a reimbursement scheme that doesn't change the total cost of care. Value-based payment is really a policy scheme focused on the provider level, which doesn't even affect the patient or consumer. It's one pool of dollars that is being reallocated. Providers are just reallocating those dollars and actually reducing the total cost of care. Who is benefiting doesn't actually translate down to the patient or the consumer.”Sanjula JainTime Stamps: (00:25) The Macroeconomics of Health Care(8:40) Value-Based Care in Action With Health Bundles14:30) The Economics of Prenatal Care

In this episode, we sit down with NCQA leaders Stacy Grundy, Rachel Harrington and Kristine Toppe for a behind-the-scenes look at the upcoming Health Quality Forum 2025, and a discussion about the complexities and possibilities of modern health care, with a focus on data sharing and strategies to address health inequities.Learn about data-driven collaborations in states like Maryland, Pennsylvania and North Carolina, where public agencies, health systems and community groups are uniting to improve outcomes.And get an inside look at our hands-on workshops on NCQA Health Equity Accreditation and Virtual Care Accreditation, designed to give professionals at the leading edge of virtual services the tools they need to help reduce disparities.The conversation and conference highlight stories of how virtual care is dissolving data silos and transforming maternal health in states like Arkansas. The emphasis of this episode—and the forum—is on curating diverse voices not often featured at national meetings. The common thread: Moving beyond identifying problems to showcase solutions that work.Key Quote:“ Data for the sake of data doesn't help anybody. If it just sits there and you pat yourself on the back, ‘I've got this sitting in my database';  that doesn't help.  What you do with it, matters.We have a couple of sessions  digging into  innovating to address health disparities, talking about  analytics  to understand  populations and how to address interventions. Also, we have  sessions  focused on creating equitable systems of care for populations with disabilities.Understanding where  unmet needs are, how to  make things accessible, make things usable—data is part of that. It's understanding who, what, when, where and how to take what you're sitting on in your organization and understand it  so you can improve care.” Rachel HarringtonTime Stamps:(00:43) What's Different About the Health Quality Forum(03:40) An Expanded, Regional Lens on Quality (6:09) How NCQA Sees Data and Interoperability Differently (10:38) Improving Care in Rural Areas (16:04)  How-to Workshops on NCQA Accreditation(17:55) Personal Highlights at the Forum Links:Register for the 2025 NCQA Health ForumConnect with Stacy GrundyConnect with Rachel HarringtonConnect with Kristine Toppe

Why does a potentially deadly condition that affects 1 in 7 adults fly under the radar, undetected and undiscussed? Join us on this episode of Quality Matters as we explore Chronic Kidney Disease (CKD), a silent killer that's finally coming into the limelight of quality improvement.Our conversation begins with Dr. Ben Oldfield, a primary care physician, who sheds light on the startling prevalence and hidden complexities of CKD. Why is it so hard to detect, even with simple blood and urine tests? And why does this condition, despite its extensive impact, often get lost in the shuffle of busy health care visits?We'll unpack the challenges of diagnosing and managing CKD, exploring the emotional weight the diagnosis carries for patients and the hurdles clinicians face in communicating about it. Discover why CKD is a “loaded term” and how we can shift the narrative from fear to empowerment.But that's not all. We'll also tackle the big picture: How CKD fits into the broader landscape of cardiovascular, kidney, and metabolic (CKM) disorders. Could a holistic approach to these interconnected conditions revolutionize patient care?The conversation ends with Ben's thoughtful observations on how classic literature, particularly epic poetry, helps doctors make sense of health care's emotional complexities, connect with patients and find empowerment in the face of life and death.Join us as we explore how we can move CKD from the sidelines to the front lines of quality improvement, and how collaborative, longitudinal care can make a real difference.Key Quote:“Thinking about chronic kidney disease is a longitudinal process. It's only half the story to make the diagnosis in a snapshot in time. What's the follow up like? How are we doing with the patient over time? Because oftentimes quality measures can look at things in a snapshot in time. Chronic kidney disease really begs us to think more longitudinally.”“Benjamin Oldfield, MDTime Stamps:(02:54) The Silent Nature of CKD(07:05) Quality Measurement and CKD(11:08) The Link Between CKD and Cardiovascular Kidney Metabolic syndrome(13:06) CKD and CKM as Quality Priorities (15:45) Narrative Medicine and Personal InsightsLinks:NCQA Kidney Health ToolkitConnect with Benjamin Oldfield

Continuing the last Quality Matters episode, host Andy Reynolds and NCQA Chief Technology Officer, Ed Yurcisin, break down the complexities of the digital transformation in health care quality and explore the importance of high-quality data exchange, particularly in the context of HEDIS reporting and the FHIR interoperability standard. Ed explains how NCQA's work in digital HEDIS measurement not only improves health care quality reporting, but also lays the groundwork for broader industry advancements. By ensuring consistent, standardized data for digital HEDIS, NCQA is setting the stage for better measurement of public health, smoother prior authorization and general data accessibility.The conversation also explores the technical side of digital quality measurement, focusing on Clinical Quality Language (CQL) and the role of HEDIS “engines” in the health care data ecosystem. Ed clarifies the difference between SQL and CQL, and underscores that NCQA's focus is on measures' content, not on building the end-to-end software systems that run measures.Through collaborations like the Digital Quality Implementers Community, NCQA is working to ensure alignment across CQL platforms so everyone is “doing the same math.” Amol Vyas, NCQA Vice President for Interoperability, joins the conversation to explain how a public-private partnership is bringing choice and confidence to the market for CQL engines.Ed reflects on how his international perspective and personal experiences shape his passion for health care data interoperability. He shares how challenges accessing medical records for his family members underscore the need for a seamless, patient-centered health care system. His real-world perspective highlights why creating standardized, high-quality data isn't just a technical challenge, but a crucial factor in helping to ensure better, safer care for all.As the episode wraps, listeners are encouraged to explore NCQA's resources and upcoming events to stay informed on the future of digital quality. Key Quote:“ HEDIS measures are incorporated into government payment programs—for example, Medicare Star Ratings. There's incentive to enable digital HEDIS because it is tied to your CMS Star Ratings and the money a Medicare advantage plan might receive from the government. That's not the case for other important use cases, whether it be public health or prior authorization. So our infrastructure is tied to financial returns incenting organizations to make higher quality data accessible for digital HEDIS. And that means if it's good enough for digital HEDIS, it's been cleansed and analyzed in a way that could be used for public health, could be used for prior authorization—all of these different use cases.”Ed Yurcisin Time Stamps:(02:10) Clearing a Path for Data Quality(05:30) HEDIS “Engines” vs. HEDIS “Calculators”(07:17) Measures' Content vs. Software that Runs Measures(11:18) Digital Quality Implementers Community(19:35) The Need for Data Quality Cuts Close to Home Links:Bulk FHIR Quality Coalition Digital Quality Implementers CommunityNCQA Digital Hub Connect with Ed YurcisinConnect with Amol Vyas 

In this episode of Quality Matters, host Andy Reynolds is joined by Ed Yurcisin, Chief Technology Officer at NCQA, to break down the complexities of digital transformation in health care quality. Ed explains how NCQA's push for digital measurement cuts through inefficiencies and inconsistencies in assessing quality. Traditionally, HEDIS® quality measures have existed as large, text-heavy PDFs, leaving room for misinterpretation. By digitalizing these measures into computer code—Clinical Quality Language (CQL)—NCQA removes ambiguity and standardizes interpretation. That makes it easier for health care organizations to implement and use quality measures. This shift reduces administrative burden and helps ensure that quality assessments are more accurate and actionable.The conversation then shifts to FHIR® (Fast Healthcare Interoperability Resources), a standard designed to streamline health care data exchange. Ed explains that while FHIR might sound intimidating, it's built on the basic web technologies that power everyday internet browsing. FHIR brings five essential components to the table—JSON files, Rest APIs, standardized value sets, a common data model and government-mandated data exchange. While the government requires organizations to “pitch” data (make data available), there's no mandate to “catch” data (actually use the data). That means organizations that choose to use the data gain a competitive advantage.The discussion ends by focusing on data quality, an issue that looms large over digital transformation efforts. Ed introduces the Bulk FHIR Quality Coalition, a collaborative initiative aimed at improving the reliability of data exchanged between health care providers and insurers. Using the analogy of water through pipes, Ed explains that current data-sharing efforts help ensure flow, but don't always guarantee that data are “clean” enough to be useful. The coalition enhances existing provider–insurer relationships to test and improve large-scale data exchange methods. Ultimately, Ed underscores that digital transformation in health care is only as strong as the quality of the data being exchanged. Standardization, accessibility and interoperability are the foundations of progress, ensuring that technology-driven solutions improve enhance outcomes. Digital HEDIS, FHIR and the Bulk FHIR Quality Coalition are examples of how NCQA is reducing measurement burden to streamline measurement and improve quality. Key Quote:“ The digital transformation of health care is necessary to deliver higher quality care. But that is dependent on high-quality data and the ability to exchange this data.  It starts with high-quality data–making it accessible, interoperable,  exchangeable. That is the foundation for being able to deliver digital health care transformation.  Nothing in digital transformation in health care makes sense without high-quality data exchange.”-Ed YurcisinTime Stamps:(1:03) The How and Why of Digital Measurement(04:14) Understanding FHIR(08:32) From Data Exchange to Competitive Advantage(10:42) The Bulk FHIR Quality CoalitionLinks:Connect with Edward YurcisinNCQA Digital Hub Bulk FHIR Quality Coalition 

On this episode of Quality Matters, host Andy Reynolds is joined by Brittany Cunningham, Vice President of Episodes of Care and Population Health at Vanderbilt University Medical Center, to discuss how value-based care is reshaping health care through MyHealth Bundles. By packaging treatments into predictable, all-inclusive bundles, employers save money, patients avoid surprise bills and providers can focus on delivering high-quality care instead of navigating insurance complexities.But does bundling mean cutting corners? Brittany sets the record straight: The model eliminates waste, not necessary care. With lower C-section rates, near-zero infection rates for joint replacements and faster recovery times for spinal surgeries, bundle results are strong. Employers love the savings, patients love the simplicity and providers appreciate the shift from restrictive insurance rules to evidence-based care.So why isn't this standard everywhere? Andy and Brittany explore the hurdles, from outdated billing systems to awareness among employers. NCQA's Meghan Malone-Moses joins the conversation to share insights on why value-based care is the future—and how more health care systems to catch up. Tune in for a conversation that could change how you see health care.Key Quote:“ Value-based care, while the employers want to deliver higher value and higher outcomes to their employees and their members, it's hard to understand what that level of risk is. A lot of employers don't understand what it means to take value-based care on. The biggest thing is that education of what value-based care is and that the provider is taking on the risk. They are paying less than what they would pay in fee-for-service and they are getting the same or even higher outcomes for their members.”-Brittany CunninghamTime Stamps:(00:29) Introducing MyHealth Bundles(02:11) Benefits and Challenges of MyHealth Bundles(04:10) Predictability and Utilization in Bundled Care(09:17) Challenges in Implementing Commercial Bundles(10:30) When Bundles = Peace of Mind(13:02) How Employers View Value-Based CareLinks:MyHealth Bundles' ImpactConnect with Brittany Cunningham

In this engaging episode of Quality Matters, host Andy Reynolds is joined by Aaron Neinstein, Chief Medical Officer at Notable, to explore how AI is reshaping health care. It's not all robotic efficiency and cold algorithms. Aaron shares how AI takes over repetitive and data-heavy tasks so doctors can focus on their patients. Imagine spending less time sorting through charts and more time asking, “How does your illness affect your life?” That's the transformative hope of AI.The conversation takes a deep dive into the pressures on the health care workforce—from burnout to unstaffed job positions—and how AI could be the labor multiplier health care has been waiting for. But it's not just about solving staffing shortages or making systems faster. Aaron foresees an optimistic future where AI helps personalize care, tailoring interactions to each patient—including by health literacy and language. It's a future that feels surprisingly human, thanks to tech doing what it does best: Crunching the numbers and leaving empathy to the people.No responsible discussion of AI can omit cautionary tales. Bias in training data, transparency and ethical partnerships all come into focus as Aaron reminds us to move thoughtfully in this brave new world. Whether you're excited about AI, or skeptical, or just curious how it might impact your next doctor visit, this episode offers a balanced and insightful take. Key Quote:“Nothing in health care AI makes sense, except in light of seamless integration with clinical workflow.The mistake I've made, that I've seen others make, is, ‘Hey, we've got this great new tool. Use it on the side of what you're doing today. It's going to be so good, it's going to be worth it for you to move out of your EHR and come use our tool.' And it never works.People have their home that they work in, that they do all their work in every day. And the new tool, the new automation, the AI has to be tightly integrated into workflow, has to be integrated into the core system. Or it's just not going to work.”Aaron Neinstein, MDTime Stamps:(01:01) The Urgency of Digital Transformation(03:18) AI's Impact on Patient Care(05:45) Addressing Fears and Misconceptions(13:00) Transparency and Guiding Principles(14:21) NCQA's AI InitiativesLinks:Connect with Aaron NeinsteinLearn more about Notable 

This week on Quality Matters, we dive into a complex discussion on the often perplexing landscape of the health care economy with guest Sanjula Jain, Chief Research Officer at Trilliant Health. This isn't your standard health policy chat; it's a bold exploration of how costs, value, and quality intersect—and often misalign—in America's health care system. Sanjula challenges us to rethink buzzwords like "value-based care" and "value for money," peeling back the layers to reveal stark realities behind these terms. Is our system delivering what we pay for, or are we caught in an unsustainable loop of rising costs and stagnant outcomes? The answers may surprise you.Sanjula combines sharp analysis with relatable analogies. Her insights into the difference between maximizing and optimizing value—and why the latter could save the health economy—offer a framework for health care enterprises seeking competitive advantage in a negative-sum game.The episode also spotlights the human element of health care economics, from patients delaying care due to unaffordable costs, to the flawed assumption that higher prices mean better outcomes. Sanjula doesn't mince words: The current system is failing and incremental policy tweaks aren't cutting it. But her optimism shines through as she calls on employers, voters and innovative thinkers to drive change. Key Quote: “Think about the airline industry and retailing, large consumer brands. They're constantly having to think about value and there ends up being fewer players. It's going to be interesting to see who is up for competing. Those who don't figure out a way to change their approach are going to be at a disadvantage. Nobody wants to say, “You are going to fail.” No one likes to talk about the bad things coming our way. But I view it as a warning. Hopefully some players are starting to think differently and understand nuances of their markets and how they can optimize. Because the optimization equation is going to look different for everybody.”-Sanjula JainTime Stamps:(02:05) Understanding Health Care Costs and Value(03:51) Value for Money vs. Value-Based Care(06:20) Optimizing vs. Maximizing Value(11:10) What Most People Get Wrong About Value(13:24) Quality Measurement and Digital SolutionsLinks:NCQA on Value-Based CareConnect with Sanjula Jain

On this episode of Quality Matters, we highlight a thought-provoking panel from the NCQA Health Innovation Summit, featuring experts Dr. Bryan Buckley, Tosan Boyo, Dr. LaShawn McIver, Camille Burnet and Daniel Dawes. The conversation cuts through labels and buzzwords to remind listeners that equity is about giving everyone an opportunity to be as healthy as they can be. The wide-ranging discussion references rural health, maternal care and veterans health as areas where an equity lens can help improve outcomes.Panelists offer practical solutions grounded in data and accountability. Camille Burnett emphasizes the importance of collecting and using the right data to close care gaps, while Tosan Boyo challenges health systems to move from talk to tangible results. Daniel Dawes provides hopeful perspective, framing today's challenges as part of a historical cycle that calls for persistence, innovation and a focus on structural solutions.This episode is both a source of inspiration and a call to action. Health equity, as Bryan Buckley reminds us, is an enduring pillar of high-quality care. The work is hard, essential and ongoing.  Key Quote: “Everyone talks about health equity. People believe they understand it. People are constantly hearing about it. We've talked about health equity quite a bit in the past five years. But then I don't want health systems to start losing the thread as to, 'Oh, we talk about it, therefore it's happening.' What we're doing is fundamentally about morbidity and mortality. Our work is to ensure that no population is dying or getting sicker than the other. We want to make sure no one is dying or getting sicker at a higher rate than anywhere else.”Tosan Boyo Time Stamps:(01:01) Defining Health Equity(04:09) The Distinction Between DEI and Health Equity(06:10) The Connection to Digital Measurement(07:38) Historical Perspective(09:30) From Activity to Productivity(10:54) Equity's Enduring Connection to Quality Links:Quality Matters Ep. 11:  Hospital President: Health Equity Verifies QualityNCQA Health Equity Resource Center Connect with Bryan BuckleyConnect with Tosan BoyoConnect with Camille BurnettConnect with Daniel DawesConnect with LaShawn McIver

In this episode of Quality Matters, we dive into the complexities of behavioral health care with Julie Seibert, Assistant Vice President of Behavioral Health at NCQA, and Tom Tsang, founding CEO and Chief Strategy Officer at Valera Health. Together, they explore the interconnected challenges of access, quality and payment in behavioral health, emphasizing the need to treat the whole person by addressing both mental and physical health. Julie highlights NCQA's three-part framework for behavioral health—access, quality, and payment—emphasizing that linking these elements is critical in improving care.Tom shares how conversations around mental health have changed since the pandemic, making the connection between behavioral health and physical health more clear. He discusses the ripple effects of mental health conditions on chronic disease management and diverse societal problems, such as rising rates of adolescent substance abuse and suicide. Both Julie and Tom reflect on the potential of innovations like measurement-based care, telehealth and value-based payment models to expand access and improve outcomes. They also discuss ongoing systemic barriers, including a shortage of providers who accept insurance.Julie and Tom shine a light on emerging solutions, from CMS payment reforms to NCQA's development of quality measures tailored for behavioral health. This discussion offers invaluable insights into addressing the urgent need for accessible, high-quality behavioral health care that meets the needs of an increasingly diverse America.--Key Quote: “Access, quality and payment are tied together. If payment models are not sufficient to cover costs of care, you have fewer practitioners that provide services. And if there are fewer practitioners, it's difficult to have access. If there are not enough people to permit sufficient access, that lowers quality. They're all inextricably combined.”-Julie Seibert“People recognize that it does impact our physical health and that we have to take into account physical and mental health as a whole. People with chronic medical conditions, 30 to 40 percent of their total cost of care could be impacted by their mental health conditions. A lot of people have changes in morbidity and mortality because of loneliness. Depression can impact someone's intake of food consumption, impacting fasting glucose and adherence to medical management of their chronic illnesses. We've also seen the impact on the child and adolescent population in terms of learning disabilities, teenage suicides, drug use, alcohol consumption. We've seen all of that happen over the last five years.”-Tom Tsang--Time Stamps:(00:30) The Complexity of Behavioral Health(03:18) A 3-Pronged Model for Behavioral Health(06:23) Quality Dimensions in Behavioral Health(08:42) Bringing Value-Based Care to Behavioral Health(11:57) Payment Models and Challenges in Behavioral Health(15:25) Telehealth in Behavioral Health: Opportunities and Challenges--Links:NCQA White Paper: Developing a Behavioral Health Quality FrameworkConnect with Julie SeibertConnect with Tom Tsang

This episode of Quality Matters features highlights from the NCQA Health Innovation Summit panel discussion on data interoperability, held on November 1st in Nashville. Moderated by Arcadia's Aneesh Chopra, the panel explored how to make health data accessible and usable for improving patient care. Panelists (Laura McCrary of KONZA, Dr. Marc Overhage of Elevance Health and Abdul Shaikh of AWS) emphasize interoperability is critical for quality reporting, care coordination and closing care gaps. Emphasizing trust as the cornerstone of data exchange frameworks such as TEFCA, panelists outline the need for alignment between payers, providers and technology organizations to ensure better health outcomes.  The panel unpacks technical and operational challenges surrounding interoperability, such as integrating fragmented data sources and transforming raw reports into insight practitioners can use at the point of care. Panelists compare HIEs and QHINs to highways, illustrating how these systems enable cross-border data sharing. But delivering actionable information, rather than overwhelming clinicians with reports, remains a challenge. Solutions such as Bulk FHIR and cloud-based technologies are highlighted as promising ways to help data reach its best, highest use. The discussion closes with an appeal for greater collaboration and participation in initiatives like the NCQA Bulk FHIR Quality Coalition to test modern quality measures. As Laura McCrary points out, the interoperability challenge isn't just technological—it's cultural and contractual. By aligning incentives and fostering trust between stakeholders, health care can evolve from fragmentation to seamless, person-centered care.  Key Quote: "Bringing data together for a particular patient so we have a comprehensive view for clinical care, quality assessment, predictive modeling, whatever it might be–it's still the golden ring that I'm trying to get to.We have standards and that's great, and those continue to improve.It's pretty amazing the volume of data and the number of people that we're able to access and share data between payers, providers, other participants in the healthcare ecosystem."Marc Overhage, MD Time Stamps:(2:55) Data exchange is all about trust.(4:38) QHINs are the superhighways of health data exchange. HIEs are the on- and off-ramp.(5:25) QHINs were created to work around geographic limitations of HIEs.(6:12) QHINs' challenge is providing information in a way that practitioners can use.(7:21 ) To understand where data exchange can go wrong, focus on the interfaces between steps.(9:12) Data exchange agreements often require legal expertise as much as technical expertise.(11:13) The industry faces a big binary choice about how to organize quality information.(12:46) Bulk fire and cloud computing are a powerful combination.(14:31) Join the Bulk FHIR Quality Coalition.Links:Bulk FHIR Quality CoalitionQuality Matters Ep: 07Quality Matters Ep: 08Connect with Aneesh ChopraConnect with Laura McCraryConnect with Marc OverhageConnect with Abdul Shaikh 

n this episode of Quality Matters, host Andy Reynolds sits down with Tosan Boyo, President of Sutter Health East Bay Market, to discuss his inspiring journey from Nigerian immigrant to leading a major health care institution. Boyo shares how his early experiences as a patient in a safety-net hospital shaped his commitment to health equity and continue to shape his leadership. He reflects on key moments that drove his passion for providing equitable care and the responsibility health care leaders have in ensuring access for all.Boyo highlights the importance of community engagement in health care workforce development, emphasizing the need for institutions to reflect the communities they serve.He also highlights the crucial role of transparent data reporting in driving improvement and building trust. Boyo discusses the impact of partnerships and how collaboration sets a precedent for addressing inequities.Tosan will participate in a panel discussion at NCQA's Health Innovation Summit, where he will discuss ongoing efforts and challenges in advancing equitable care. His insights offer a roadmap for ensuring that health care systems evolve to meet the needs of diverse communities.Key Quote: “Health equity gives us tools and to validate we are living up to the thesis that motivates us to come to work every morning.  Fundamentally, delivering high quality outcomes is always the number one priority with that thesis being a foundation, how are we ensuring every patient is achieving the high quality outcome? We verify that by Saying let's stratify your outcome metrics by race and ensure that race is not a factor that one population is not getting the same high quality outcome Let's do it by language and ensure that language is not a barrier to access and not a barrier to following the instructions that you get from a physician. Let's verify by zip code, to understand socioeconomic status. How are we ensuring that regardless of zip code, you are getting the best care? These are different ways we can verify we are living up to the priority to deliver high quality outcomes.”-Tosan BoyoTime Stamps:(00:57) Tosan Boyo's Journey into Health Care(02:58) Defining Health Equity and Its Importance(09:59) Building Trust and Community Relationships(15:25) The Future of Health Equity(18:45) The 2024 NCQA Health Innovation SummitLinks:Connect with Tosan BoyoCMS Universal FoundationTosan Boyo at Quality Talks 2022 Institute of Medicine: Crossing the Quality Chasm

In this episode of Quality Matters, host Andy Reynolds previews the upcoming Women in Quality panel at NCQA's Health Innovation Summit. He speaks with Vanessa Guzman, CEO of SmartRise Health and Ella Es Health, who will moderate the panel. Vanessa shares her insights on empowering women in quality by cultivating self-awareness, fostering connections and building a culture of quality. She also introduces two thoughtful panelists, Khanh Nguyen, CEO of Cozeva, and Lynn Todman, Vice President of Health Equity at Corewell Health, who bring unique perspectives on resilience, community impact and health equity.The discussion emphasizes the importance of trust, community and personal reflection in leadership, with personal stories from each guest about navigating challenges and creating meaningful change. The episode concludes with practical advice for attendees of the Women in Quality event on November 1, encouraging self-reflection and a focus on personal growth.Key Quote: “The Women in Quality reception will focus on three segments. The first one will focus on cultivating oneself, understanding your purpose, walking your journey. What does that look like? The second segment will be focused on connection and collaboration. How to build meaningful relationships; how to build a trusted network. And then the third will be focused on creating and expanding that culture of quality. What areas of your life and workforce meet your goals and objectives? How are you tracking and measuring those processes?  When you combine those, you're manifesting the goals that you have set.”Vanessa GuzmanTime Stamps:(2:23) Co-creation at the 2024 Health Innovation Summit's Women in Quality event(5:18) Finding growth and impact as a quality professional(9:14) Improving quality, building community(11:55) Building trustLinks:NCQA's Health Innovation SummitConnect with Vanessa GuzmanConnect with Khanh NguyenConnect with Lynn Todman

In this episode of Quality Matters, host Andy Reynolds is joined by Dr. Tiffany Inglis, National Medical Director for Women's and Children's Health at Carelon Health, to explore the Elevance Health Obstetrics Practice Consultants program. A winner of an NCQA Health Innovation Award, the Elevance Health program breaks new ground by bringing value-based care to obstetrics, a field where value-based strategies remain rare. Dr. Inglis discusses the program's focus on improving maternal health outcomes by addressing racial disparities and providing practitioners with insight and know-how. By emphasizing collaboration and data-driven support, the program improves the care of mothers and babies. The conversation further examines the growth and impact of the program since its inception in 2015. Dr. Inglis highlights measurable indicators of success, including double-digit reductions in low birth weight and preterm births. The discussion addresses implications of integrating value-based care into obstetrics, showcasing how this model not only improves outcomes for mothers and babies but also fosters an effective, sustainable health care system. Key Quote:  “For me, the surprise has been the impact you can have by taking this approach of value-based care, tied to quality, and then aligning it to provider supports. The member gets better care, the provider gets their value-based care contract stuff taken care of, and the plan gets a better outcome for mom and baby. It's the triple win, a good outcome for everyone. And I think the thing that caught me most off guard was just the scale at which we can improve outcomes and see better care.”Dr. Tiffany Inglis Time Stamps:00:43 Elevance Health OB Practice Consultants Program's Impact on Maternity Care01:45 The Role and Growth of OB Practice Consultants05:10 The Relationship to Other Quality Initiatives  08:36 Challenges and Misconceptions in Value-Based Care12:17 Tips for Implementing Value-Based Care Links:Connect with Dr. InglisNCQA Health Innovation AwardsNCQA Birth Equity Accountability through Measurement (BEAM) Program

On this episode of Quality Matters, we explore the growing importance of Health Information Exchanges (HIEs) and Qualified Health Information Networks (QHINs) with Laura McCrary, President and CEO of KONZA National Network. Laura discusses the pivotal role these systems play in quality care, enabling the secure and efficient sharing of medical records across diverse networks. By advancing the digitalization and interoperability of health data, these networks enhance patient safety and care coordination.We explore how integrating claims data with clinical data enhances quality, underscoring the critical importance of trusted networks for data exchange. Laura dispels common myths surrounding HIEs and QHINs, while offering practical tips for health care organizations curious about connecting to these essential systems.Additionally, we examine national efforts to expand connectivity and ensure that all health care organizations are part of a growing, robust data infrastructure. This episode serves as a handy guide for how to leverage HIEs and QHINs to participate in more capable and coordinated health care ecosystem.Key Quote: “There is a lot more information available. It really is both a blessing and a curse. In the past, there was no information available for the doctor. Now there's so much. The first problem was how did we actually move the data from Florida, say, to New York? It's been solved through QHINs. As we solve one problem, we've created a new one, which is there's too much information available. We've got to address this new problem.”-Laura McCrary, Ed.DTime Stamps:(01:48) Challenges and Change in Data Exchange(03:48) Myths and Realities of HIEs and QHINs(07:35) Connecting Different Kinds of Data(10:27) Dimensions of Trust(14:29) Reducing Burden with Digital Measurement(16:06) Future of HIEs and QHINs--Links:NCQA resources on digital qualityLearn about KONZAConnect with Laura

In this episode of Quality Matters, host Andy Reynolds delves into the transformative impact of the Trusted Exchange Framework and Common Agreement (TEFCA) on health care data interoperability. Joined by Amol Vyas, NCQA Vice President of Interoperability, and Eric Musser, Vice President of Federal Affairs, the discussion uncovers how TEFCA is reshaping the landscape of health information exchange.Amol explains TEFCA's function as a voluntary, national network (analogous to the postal service in its role as a connector) and highlighting implications for the free flow of HEDIS data. Eric provides insight into TEFCA's bipartisan roots in the Cures Act of 2016, emphasizing TEFCA as a model of public-private partnership and standards-based improvement. Key Quote: “I think TEFCA has kind of been the underdog in health policy for a while now. Value-based care, patient safety, whole-person care, all those things are really salient topics that are brought up a lot. I think TEFCA is about to have its moment and I'm excited to see it come to greater fruition. I'm really happy to see all the progress we've made. It's going to take a full government, full industry approach to make this work for people. I think we're well on our way,”-Eric MusserTime Stamps:(00:28) Understanding TEFCA(01:42) New SOPs and Their Impact(06:36) Public Policy Perspective on TEFCA(10:00) Public-Private Partnership in TEFCA(12:10) Looking Ahead with TEFCALinks:Bulk FHIR Quality CoalitionDigital HubConnect with AmolConnect with Eric

In this episode of Quality Matters, host Andy Reynolds sits down with Rebecca Jacobson, CEO of Astrata, to explore the challenges and opportunities in transitioning to digital quality measurement in health care.Rebecca offers an in-depth look at the sociotechnical shifts required for this evolution, sharing practical strategies to help organizations navigate this complex process. Discover how to overcome common obstacles, and learn about the real financial benefits that can convince even the most skeptical CFOs to invest in this transition.Rebecca also provides a candid assessment of the industry's current state of readiness, emphasizing the importance of starting early for long-term success. She discusses why progress has been slower than expected and shares her updated timeline for widespread adoption.Key Quote: “I'd want my billboard to say: “Digital quality, you can do it.”  Big things like this, big transformations that impact so much of the organization, they can be daunting, but we've seen plans make substantial progress that are clearly going to do very well. It can be done. Every quality team has it in them to guide this transformation and derive benefit. Just start now and have the confidence that you're able to do it, that there are a lot of resources that help you.”-Dr. Rebecca JacobsonTime Stamps:(00:00) Introduction to Digital Quality Measurement(01:03) Understanding the Industry's Readiness for Digital Transformation(02:17) Challenges and Benefits of Digital Transition(09:53) The Role of AI and Machine Learning(14:55) Current Progress and Future DirectionsLinks:Connect with RebeccaLearn more about AstrataJoin the NCQA Industry CouncilExplore the NCQA Digital Quality Hub

In this episode of Quality Matters, host Andy Reynolds discusses the U.S. Playbook to Address Social Determinants of Health with its lead author, Dr. Sandra Elizabeth Ford. Dr. Ford, a pediatrician and public health advocate with extensive experience at both local and federal levels, highlights the necessity of looking beyond clinical care to factors like housing, nutrition, and transportation. She emphasizes the importance of expanding data gathering and sharing, supporting flexible funding, and investing in backbone organizations to improve healthcare outcomes.Dr. Ford also tackles the disconnect between local and national levels, advocating for leveraging local expertise and strengthening local programs before seeking federal support. The episode concludes with practical insights on integrating social needs into healthcare delivery and the importance of addressing these determinants to foster a sustainable healthcare system. Dr. Ford dives into what makes a successful organization in public health, focusing on the critical role of data. From the challenges of data standardization and sharing to the importance of good governance and leadership, this episode offers invaluable insights. This conversation is a must-listen for anyone passionate about creating a comprehensive healthcare system that truly considers the full spectrum of social determinants of health.Key Quote: “We are not going to doctor ourselves out of the healthcare crisis. If we really want to address healthcare crises in this nation, we need to understand how are people living, what they're missing. We need to ask questions around how people live their lives. It's cheaper to give somebody a food prescription than it is to treat an amputee from diabetes. So if we ask the questions on the front end of what people need, we're better able to serve them from a clinical perspective.”-Dr. Sandra Elizabeth FordTime Stamps:(00:51) The Necessity of the Playbook(02:48) Expanding Data Gathering and Sharing(10:32) Challenges and Solutions in Data Management(15:55) Common Misconceptions in HealthcareLinks:Learn more about the PlaybookConnect with Dr. Sandra Elizabeth Ford

On this episode of “Quality Matters” with host Andy Reynolds, we explore the vital role of Sexual Orientation and Gender Identity (SOGI) data in healthcare. Our expert guests, Kellan Baker, Executive Director of the Whitman-Walker Institute, and Dr. Carl Streed, a primary care physician at Boston University, share why SOGI data are essential for delivering personalized health care interventions and improving overall health outcomes. Understanding sexual orientation and gender identity alongside other demographic variables like race and ethnicity is crucial for providing comprehensive and inclusive care. Emphasizing the importance of building trust within healthcare settings, our guests discuss how fostering a trustworthy environment encourages the sharing of sensitive SOGI information, which is vital for patient care quality.The conversation addresses the challenges the current political climate poses and its potential negative impacts on LGBTQ health. We highlight the necessity of robust privacy protections to prevent the misuse of SOGI data and the role of the entire healthcare team in safeguarding this information. Additionally, we share insights into new resources from the US Department of Health and Human Services to enhance demographic data quality. Calvin emphasizes recognizing LGBTQ individuals as people with unique stories and the importance of methodological data collection. For further guidance, recommendations include resources from the Office of the Assistant Secretary for Planning and Evaluation at the US Department of Health and Human Services. Key Quote: “These are intimate areas of people's lives that we're dealing with in health care, and HIPAA was enacted to protect that information from exploitation and misuse. so it's incredibly sad to see state actors intentionally misusing the law. To take personal health information from patients, from families, from healthcare institutions, not just that incredible intrusion into the provider patient relationship, but then also to Press charges against healthcare providers, for providing medical care in accordance with their training and expertise. It's an incredible violation of HIPAA and something that should concern all of us, regardless of whether we're transgender or we provide care to transgender people.”-Kellan Baker, Executive Director of the Whitman-Walker InstituteTime Stamps:(00:44) Understanding SOGI Data(03:26) Challenges and Misconceptions about SOGI Data(05:51) Legal Issues and Misuse of SOGI Data(11:01) Finding Trust in Healthcare Systems(13:12) The  Future of SOGI Data CollectionLinks:Connect with Kellan BakerConnect with Dr. Carl StreedLearn more about the Whiteman-Walker Institute Learn more about the GenderCare Center at Boston University School of Medicine

In the first episode of a two-part series titled, 'In Data We Trust,' host Andy Reynolds and Tam Ward, Senior Vice President of Business Strategy and Operations at Oscar Health,  discuss the intersection of technology and health care to improve care equity, especially in underserved communities. Focusing on initiatives by Oscar Health, Tam highlights efforts to build culturally competent care networks and improve data-driven solutions for marginalized groups, including African Americans and the LGBTQ community. The episode emphasizes the importance of trust, transparent data sharing, and personalization in healthcare to address disparities and enhance patient experiences.Key Quote: “If there was one ask I could have of those in a place of influence to help create standardization around provider data, it's share the attributes of the physician that are important to the patient and hold us accountable for doing what's right with that information.”-Tam WardTime Stamps:(02:32) Oscar's Approach to Culturally Competent Care(04:57) Challenges and Solutions in Provider Data(08:46) Building Trust in Healthcare(10:58) Focus on LGBTQ+ CommunityLinks:Connect with Tam Visit Oscar Health

Join us for an insightful conversation with North Carolina Secretary of Health and Human Services, Kody Kinsley, as he shares how growing up without health insurance influences his drive to improve health care access and affordability in his home state. Discover the transformative impact of the state's recent Medicaid expansion and substantial investments in behavioral health.Secretary Kinsley emphasizes North Carolina's novel, bipartisan approach to improving care. The discussion covers innovative strategies for staffing the 988 crisis hotline and the unusual integration of the health care system and the prison system. Secretary Kinsley ends with reflections on leadership in an era of identity politics and his advice for quality advocates everywhere. Key Quote: “We are very excited to have, after 10 years been able to finally expand Medicaid. And not only have we gotten it done, we've gotten it done well.  The other thing that's particularly exciting was a near billion-dollar investment in behavioral health. That is just so consequential to overall health and well-being, something that had also been forgotten and neglected for too long,”-Secretary of the North Carolina Department of Health and Human Services Kody KinsleyTime Stamps:(01:48) Medicaid Expansion: A New Era(05:11) Bipartisanship and Community Engagement(06:37) Challenges and Solutions in Behavioral Health(11:56) Innovative Approaches to Health Care and Justice(13:23) Social Determinants of Health: A Holistic Approach(21:09) Taking Pride in One's Holistic Identity and Quality GainsLinks:Learn more about Secretary Kinsley

University of Chicago professor and Doctor, Marshall Chin, joins us on Quality Matters to revolutionize medical training with his unique blend of improv and stand-up comedy. Discover how these innovative techniques equip medical students with the skills to care for diverse patients and engage in vital discussions about systemic racism and social privilege. By prioritizing active listening and real-time interaction, Dr. Chin's approach helps shift the perspective from merely addressing health disparities to fostering genuine health equity.The episode culminates with actionable strategies to propel health equity forward, highlighting the importance of culturally tailored solutions and comprehensive interventions. We explore the power of honest dialogues about racism, power, and privilege, and discuss how lifelong learning and diverse experiences, akin to team sports, can drive systemic change. Join us for this enlightening conversation that underscores the critical need for continuous improvement and authentic community partnerships to pursue health equity.Key Quote: “The thing about health equity is that it's the right thing. Everyone wants to do the right thing. And it requires all this expertise and all these stakeholders. It has the community expertise. It requires the clinicians on the staff who have the frontline experience. It requires people who do quality improvement. It includes the data people. I mean, everyone has a role.” - Dr. Marshall ChinTime Stamps:(00:00) Achieving Health Equity Through Innovation(05:55) Equity and Intersectionality in Healthcare(14:28) Advancing Health EquityThrough Lifelong LearningLinks:Resources Marshall Chin recommends in the episode include:Health Care Payment Learning & Action Network.Achieving Health Equity tools from The Robert Wood John FoundationWhat Should Antiracist Payment Reform Look Like?Cruelty and Health Inequity (abstract)The book The Sum of Us: What Racism Costs Everyone and How We Can Prosper Together , by Heather McGhee, and discussed here 

 Welcome to "Quality Matters," the podcast where we unpack the complexities of modern healthcare to shape a brighter future. Join us as we delve into the dynamic world of healthcare quality and innovation, exploring topics such as digital transformation, health equity, and quality standards.Each episode brings together thought leaders, industry experts, and innovators to discuss the latest trends, best practices, and challenges shaping the future of healthcare. With a focus on convening voices from across the industry, "Quality Matters" provides a platform for meaningful conversations and collaboration.Whether you're a health plan leader, a health IT professional, or simply someone passionate about improving healthcare outcomes, tune in to gain valuable insights and actionable strategies for driving positive change in healthcare delivery.Because when it comes to healthcare, quality truly matters. Join us on "Quality Matters" as we shape tomorrow's healthcare today.

In this episode, we highlight two companies that leverage data from many different sources to create a more complete picture of a person's health. The ultimate goal? Shifting away from the current model of “sick care” - where patients primarily see their doctors when they aren't feeling well – to care models that prioritize long-term health and self-management with guidance from providers. These companies are helping lead the way to value-based care, from using AI to sift through patient-reported data and provide actionable insights, to integrating NCQA's HEDIS measurements into their data platform, thereby putting quality at the center of everything they do. Here, you'll get a glimpse into the challenges and opportunities in our current data-rich health care ecosystem.The episode begins with a conversation with leaders from Welldoc. Welldoc is a health tech company developing patient-facing apps to support self-management of chronic conditions. Using an omnichannel approach, their apps gather as much data as possible from sources including remote monitoring devices, like wearables, and clinical data.Chief Analytics Officer, Dr. Anand Iyer, and Chief Medical Officer, Dr. Mansur Shomali, explain how Welldoc uses AI to parse the patient information, ultimately helping doctors and patients work together to construct an effective path to wellness.Jessica Robinson is Chief Platform Officer for health care digital developer The Garage. Jessica manages all aspects of the product life cycle, from the spark of innovation through design, development, testing, and roll-out. Founded in 2012, The Garage aims to utilize digital tools to help providers shift from fee for service models to value-based models of care.In this interview, recorded live at NCQA's 2023 Health Innovation Summit, Jessica explains how The Garage works with Management Service and Accountable Care organizations, among other provider groups, to develop digital applications that help clinically integrated networks across 34 states harness the full extent of the population data available to them. The Garage also utilize NCQA's HEDIS measures into their platform, allowing networks to visualize the full patient care team across the entire care continuum and deliver optimized quality care to their patients.For information on NCQA's Health Equity Forum, click here: https://events.ncqa.org/healthequityforum

The course of the Digitalization of Health doesn't always run smooth. But for every set of pain points a provider might experience, there are companies developing technological solutions – platforms and tools – that not only guide us through digital transformation but identify crucial patient and population data along the way.In this episode, we talk with two health tech leaders, interviewed during NCQA's 2023 Health Innovation Summit in Orlando, Florida, about their strategies and successes in using digital tools that can ultimately reveal and resolve gaps in health care delivery.Sebastian Seiguer, is co-founder and CEO of Scene Health. Scene Health is a company focused on medication “engagement”, a comprehensive approach that means more than just getting patients to take their medicine. They provide personalized medication support by combining video technology, clinical coaching, and validated interventions to improve medication adherence rates. Within the tapestry of their mission is the clear goal of reaching and engaging with diverse, vulnerable, and hard-to-reach populations.Upendra Patel, CEO of AaNeel Infotech, is finding ways to support clinicians through EHR, or Electronic Health Record, interoperability. AaNeel Infotech worked with Medstar Health to transform an isolated risk calculator into a FHIR-based app. Upendra's company helped them use the SMART on FHIR methodology. That's FHIR as in “Fast Health Interoperability Resources” and SMART as in “Substitutable Medical Applications and Reusable Technologies”. Using the SMART on FHIR approach, AaNeel Infotech helped create an app called “Mobilizing a Million Hearts”, which integrates the Million Hearts Longitudinal Atherosclerotic Cardiovascular Disease risk calculator into the MedStar Health EHR system and allows Medstar providers to get an even more comprehensive view of their patients at risk for cardiovascular disease.

This episode of “Inside Health Care: a Podcast by NCQA” features three interviews recorded live at our Health Innovation Summit in October 2023. Among many panels and presentations was an incredible session titled “Health Equity Trailblazers: Where Vision Meets Commitment.” Health equity leaders discussed their organizations' health equity strategies, vision and lessons learned, delving into how leaders can commit to and advance health equity priorities. Each of this episode's guests sat on that panel then sat with me for a deeper dive. These leaders, each in their own way, want to inspire us to action.Dr. Joneigh Khaldun is Vice President and Chief Health Equity Officer for CVS Health. In this role, she advances the company's data-driven strategy to improve access to services, address social determinants of health and decrease health disparities. She is a sought-after speaker and thought leader who has appeared on Meet the Press, MSNBC and CNN, among others, and she has testified before Congress.In her past work, as the top doctor leading Michigan's COVID response, she is credited with the state's early identification of and actions to decrease disparities, and in 2021 was appointed by President Biden to the national COVID-19 Health Equity Task Force. She is a practicing emergency physician who earned her MD from the Perelman School of Medicine at the University of Pennsylvania.Dr. Ronald M. Wyatt is a renowned global health care quality and safety expert with a passion for advancing health equity worldwide. Dr. Wyatt is Founder and CEO of Achieving Health Equity, LLC. As a distinguished Senior Fellow with the Institute for Healthcare Improvement, he holds pivotal roles as Chief Science Officer and Chief Medical Officer at the Society to Improve Diagnosis in Medicine, an organization dedicated to enhancing diagnostic accuracy in health care. As an expert in hospital safety oversight, Dr. Wyatt holds a significant role in shaping the National Patient Safety Goal on Health Equity. His contributions to the National Patient Safety Plan, authored by AHRQ and IHI, underscore his commitment to advancing health care on a global scale.Dr. Bryan O. Buckley moderated the Health Care Trailblazers panel at NCQA's 2nd annual Health Innovation Summit. Dr. Buckley is NCQA's Director for Health Equity Initiatives. In this position, he plays a key role in developing partnerships with funding and research organizations, care delivery systems, the managed care industry and communities to translate research knowledge and real-world evidence into development of equity-oriented products and programs. These include NCQA's Health Equity Accreditation programs.

In this Inside Health Care interview, we explore GME — graduate medical education — and explore a few fundamental questions. How can we make sure today's medical residents are paying attention to their patients? How do we teach residents to ask the right questions? And even more fundamentally, how do we make sure that the next generation of clinicians knows how to implement value-based models of care in order to focus on person-centered outcomes?A value-based model helps patients envision what their lives could be a few months, or even years, down the line. And that's the point at which clinicians can help patients develop a treatment plan to get them from point A to point B. That may be the best way to keep a patient healthy, boost their interest in their self-care and prevent repeat visits for the same problem.So the questions stand regarding graduate medical education. How do you teach med school students the value of quality? How do you train them to follow a model of value-based care? And if your hospital's HEDIS scores are low, how much of that is because of the residents? What's the correlation between medical residencies and health care quality?Michael Kanter, MD, is a professor and chair of Clinical Science at the Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, California. In his work within Kaiser Permanente's health care system, he's overseen the quality of care provided by 22,000 physicians to 12.2 million patients. He also was responsible for development of Kaiser's national quality strategy. An expert in patient safety and clinical quality, he developed policy-based and software-based programs that decreased the number of missed or delayed diagnoses and increased patient engagement.Jung Kim, PhD, MPH, is Assistant Professor for Health Systems Science at the Kaiser Permanente Tyson School of Medicine, and a protégé of Dr. Kanter. Dr. Kim explores approaches to health care and healing, including studies on the roles of acupuncture and other East Asian practices as complementary or alternative medical treatments for cancer, H-I-V and other conditions. As we'll hear in our interview, Dr. Kim also investigates innovations in medical education residency programs, including analysis of email communication among medical students and new learning strategies for medical education.

We close 2023 with our annual year-end State of Health Care interview with NCQA President Peggy O'Kane. In this interview, Peggy talks with Vice President for Public Policy and External Relations, Frank Micciche, about NCQA's progress in 2023—both in improving equitable access to health care and implementing digital transformation across the ecosystem. As you'll hear, we're hitting the ground running in 2024. With new digital products, digital quality implementers and digital solutions to reveal—and reverse—health care disparities, NCQA stands ready to take the lead on advancing quality for everyone.Don't forget to sign up for NCQA's next big event: the Health Equity Forum, coming up March 4th and 5th, 2024, at the Westin Los Angeles Airport. The Health Equity Forum convenes state officials, advocates and health care providers, showcasing the blueprint for creating and implementing statewide health equity strategies. Our next Quality Talks event is planned for Spring 2024. And as mentioned in this episode's interview, go to www.ncqasummit.com to learn more about our Health Innovation Summit, and click here to register for our next event, October 31-November 2, 2024, in Nashville.

In this episode of our “Inside Health Care” podcast, we hear two interviews that each demonstrate how close we are to solving the challenges of health disparities and digital transformation. Our first interview finds a real-life, “Last Mile” solution that will bring historically under-served populations to the health care services they need and deserve. Our second interview reveals how improved efficiencies in digitalization actually make it easier to add even more data – and more data crunching – into the mix. PHIT4DC stands for the Public Health Informatics and Technology for the District of Columbia Workforce Diversification Program. PHIT4DC brings together public health programs at two HBCUs—historically Black Colleges and Universities—namely, the University of the District of Columbia and Howard University. Together, these esteemed institutions train professionals from historically under-served neighborhoods in 21st-century IT knowledge and skills so they can return to their neighborhoods and give back to their communities.PHIT4DC trains PCMH professionals in order to send them to work in and support their hometown communities and neighborhoods. It's a powerful solution for bridging the gap in health equity provision. And it's probably possible to set up this model in any U.S. city. But, as you can imagine, it's no small feat. Dr. Mary Awuonda currently serves as an Associate Professor and Director of the Center of Excellence at the Howard University College of Pharmacy. In her directorship role, she helps the College advance its health care workforce diversification mission and student academic success initiatives. She is published in the areas of minority health, health disparities, health outcomes research and workforce diversification. Hannah George is a health care consultant with years of service across the health care industry. She's been a college professor/mentor for nursing students and director of nursing for multiple home health agencies in the District of Columbia. She's worked on multiple health care research protocols and served as senior clinical lead on multiple projects and initiatives. Hannah is certified in Project Management, is a Certified Professional in Healthcare Quality (CPHQ) and a Certified Professional in Patient Safety (CPPS).Digitalization ensures the safe and efficient transfer and parsing of health care data between providers. Patients benefit, clinics benefit, clinicians can spend more time with patients. And improvements in data transfer and parsing reveal more population data than ever before, which uncovers gaps in health equity. And with that population data, researchers can start to reverse deficiencies and ensure better health care for all.Josh Hetler is Chief Operations Officer at DataLink and an expert in the potential revelations of supplemental data. Josh has over a decade of experience developing software products for advancing value-based health care. At DataLink, he's held management, director and vice president positions, successfully building strategies that impact customer adoption and engagement. Josh was interviewed live and in person at NCQA's 2nd annual Health Innovation Summit, in October 2023 in Orlando, Florida.

In this episode of Inside Health Care, we present two interviews that each ask really basic, yet complex, questions about health care.The first question: Why is it so hard to develop a health care coordinator service for patients at the local level? It's something most of us could use: a helper to walk with us through a health journey, advise us in a crisis and make sure we get all the tests and records we should have.Taylor Justice is a U.S. Army veteran and co-founder of Unite Us. Unite Us provides end-to-end solutions that establish a new standard of care that identifies and predicts social care needs in communities, helps enroll people in services and leverages meaningful outcomes data to drive community investment. With services extending to at least 44 U.S. states, Unite Us creates accountable coordinated-care networks, interconnecting providers of social services to reduce the cost of care by integrating ALL social determinants of health.The other question: Why are patient alcohol and substance use issues so often overlooked in primary care? This interview will not only answer that question: it will point patients and providers in the right direction: toward adoption of universal alcohol screening and follow-up. Three experts remind us that there is help to implement evidence-based alcohol health care—free resources from NCQA and the National Institute on Alcohol Abuse and Alcoholism [NIAAA].At NCQA's second annual Health Innovation Summit, we interviewed Dr. Thekla Brumder-Ross, Dr. Katharine Bradley and Dr. Laura Kwako.Dr. Thekla Brumder-Ross is a clinical psychologist and national leader of addiction medicine. In her 14 years at Kaiser Permanente, Thekla led and implemented large-scale practices and policies in addiction medicine, treatment protocols and primary care behavioral health integration. Notably, she led the addiction medicine leaders of operations and research across the Kaiser Permanente Enterprise, facilitated the spread of the “screening, intervention and referral to treatment” methodology known as “Alcohol as a Vital Sign” across eight Kaiser markets, and developed a national “harm reduction” strategy. Thekla currently provides strategic consultation to the NIAAA.Dr. Laura Kwako is chief of the Treatment, Health Services, & Recovery Branch in the Division of Treatment and Recovery at the NIAAA. Her office supports research in broad categories, including behavioral health treatments, translational research and innovative methods and technologies across the continuum of care.Her work also focuses on under-served populations, including NIH-designated health disparity populations, individuals with co-occurring disorders and fetal alcohol spectrum disorders. During her time at NIAAA, Laura has been involved in development of the Healthcare Professional's Core Resource on Alcohol and the Addictions Neuro-clinical Assessment. She received her PhD in Clinical Psychology from Catholic University in Washington, DC.Dr. Katharine Bradley is a primary care general internist, and her research on unhealthy alcohol use and opioid use disorder has included developing trials of implementation of alcohol screening, brief interventions and shared decision making for alcohol use disorder across primary care clinics. She recently received NIAAA funding for the SIP trial, the full title of which is Systematic Implementation of Patient-Centered Care for Alcohol Use Trial: Beyond Referral to Treatment.Drs. Brumder-Ross, Kwako and Bradley collectively strive to link substance use disorders and treatment to behavioral health, which they see as just one part of a “whole health” approach to clinical medicine. We discussed some amazing tools now available to incorporate screenings for alcohol or drug use into mainstream primary care assessments. And those tools, by the way, take advantage of NCQA HEDIS measures. But let's hear it from them.Some resources discussed in this interview:The NIAAA Alcohol Healthcare Roadmap: A simple workflow that plans and providers can adaptHealth plans can adopt the NCQA HEDIS measure on Alcohol Screening and Follow Up – now publicly reportable, bringing potential financial incentives to health plansImplementation guides available in Core Additional LinksNCQA resources for patient screeningFree training from NIH: NIAAA's Healthcare Professional's Core Resource on Alcohol

In this episode, we explore a much-discussed Inside Health Care topic: interoperability. Within the process of health care digitalization, interoperability deals with the multi-lane, multi-directional transfer of electronic health records, or EHRs. But more and more, in that transfer process, companies discover data they hadn't considered using, data needing refinement, and data that tells stories of patients being overlooked and left behind.In the first interview, my guest and I discuss the best way to smoothe the road to health equity: form a patchwork of different types of health care companies that can safely and efficiently shepherd data along the patient journey. Later, I co-interview a team that discovered a disparity gap and closed it—permanently. Their secret? Ask the community how to reach those patients.Mo Weitnauer is MRO's Chief Product Officer. She drives its product strategy and roadmap. Throughout her high-level career, Mo has helped develop tech-based strategies for managing medical costs and patient bills, trying to even things out for both sides while still striving to advance care quality.Mo graduated with a bachelor's degree in Biochemistry and Economics from Smith College, and she got her master's degree in Health Policy and Management from Harvard's T.H. Chan School of Public Health.Next, we hear a success story from a team from WellSpan Health, a health care that found a gap in health care equity and nailed down a solid and sustainable solution.Jenna Jansen is Senior Director of Quality at WellSpan Health. She earned her BS and MPH degrees from West Virginia University. She is a Fellow of the American College of Healthcare Executives and also a CPHQ.Jodi Cichetti is Vice President of Quality, Patient Safety and Infection Control and Prevention at WellSpan Health.  She's an RN with a background of working in the ICU. She holds an MS in Health Systems Management from the University of Baltimore, and her certifications include, among others, a CPHQ, a.k.a. she's a Certified Professional in Healthcare Quality.Jenna and Jodi presented a session at the Health Innovation Summit titled “STOP, Collaborate, & LISTEN! Improving Equitable Access to Care”. In the interview, they told the story of how their research revealed a gap in care delivery. Using various analytical tools including NCQA's breast cancer screening measure, part of our HEDIS set of measures, they discovered a disparity among Spanish-speaking patients.

In this episode, we hear clips from four interviews recorded live at NCQA's 2nd annual Health Innovation Summit.Parker Holcomb is Chief AI Engineer at Elevance Health. At NCQA's 2023 Health Innovation Summit, he participated in a session titled “Building Trust in Clinical Data for Value-Based Care”. Parker stands at the forefront of data quality, constantly seeking to perfect data quality standards, all towards closing gaps in health equity. So how do professionals and technologists align the movement toward digital health transformation in the direction of value-based care?Dr. Joseph Betancourt is president of the Commonwealth Fund. One of the nation's preeminent leaders in health care quality, Dr. Betancourt formerly served as senior vice president for Equity and Community Health at Massachusetts General Hospital (MGH), overseeing a number of entities including the Center for Diversity and Inclusion.A prolific author, lecturer, and board-certified internist who focuses on Spanish-speaking and minority populations, Dr. Betancourt is also an associate professor of medicine at Harvard Medical School. This is notable for this interview, as he earned his MPH from Harvard with one of the first classes in the Commonwealth Fund–Harvard University Fellowship in Minority Health Policy.At the 2023 NCQA Health Innovation Summit, he led a session titled “Pursuing the North Star: A high performing, equitable health care system”. And as you'll hear, increasing diversity among health care professionals and rebuilding the trust of historically under-served patients are just two of a myriad of ingredients necessary to right the ship on the journey to Health Equity.Next, we hear a success story from a team from WellSpan Health, a health care that found a gap in health care equity and nailed down a solid and sustainable solution.Jenna Jansen is the Senior Director of Quality at WellSpan Health.Jodi Cichetti is Vice President, Quality and Patient Safety, at Wellspan Health.Jenna and Jodi presented a session at the Health Innovation Summit titled “STOP, Collaborate, & LISTEN! Improving equitable access to care”. In the interview, they told the story of how their research revealed a gap in care delivery. Using various analytical tools including NCQA's breast cancer screening measure, part of our HEDIS set of measures, they discovered a disparity among Spanish-speaking patients.Christopher J. King is the inaugural Dean of the School of Health and former Chair of the Department of Health Systems Administration at Georgetown University in Washington, DC. An academic administrator, associate professor, and strategist, who is board certified in healthcare, Dr. King's writing and teaching focus on the intersection of institutional racism, social determinants of health, and healthcare administration. And he envisions a world in which health status cannot be predicted by race, social class or place of residence.At this year's NCQA Health Innovation Summit, Dr. King joined the dais in a session titled “No Quality without Equity”. In this clip from our interview, Dr. King talks about race-based clinical data in health care. And in his view, the use of this data is doing more harm than good.Stay tuned for more information about NCQA's next Health Innovation Summit, set for Nashville, October 31-November 2, 2024. For more, go to https://www.ncqasummit.com.

In this episode of “Inside Health Care,” we meet two guests, in two interviews. Our first guest advocates for birth, racial and gender equity, driven by her own distressing experiences as a patient. Our second guest developed effective ways to implement virtual care on a large scale to improve equity and representation for rural communities.Sinsi Hernández-Cancio, JD, is a vice president at the National Partnership for Women & Families, where she leads the Health Justice team. Born in Puerto Rico, Sinsi is a national health and health care equity policy and advocacy thought leader dedicated to advancing equal opportunities for women and families of color. The Partnership worked with health care experts and partner organizations to develop a report that includes recommendations for improvement in resolving gaps in health equity that executive leaders can tailor to their organizations.Debbie Welle-Powell, MPA, is CEO of DWP Advisors and an Adjunct Professor at the University of Colorado Executive MBA. But Debbie is best and widely known in the health care world as the former Chief Population Health Officer at Essentia Health. Headquartered in Duluth, Essentia is an integrated delivery system of 14 hospitals and 1,500 providers spanning the states of Minnesota, North Dakota and Wisconsin. Debbie designed, built and operationalized Essentia's $2.5 billion transition from a primarily fee-for-service model of care to one that focuses on value.Later in our “Fast Facts” segment, we observe Breast Cancer Awareness month for October 2023. We discuss the CDC's guidance on how to help people with cancer "Stay Mentally and Emotionally Healthy.” We also discuss NCQA's Breast Cancer Screening HEDIS measure, which assesses women 50–74 years of age who had at least one mammogram to screen for breast cancer in the past 2 years.

In this episode of “Inside Health Care,” we take a look back at what we've learned since the pandemic hit over two years ago. We first chat with an upcoming star speaker at NCQA's 2023 Health Innovation Summit on what we've garnered from the growth of telehealth in remote medicine. Then in our second interview in this episode, we discuss the public's conflict with immunization and new strategies on encouraging vaccination.Dr. Leslie Eiland is an Associate Professor of Medicine in the Department of Internal Medicine, Division of Diabetes, Endocrinology & Metabolism at the University of Nebraska Medical Center. She is Medical Director of Patient Experience and Digital Health at Nebraska Medicine, and has been Medical Director of the endocrine telehealth program there since 2014. The program provides care via telehealth to eight rural community hospitals in Nebraska and Iowa. Dr. Eiland's clinical areas of interest and expertise are remote delivery of endocrine care and providing endocrine support for primary care providers in rural communities.For our second interview, we wonder: what have we learned from the pandemic? With backs up against the wall and clinical care pushed to capacity, 2023 was a time of reflection...and re-invigoration. In this interview, hosted by Dr. Sepheen Byron, Assistant Vice President, Performance Measurement at NCQA, you'll hear about one such effort to see what we've learned about, and gain new insights into approaches to care, from review of pandemic care. In this case, we focus on Adult Immunization and improving adult immunization rates.A panel of experts, including partners from NCQA, convened in June of 2023 for a roundtable discussion on adult immunization. They not only discussed clinical guidelines and approaches to better health. They considered simple human behavior: how to rebuild trust with patients and ultimately find new ways to encourage them to vaccinate. In September 2023, NCQA released a white paper summarizing the roundtable's discussions and their conclusions.Megan Lindley, MPH, is the adult vaccination Team Lead of the Applied Research, Implementation Science, and Evaluation Branch in the Immunization Services Division of the CDC. Her areas of research interest include immunization law and policy, adult immunization quality measurement, vaccination in pregnancy and healthcare personnel vaccination. She was an active member from 2012-2019 and a co-chair from 2018-2019 of the National Adult and Influenza Immunization Summit's Quality Measures Workgroup, which developed two immunization quality measures that were added to HEDIS in 2019: a measure of routine adult vaccination and a composite measure of vaccination of pregnant women. Ms. Lindley has authored or co-authored over 100 peer-reviewed publications.In our Fast Facts segment, we observe September's Prostate Cancer Awareness Month with important information from the CDC on symptoms and screening. We also discuss one of a number of NCQA's cancer-related HEDIS screening measures. Colorectal Cancer Screening, which we call C-O-L or C-O-L-E, assesses adults 50–75 who had appropriate screening for colorectal cancer with any of a number of tests, including a colonoscopy every 10 years, computed tomography colonography every 5 years and a stool DNA test every 3 years.

In this episode of “Inside Health Care,” we talk interoperability with a cardiologist who helped develop a new standard for data records exchange. Fast Healthcare Interoperability Resources, a.k.a. FHIR, can improve efficiencies in use and transfer of electronic health records. It can ease pressure on medical staff while also improving health equity measurement.In our discussion with Dr. James Tcheng, we focus on the CardX Hypertension Project. CardX, or cardiovascular data exchange, was launched in 2022 by the University of Nebraska Medical Center's Center for Intelligent Heath Care. The project stems from the greater CodeX FHIR Accelerator project. The project seeks to use FHIR as a standard for data transfer and parsing. The project's stated objective is to “facilitate the communication of hypertension management data between clinicians and patients to increase the proportion of individuals with hypertension who are treated to goal.”Our guest is Dr. James Tcheng, cardiologist and professor of Family Medicine and Community Health at Duke University's School of Medicine. In addition to his work with patients, his research ranges from developing therapies for cardiovascular disease to use of A.I., I.T., and clinical informatics to improve efficiencies in the delivery of care. I'm pleased to say that Dr. Tcheng will be presenting a session on the CardX FHIR Accelerator at NCQA's annual Health Innovation Summit, coming October 2023.Later on in our “Fast Facts” segment, we observe September's Healthy Aging Month in the U.S. with information about osteoarthritis. We also give a rundown of NCQA's HEDIS OMW measure, namely Osteoporosis Management in Women Who Had a Fracture. This measure assesses women 67–85 years of age who suffered a fracture and who had either a bone mineral density test or a prescription for a drug to treat osteoporosis in the 6 months after the fracture.

In this episode of “Inside Health Care,” we chat with a prominent NCQA board member about flipping fee-for-service models to value-based models, all in order to ease digital transformation. Then, we talk about the challenges and true rewards of pursuing Credentialing Accreditation. Dr. Craig Samitt is the CEO and Founder of ITO Advisors, an advisory and investment firm committed to value transformation of the health care industry. Dr. Samitt sits on many boards in addition to NCQA's Board of Directors. He also serves as a strategic advisor to federal agencies, public and non-profit health plans and numerous digital health and care delivery organizations.At the Health Innovation Summit, Dr. Samitt will panel alongside NCQA President Peggy O'Kane and other experts. In a session called “Payment Models and Digital Transformation,” they'll discuss the opportunities and challenges associated with digital transformation in a fee-for-service landscape. Bill Vargo is Program Manager in the Northwestern Medicine Physician Network of Northwestern Medicine. He helped lead Northwestern Medicine through NCQA's Credentialing Accreditation process, and he wanted to share with us the need for this program, the rewards of simply going through the evaluation and how Northwestern did it. NCQA Credentialing Accreditation helps improve credentialing and protects consumers by ensuring a consistent, effective and diligent credentialing process. It provides a framework for organizations to implement industry best practices that help them efficiently credential and re-credential health care professionals.Later in our Fast Facts segment, we observe August as National Breastfeeding Month with some data on federal legislation regarding breastfeeding in the workplace. This information is provided by an independent nonprofit organization, the United States Breastfeeding Committee. We then describe NCQA's Prenatal and Postpartum Care HEDIS quality measure, also known as PPC.

In this episode of “Inside Health Care,” we talk digital transformation with a prominent medical informaticist. Then, we hear a conversation on NCQA's long-term services and supports programs, a.k.a. LTSS, from a long-time accredited managed care supporter.Dr. John Glaser is Executive in Residence at Harvard Medical School Executive Education. Previously he was Chief Executive Officer of Siemens Health Services. He is former Chair of the Global Agenda Council on Digital Health in the World Economic Forum, and former Senior Advisor to the Office of the National Coordinator for Health Information Technology. He's also a member of NCQA's Board of Directors.Dr. Glaser will also be at NCQA's second annual Health Innovation Summit in October 2023. In addition to helping open the Summit, he'll sit on a C-suite panel alongside NCQA President Peggy O'Kane and other industry leaders, discussing, among other things, the transition to a digital health ecosystem.Centene is the largest Medicaid Managed Care Organization in the U.S., as well as the largest carrier on the Health Insurance Marketplace.Nicole McLean is an accreditation manager for Centene, and she spends much of her time working with NCQA on our LTSS programs. But which services are included in LTSS? What could they be? Well, as Nicole will tell you, in order to evaluate which services and supports people need, you first have to learn about...the patient.Later in our Fast Facts segment, we observe August as National Immunization Awareness Month. First, we present some tips from the CDC for providers' offices on how to talk about vaccinations to young patients and their families. We also mention NCQA's HEDIS "Childhood Immunization Status" measure.

In this episode, we talk with two leaders of an amazing NCQA partner company, Cozeva, while revisiting one of NCQA's cutting edge digital products, our Data Aggregator Validation program [DAV]. Cozeva, a member of the original program cohort, is an integrated, comprehensive population health platform.Our Data Aggregator Validation program now forms the backbone of Cozeva's services. Cozeva currently provides health care data solutions to nearly 37,000 providers across 16 states. For more details on NCQA's data analysis work, check out our Data Measures Roadmap.Dr. Khanh Nguyen is Chief Executive Officer of Cozeva. Khanh has a doctorate from the University of California San Francisco School of Pharmacy, focusing on health policy and management. She has over 15 years of experience in creative payer-provider collaborations. Khanh is an expert in data crunching, discussing how improving and easing the flow of health care data will then improve efficiency for both payers and providers.Dr. Rosh Singh is Cozeva's Chief Technology Officer. In his over eight years with Cozeva, Rosh was previously VP of Product Management, and before that, Director of Analytics. He has a PhD in Biomedical Engineering from Cornell and over 15 years experience combining product management with A.I. and machine learning. He creates what he calls “decision science,” finding hard- and soft-tech solutions that support multi-billion-dollar transactions.Later on in our Fast Facts segment, we observe Gastroparesis Awareness Month with important information that could save a life. The episode also discusses NCQA's Colorectal Cancer Screening measure [COL], featured as part of our HEDIS package of quality health care measures.

In this episode, we're focusing on NCQA's PCSP—Patient-Centered Specialty Practice Recognition program. As noted on our website, the PCSP Recognition program focuses on coordinating and sharing information among primary care clinicians and specialists. It requires clinicians to organize care around patients—across all clinicians seen by a patient. Patients and their families or other caregivers are included in planning care and considered partners in managing conditions.Specialty practices that earn NCQA's PCSP Recognition communicate more effectively with primary care, integrate services better with primary care and improve the quality of their care. Patients see the difference through reduced costs, better data and records management, improved identification and oversight of chronic conditions, and more face time with a more satisfied medical staff.For this interview, we found one of our greatest advocates of the PCSP Recognition program, an extremely busy and dedicated medical team from Providence Heart Institute in Portland, Oregon. A number of years ago, they saw the need for PCSP, found solutions that worked conclusively and spread the word throughout their company about the effectiveness of the patient-centered specialty practice model of care. Xiaoyan Huang, MD, Chief of Clinical Cardiology, leads clinical operations and care transformation for advanced heart failure, electrophysiology, general cardiology and interventional cardiology subspecialties. Danielle Christensen is Clinical Program Manager at the Providence Heart Institute in Oregon. With experience in both ambulatory and acute care settings, Danielle's expertise spans business development and strategy, change management and development, and the optimized exchange of electronic health records. Dr. Huang and Danielle led a session at NCQA's first Health Innovation Summit in the fall of 2022. And they ran a fascinating and informative training webinar which is still available for download on our education website. The title of their course: “CCE Quarterly: Building with a Blueprint: Taking a Patient-Centered Specialty Practice from Medical Neighborhood to High Performing Network.” The interview is hosted by NCQA's Senior Vice President for Product and Customer Operations, Lori Ferguson. Later on, in our Fast Facts segment, we observe National Minority Mental Health Awareness Month with important stats to share with colleagues and community. Among many of our products and measures addressing behavioral health needs, we mention is NCQA's “Managed Behavioral Health Organization Accreditation” or MBHO, an important accreditation for employers.

On this episode of Inside Health Care, we talk Medicaid with a large, equity-focused provider about the end of the Fed's pandemic-related emergency Medicaid provisions. Following that, a chat with one of our 2022-2023 PCMH Certified Content Expert Quality Award winners. Later on, some fast facts for you in observance of World Hepatitis Day.Elevance Health, a large multi-state health insurance provider, is the largest managed care company in the Blue Cross Blue Shield Association. In September of 2022, an Elevance Health subsidiary, Simply Healthcare Plans of Florida, became one of the first health care organizations in the U.S. to earn accreditation in NCQA's Health Equity Accreditation Plus program.We interview Elevance Health Medicaid President Aimée Dailey alongside Staff Vice President for Medicaid Whole Health Kalunde Wambua to find out more about the company's continued commitment to Equity improvement.We also talk with one of NCQA's 2022-2023 PCMH Certified Content Expert Quality Award winner, Susanne Campbell, Senior Program Administrator for the Care Transformation Collaborative of Rhode Island. We talked about the challenges of getting people on board with quality measurement. And we learned that, as measurement improves, customer focus improves, and health delivery becomes more efficient, all leading to solutions for resolving historic gaps in health equity.Finally, in our Fast Facts segment, we observe the World Health Organization's World Hepatitis Day, scheduled annually every July 28th. We include resources from the U.S. Department of Health and Human Services alongside an article from the NIH. Hepatitis awareness includes further reminders for childhood immunization, something NCQA measures in our HEDIS Measures package called Childhood Immunization Status, or C-I-S. The measure calculates the rates for a number of childhood vaccines and vaccine combinations. Among the vaccines in the list, alongside DTaP, MMR, and the flu, are vaccines for both Hep A and Hep B.We're also proud to announce that Inside Health Care won two media industry awards, both announced in June 2023. We won a Merit award from the Digital Health Awards. We've also been named a Gold Winner 2023 by the Hermes Awards. Thanks to all our interviewees and leadership staff at NCQA for their support along the way.

On this episode of Inside Health Care, we celebrate Pride Month with discussions on gender health equity, sexual orientation and gender identity health care quality issues, and health care access and representation for the LGBTQIA+ community. Later, some tips on improving the provider experience for transgender patients.Dr. Alex Keuroghlian is an expert in Sex- and Gender-Informed Medicine and Sexual and Gender Minority Health Care. As a psychiatrist, Dr. Keuroghlian's work often centers on patients suffering from post-traumatic stress disorder, or PTSD, especially within the LGBTQIA+ community. They hold numerous leadership and teaching positions at Massachusetts General Hospital and Harvard Medical School. They also support and educate health care centers and clinicians in gender equity with their leadership as Director of the Division of Education and Training at The Fenway Institute, and Principal Investigator of the National LGBTQIA+ Health Education Center, a HRSA-funded cooperative agreement to improve health care for LGBTQIA+ people at health centers around the country.NCQA Senior Research Scientist for Health Equity Dr. Rachel Harrington discusses gender-equity needs and perspectives in health care. Her team develops improvements to NCQA's HEDIS measures updates. We discuss why it's been so difficult to gather health data on LGBTQIA+ populations.Later in our Fast Facts segment, we include tips via the CDC from the GLMA on improving the provider experience for transgender patients.

On this episode of Inside Health Care, we feature two interviews celebrating winners of two different NCQA awards: a NCQA 2022 Health Innovation Award and a 2022-2023 PCMH CCE Quality Award Winner. Later in the show in our Fast Facts segment, we discuss gender equity-related health care terminology.In our first interview, we talk with Dr. Ava Jones, PhD and RN, the Director for Health Equity and Accreditation at United Health Care Community and State's Florida Plan. Dr. Jones workplace won an NCQA 2022 Health Innovation Award, for the “UnitedHealthcare Community Plan of Florida Housing Navigation Program.” A healthcare navigator assists plan members with advice or suggestions on how to pursue a medical issue affecting them or their family. Dr. Jones explains the nature and importance of a housing navigator.NCQA PCMH Recognition is like a seal of approval for quality assurance. A health care practice that earns that seal can be trusted for their dedication to delivering quality care—which means they're dedicated to their patients. And having a Certified Content Expert, or CCE, almost guarantees a practice will continue its dedication to excellence for years to come.NCQA's 2022–2023 PCMH Certified Content Expert Quality Award Winner Deneane Anderson works for the Capital Area Health Network, also known as CAHN, in Richmond, VA. She's been in the medical field for the past 15 years and has been a patient advocate for the past 14 years at CAHN and operates as the Transformation Manager of the PCMH Team at CAHN. Click the link for more information about becoming a PCMH CCE.Our Fast Facts segment in this episode celebrates Pride month with background on federal protections for those people identifying as LGBTQ+, info on gender-affirming care and gaining health insurance. We then focus on NCQA's efforts to update HEDIS measures to include language for Sexual Orientation and Gender Identity.

On this episode of Inside Health Care, we talk about acupuncture, yoga and a host of other “alternative” therapies with a health leader in the U.S. government. After that, we explore a newly announced breakthrough in digitalization exploration with NCQA's Chief Technology Officer.Our first guest is one the foremost experts in the U.S. on integrative medicine. He answers some difficult questions. How have some alternative therapies become legitimized? And what are the risks of unregulated therapies?Benjamin Kligler, MD, MPH, is Executive Director of the Office of Patient Centered Care and Cultural Transformation (OPCC&CT) at the Veterans Health Administration. He is a board-certified family physician, working as a clinician, educator, researcher and administrative leader in the field of complementary and integrative medicine.At NCQA's 2023 Quality Talks, Dr. Kligler talked about “whole health” and how it relates to his work.In our next interview, NCQA Chief Technology Officer Ed Yurcisin breaks down our newest development in digital health, our newly-announced requirements and open source software for interpreting and executing clinical quality language (CQL) so any organization or software developer can use HEDIS Digital Content Services.Later in Fast Facts, we observe Osteoporosis Awareness and Prevention Month. We also discuss the NCQA has HEDIS measure, Osteoporosis Screening in Older Women, that assesses the percentage of women 65–75 years of age who receive osteoporosis screening.

On this episode of Inside Health Care, we interview a pioneering speaker and a featured presenter at NCQA's 2023 Quality Talks event.We first interviewed Dr. Pippa Shulman back in episode 76, which dropped in April 2022. Since then, Dr. Shulman's seen the growth and expansion of her business, Medically Home, the world's first virtual hospital. Medically Home is a tech-enabled services company, providing all the necessary capabilities to safely shift medical care from hospitals to patients' homes. Dr. Shulman is board certified in family medicine, preventive medicine, and hospice and palliative medicine. Dr. Shulman and her company were described in a January 2023 New York Times article titled “Your Next Hospital Bed Might Be at Home.”Later in the show, we'll hear some fast facts regarding Stroke Awareness Month, including warning signs from the CDC and info about NCQA's Heart/Stroke Recognition Program (HSRP).