Podcasts about hedis

Traditional approaches to closing care gaps in Medicare Advantage often fail to reach the members who need it most. This episode goes beyond conventional strategies to explore how innovative, remote, and community-driven solutions are transforming chronic care management—particularly for cardiometabolic conditions like diabetes, hypertension, and heart disease. Learn how health plans are leveraging proactive outreach, virtual engagement, and data-driven interventions to improve HEDIS scores, boost Star Ratings, and drive better long-term outcomes. Through real-world case studies and expert insights, we'll uncover scalable, cost-effective approaches that enhance care access, reduce avoidable hospitalizations, and deliver measurable impact for both members and plans.   Panelists:  Michael Harris, CEO, HealPros Tejaswita Karve, Ph.D. - Healthcare Quality and Innovation Leader, Stars Leader, Mass General Brigham Health Plan Mike Rapach, SVP Government Programs, President & CEO, CareFirst Community Health Plan Maryland Daniel Weaver, SVP Stars and Quality, Zing Health Bios: https://www.brightspotsinhealthcare.com/podcast-episodes/   This episode is sponsored by HealPros: HealPros helps health plans find and address missed care opportunities in member's homes, at events in their communities, and remotely. Our team specializes in helping polychronic members access the care they need, from anywhere. HealPros' Care Access Pros completed over 70,000 in-home visits in 2024 and is committed to engaging even more members in 2025 - including those that are hard-to-reach – as we work towards our vision of transforming millions of live each year. Our Care Connection Specialists make over 4,000,000 calls to members each year. With a sophisticated logistics operation, national footprint, and national network of providers, HealPros is available to work in all 50 states and the US Virgin Islands. For more information, visit www.healpros.com. Bright Spots in Healthcare is produced by Bright Spots Ventures   Bright Spots Ventures brings healthcare leaders together to share working solutions or "bright spots" to common challenges. We build valuable and meaningful relationships through our Bright Spots in Healthcare podcast, webinar series, leadership councils, customized peer events, and sales and go-to-market consulting. We believe that finding a bright spot and cloning it is the most effective strategy to improve healthcare in our lifetime.   Visit our website at www.brightspotsinhealthcare.com  

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 

  AmeriHealth Caritas, Health Alliance Plan, Highmark Health and Icario discuss how AI transforms healthcare by creating personalized experiences that drive performance improvements and enhance member engagement. Learn how high-ranking health plans reinvent their approach to member experience to elevate your HEDIS scores, improve health outcomes and streamline data processes.   Guests: Vandna Bhrany, MPH, Vice President, HEDIS Strategy and Analytics, AmeriHealth Caritas  Tracy Saula. Senior Vice President, Chief Product and Experience Officer, Highmark Health  Cory Busse, VP, Strategy, Icario Mike Treash, Senior Vice President and Chief Operating Officer, Health Alliance Plan   Bios: https://www.brightspotsinhealthcare.com/events/a-new-era-for-consumer-engagement-and-hedis-combining-the-human-touch-with-ai/   This episode is sponsored by Icario Icario serves health plans by using powerful whole-person data, predictive behavioral science, and a proprietary engagement platform to offer personalized experiences that meet members where they are in their health journey. Icario combines the industry's largest member data repository with unparalleled industry expertise to implement health action programs that deliver personalized member engagement, reduce abrasion and encourage positive health behaviors.

This episode explores the challenges and opportunities plans face during the digital transition. The most common challenges are outdated systems, fragmented data sources, and managing data integration effectively. We discuss innovative strategies to reshape HEDIS reporting and analytics—from integrating diverse digital data into a unified platform to accelerating processing speeds for real-time insights. Plans can leverage these powerful analytical tools, flexible reporting, and actionable data to proactively identify care gaps, deploy intervention campaigns, streamline workflows, and ensure regulatory compliance. This episode equips health plan leaders with the strategies they need to stay competitive and fully embrace the latest industry strategies for HEDIS success. About Our GuestSharon Kurht is the Director of Quality. She has 14 years of experience in HEDIS, Medicare Stars, and Medicaid. Sharon is an RN who holds a doctorate in nursing from Northeastern University, where she is also a health informatics professor at the graduate level. Tune in monthly for exclusive insider insights and be the first to know when new episodes drop by subscribing to Apple, Spotify, and all major podcast apps.Thank you to our sponsor @ usthealthproof.com. Follow on LinkedIn.

Send us a textWere you a great resident?Me tooWere you the one that was kind, flexible, accommodating, hardworking?Me tooWere you the one who left residency and worked and worked and worked, looking for validation, wanting to hear that you could take a break, that you could get the help and support you needed to take care of patients exactly the way that you wanted too, and not the way that your system expected you too (rapidly, with empathy, thoroughness, but RAPIDLY and meeting all your HEDIS and Press-Ganey metrics. Did I say rapidly?)???Me tooToday I'm sharing 5 things that I wish I could have understood leaving residency. 14+ years later, I'm still learning these lessons, but so much more clear on why this is needed, and what I want for MYSELF as a human, let alone as a working physician mom. Support the showTo learn more about my coaching practice and group offerings, head over to www.healthierforgood.com. I help Physicians and Allied Health Professional women to let go of toxic perfectionist and people-pleasing habits that leave them frustrated and exhausted. If you are ready to learn skills that help you set boundaries and prioritize yourself, without becoming a cynical a-hole, come work with me.

In this episode we hear the second half of the conversation with Franklin County Public Health Director, Scott LaVigne, in which he shares his views on the role of properly addressing behavioral health, providing a positive patient experience, and the importance of partnerships, and how these elements, and others, work together in order for his team to provide holistic care for patients.I want to go back a little bit to something you mentioned earlier. So we talked, you talked about the needs-based care, what I call the contextualized care and Medicaid is very focused on serving the whole patient, right, which includes some of those social determinants of health. And, and we've talked about access and access to behavioral health is really important. How's Franklin County Health Partner Department partnering or attempting to partner with other agencies to address these needs?Well, one of the things that when I first came down here that that I just said we really needed to do was get our medical staff. And by that I mean everyone from the person that greets somebody when they walk in the door and checks them in to the person that works through everything with their, their claims and submitting and all the financial pieces of all that interaction from start to finish and everything in between that we had a trauma informed and, and with a focus on integrating behavioral health and, and behavioral health is a broad term. I should probably break that down because it's used a lot in different contexts. I don't look at it as a way of, of sanitizing mental health. So I look at it as a collection of mental health and substance use disorder and, and really what we wanted to focus on here and it and it goes to the social or social determinants of health. We wanted to focus on the whole patient, not just one aspect of that patient. I know I don't think I've ever heard of patients say that they felt their life was better because they met all their HEDIS metrics.Me either, by the way.But what, what we did and what I, I did do almost immediately was we purchased an outcome measurement tool because I knew that one of the things that we want to do is we didn't want somebody to have all their screenings done, you know, meet all those metrics like that on the healthcare side, but have housing insecurity and be living in domestic violence and to have substance abuse and mental health problems. Because I know as a mental health provider and a substance abuse provider in my background history that most of the people that show up in emergency rooms with preventable emergency room presentations are people that have mental health and substance use disorders and other things on board or have experience childhood trauma. So we knew that if we didn't look at that whole picture and integrate that in, we were going to have a hard time doing that. So we pulled an outcome measurement tool from behavioral health. It's called the DLA 20 and it, it focuses on 20 areas of a human's existence. And we wanted to make sure that if somebody experienced a good positive health outcomes, that translated into all these other areas as well. And that became our outcome measurement tool. So that was a big piece of what we focused on. Let's see. The other thing I mentioned already was we wanted to do more screening. We, you know, we do screenings routinely as a health department. We have to spend more time with patients because of our funding than providers in the community do. That is a blessing because we have budgeted time to take into account all of what we need to do, and that fits very nicely with a more holistic approach. So it really wasn't causing us to suffer a lot in the volume department. And we focused all our efforts. And I told everybody here, you know, one of the things we want to focus on is the equation of value. And yeah, you got to have a certain amount of volume to make that equation...

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

Repris från 2023. Utredningen om Urbans och Hedis försvinnande fortsätter. Efter att ha hittat en lapp signerad “Pat Kelly” i ett övergivet tält får polisen en huvudmisstänkt. Vill du att Olösta mord ska fortsätta att komma ut varje vecka? Du kan påverka genom att dela podden med alla du känner som kan tänkas vara intresserade och/eller sponsra via Patreon; https://www.patreon.com/olostamord Har du teorier om vad som hänt i fallen som vi tagit upp i podden? Skicka dem till: zimwaypodcast@gmail.com så kommer vi ta upp dem i kommande avsnitt. Vill du höra ett specifikt fall i podden? Önska dina fall i det här formuläret: https://docs.google.com/forms/d/e/1FAIpQLSfDlQxf9SgZyeGS-qFPaB4BP-L59lQhs7BbZACfwk7xSs-AFw/viewform?fbclid=IwAR0astYAY_SJLcst89FwKaPIeHHV9zlfAxEz6Cmrh37bbMwvMHGc8z5cwg4Mail: zimwaypodcast@gmail.comFacebook: https://www.facebook.com/Olostamord/Det här är en podd av Dan Hörning och David Oscarsson.Följ Dan Hörning här:X: @danhorningInstagram: https://www.instagram.com/dan_horning/?hl=enYoutube: https://www.youtube.com/channel/UCV2Qb7SmL9mejE5RCv1chwg Stöd oss med 20 kronor + moms i månaden och i gengäld slipper du all reklam i podden. Lyssna helt reklamfritt direkt! https://plus.acast.com/s/olostamord. Hosted on Acast. See acast.com/privacy for more information.

“Welcome to Hally® Healthcast, the wellness podcast from Hally health – your partner in helping you live your healthiest life.Every episode on our podcast addresses a new topic important to your health and well-being, bringing in doctors, specialists and other health experts who offer advice and answer your most pressing questions.Today's episode is all about juvenile arthritis. July is Juvenile Arthritis Awareness Month, so it's the perfect time to learn more about this major health concern.Here with us is Beth Jurkowski. She is a registered nurse and the HEDIS medical records review manager at Health Alliance in Champaign. Welcome, Ms. Jurkowski, and thank you so much for being with us today and sharing your knowledge and experience.

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

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In this episode, Robert Garber, Partner at 7wireVentures, sits down with Irina Ahmad and Joy Basinger to discuss his healthcare predictions for 2024, specifically around topics relating to AI, Health Equity, and GLP-1 therapies. Robert's top three predictions:  AI: The majority of health systems will leverage generative AI in clinical documentation and conversational tools.  Health equity: Payers and MCOs will drive more integrated SDoH-focused initiatives tied to the CMS Framework for Health Equity and improvement of HEDIS measures.  GLP-1 Therapies: As payers face increasing demand to ease GLP-1 restrictions, successful weight loss startups will incorporate these therapies as a part of a broader, thoughtful weight-loss solution. 

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.

Hosts Fred Goldstein and Gregg Masters MPH welcome Lauren Barca, MHA, RN, BSN, VP of Quality and Stars at 86Borders, a technology platform and care coordination company that connects health plans with their inactive, unable to reach, and underserved members. With over a decade of experience at United Healthcare, Lauren boasts a proven track record in driving success across Stars, HEDIS, CAHPS, and HOS initiatives. Recognized for her versatility and innovation in healthcare and clinical operations, she is an expert in navigating and fulfilling regulatory requirements. Lauren is deeply passionate about public health and is committed to enhancing the quality of care for economically disadvantaged and medically underserved populations. We discuss the challenges of member engagement and the need to focus on problems in living in order to optimize health care outcomes for plan members. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

This episode of PopHealth Week features Lauren Barca, MHA, RN, BSN, VP of Quality and Stars at 86Borders, a technology platform and care coordination company that connects health plans with their inactive, unable to reach, and underserved members. With over a decade of experience at United Healthcare, Lauren boasts a proven track record in driving success across Stars, HEDIS, CAHPS, and HOS initiatives. Recognized for her versatility and innovation in healthcare and clinical operations, she is an expert in navigating and fulfilling regulatory requirements. Lauren is deeply passionate about public health and is committed to enhancing the quality of care for economically disadvantaged and medically underserved populations. We discuss the challenges of member engagement and the need to focus on problems in living in order to optimize health care outcomes for plan members

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.

Kim Barrus, MSN, RN, PMP, Director, Clinical Outcomes Management, Select Health, joins Eric to discuss how her plan reinvented the consumer experience for ACA Marketplace health plans.    With almost half of ACA Marketplace customers complaining about making appointments with providers and other process challenges, SelectHealth committed to reversing the trend and implementing a complete, end-to-end consumer experience.    Kim shares the results of SelectHealth's efforts and outlines the plan's strategy giving members the seamless experience they want. Listen and get the roadmap for remaking your plan's ACA consumer experience!   About Kim  Kim Barrus began her career with SelectHealth 26 years ago and has worked in various capacities. She developed the SelectHealth Advanced Primary Care (a.k.a. patient-centered medical home) program. She facilitated the initial pilots of the program in 2010. Today, the program has 1,240 participating providers at 222 participating clinics. In her current role, Kim oversees quality, medical home, NCQA accreditation, HEDIS and CMS Stars.   Kim is a registered nurse who received her Bachelor of Science in Computer Information Systems and maintains a Project Management Professional (PMP) certification from the Project Management Institute (PMI).   This episode is sponsored by ReferWell Health plans must be acutely aware of their progress towards achieving their Care Gap Closure targets. Their most significant obstacle is to directly impact those specific areas, even though they have limited capabilities to do so. ReferWell helps health plans improve access to care by efficiently scheduling members for the care they need. ReferWell care navigators find the "Perfect Match" provider right at the referable moment when the member is saying yes to their care). They then seamlessly schedule the member's appointment while still on the call.  It's a proven process that provides better access, experience and outcomes for members and better quality performance, which affects the health plan's bottom line.

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 bonus episode, we welcome Stars expert, Megan Piotrowski, for an in-depth review of the recent Star Ratings release. On October 13, 2023, the 2024 Medicare Advantage and Part D Star Ratings were published on Medicare Plan Finder, largely representing Measurement Year 2022 data submitted to CMS. We discuss the variables that influenced performance and why it's the second year in a row, the average Star Ratings have declined and some plans might be seeing less than ideal performance. More than a third of plans saw a Star Ratings decline this cycle. Tune in to learn about the changes that will impact 2024 performance including the Tukey Outlier Deletion Method, the transition of several HEDIS measures to Electronic Clinical Data Systems (ECDS),  measure weight changes, and more.About The ExpertMegan Piotrowski is a Star Ratings and quality strategy manager evaluating market trends and competitive landscape to develop initiative offerings and long-term strategies for the continued maintenance of 4-Star Ratings. Megan has held a variety of regulatory, quality leadership and consultant roles across the continuum of healthcare. She's led the quality improvement initiatives on behalf of health plans across all lines of business, as well as for health systems, providers, and community and government-based organizations. She holds a Master of Science in Health Informatics from Northwestern University. 

Judgment of ourselves and others causes a lot of unnecessary pain, shame, blame and guilt. Judgment gets in the way of learning, growth, performance, productivity, connection, and peace. Most of us, especially physicians, move through the world judging. Once you notice and acknowledge your "judgment habit" you can make a choice. The liberation begins with noticing.   Notice where you judge yourself and others and try "opting out."   What is Needed to Move Beyond Judgment Noticing  Kindness Self compassion and compassion  Acceptance  Curiosity Love A Commitment to: change  a better way energy conservation  trust    How many times a day do you judge yourself ?  Do you think you are a problem or to blame? Do you think you don't measure up? Do you use criticism and judgment to push yourself to do more? Do you judge others?  What would it be like if you opted out of judgment? What would it be like if you showed up with hands wide open? Curious? Asking I wonder why? How Interesting or I don't know why.   Maitri is benevolent kindness and unconditional friendliness.  What if you dropped your hypervigilance and showed up in the world with maitri instead.   Judgment is rampant in medicine Medical culture (and society) teaches us constant hypervigilance and judgment about our performance is necessary to make sure we are measuring up. Patient satisfaction scores, HEDIS measures, chart completion and peer review are all also used as a way to judge us as good doctors. We judge patient complaints, diagnosis, compliance, post-op recovery time and many other things. Our feedback and evaluation sessions, peer review, and M&M are full of judgment and blame.    What if we brought caring, Maitri, love of each other, our patients and the practice of medicine to the conversation. What if we honored growth and learning? What if we gave strength-based feedback in medicine? What if we set an intention for our evaluations -specifically how we hope learners and colleagues would feel after? What if our intentions were that they felt believed in, inspired, and hopeful? What would happen if we stopped judging our colleagues and med students and instead partnered with them as teammates? What if the focus in medicine was on “caring” well- for ourselves and others? What if peer review were about learning, growing and evolving rather than blaming- finding the systemic or human fault and issuing scores= form of judgment Are you willing to stop judging your colleagues and learners? What would it be like if you opted out of judgment in patient care? What would it be like if you showed up with hands wide open?    Coach with Jessie to learn how to opt out of judgment yourself and/or arrange a retreat or coaching for your team to change the culture at your work into a truly caring culture. https://www.jessiemahoneymd.com/team-coaching-retreats Join one of Jessie's retreats as an individual to do this work in nature while caring for yourself and nourishing yourself. www.jessiemahoneymd.com/retreats Hire Jessie to speak to share some of these messages in an effective way with your leadership and teams.  www.jessiemahoneymd.com/speaking If you want to develop a mindfulness practice or a speaker for your group, reach out to Dr. Liang www.awakenbreath.org *Nothing in this episode should be considered medical advice.  

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.

Senior healthcare leaders from AmeriHealth Caritas, AvMed, HealthTeam Advantage, and ReferWell share strategies health plans can use to understand gaps in care throughout the member journey.    For health plans participating in risk-based agreements, gaps in care have severe implications for members' health outcomes and their ability to attain higher quality scores necessary to receive financial bonuses and drive member enrollment.    Hear how plans leverage data and real-time analytics to effectively and efficiently close time-sensitive care gaps to improve HEDIS, Stars and other quality scores.   Topics covered include: Provider Plan Partnerships Building a Relationship with Members Identification & Targeting Systems & Incentives   Confirmed Panelists Marsha Barlocker, RN, BSN, MS, Senior Director, Quality & Case Management, HealthTeam Advantage Chad Baugh, Chief Strategy Officer, ReferWell Vandna Bhrany, Vice President, HEDIS Strategy & Analytics, AmeriHealth Caritas Frank Izquierdo, Senior Vice President Provider Solutions and Strategic Alliances, AvMed   Bios: https://www.brightspotsinhealthcare.com/events/last-minute-gaps-in-care-strategies/   This episode is sponsored by ReferWell  Health plans must be acutely aware of their progress towards achieving their Care Gap Closure targets. Their most significant obstacle is to directly impact those specific areas, even though they have limited capabilities to do so.   ReferWell helps health plans improve access to care by efficiently scheduling members for the care they need.   ReferWell care navigators find the "Perfect Match" provider right at the referable moment when the member is saying yes to their care). They then seamlessly schedule the member's appointment while still on the call.  It's a proven process that provides better access, experience and outcomes for members and better quality performance, which affects the health plan's bottom line. 

The eCW Podcast speaks with Geli King-Brown, senior director of quality management at Healing Hands Ministries (HHM), about how her organization is expanding its locations and services to extend healthcare to those who can't afford it. Geli discusses how the Patient-Centered Medical Home (PCMH) program has helped the organization standardize the care it provides by establishing policies, procedures, and workflows. By using eClinicalWorks® PCMH and HEDIS analytics, HHM can identify subgroups of their patient population with specific conditions or diseases and see the quality improvement process around them. With the embedded reports, Geli and her team can efficiently track and monitor their progress, share those results with their patients, and highlight healthcare champions at work. The game-changing result is that Geli and her team can identify what works and what doesn't while continuously striving to improve their care.

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.

Phylicia Schroeder, Manager, Provider Engagement and Quality Analytics at Blue Cross Blue Shield of Arizona Medicare Advantage and Janine Wakim, Head of Operations at ReferWell, join Eric to discuss how the plan is transforming the member journey by instituting a cultural shift putting the member's needs above the plan's needs, adding that to accomplish this goal, the plan uses data and predictive analytics to learn about what makes its members unique. Topics covered during the episode include: - Member journey mindset - Navigation and physician scheduling - Data integration, risk mitigation (as it relates to CAHPS) and  - Provider engagement.    Phylicia and Janine share many bright spots your plan can implement to provide a tailored experience for your members!   About Phylicia Phylicia is a highly skilled Medicare Stars quality (HEDIS, CAHPS, HOS) analyst and strategist who specializes in data analysis, extrapolation and visualization through building dashboards in Power BI, technology implementation, provider engagement and clinical workflows, project management, process improvement and documentation.  She is a true innovator who never says “No” and sees obstacles as opportunities to apply creative problem-solving to find a solution.   About Janine As Head of Client Operations, Janine Wakim is keenly focused on the success and satisfaction of ReferWell's customers.  Janine leads the team that works with some of the largest healthcare systems and payers in the United States from onboarding to growth to ongoing support.  She is an operations leader with over 20 years of experience in strategic planning and process improvement, leading client experience and business analytics teams. At Gartner, she served as the lead in building the offshore center of excellence for Business Analysis to provide insights into the Research and Advisory business to grow its footprint and retain its client base. She also served in leadership roles at Datto and Potoo Solutions. Janine earned a Bachelor of Science in Finance from Lehigh University, an MBA from Columbia Business School, and an MPH in Hospital Administration from Columbia University Mailman School of Public Health. This episode is sponsored by ReferWell Health plans are acutely aware that they are measured and graded on quality, experience and health equity more so than ever before. Their biggest challenge is to impact those areas directly. ReferWell helps health plans advance health equity by scheduling underserved members for the care they need, be it medical, care gap appointments or — through your community partnerships — appointments for transportation assistance, nutritional counseling, mental health services and other community-based organization offerings. Data shows that ReferWell's solution directly impacts the members who need it most.    ReferWell care navigators find the Perfect Match right at the referable moment (when the member is leaning into their care) and schedule the member while on the phone. It's a proven process that provides better access, experience and outcomes for members, and better quality performance, which affects the health plan's bottom line. For more information, visit www.referwell.com.  

For more information, contact us at 859-721-1414 or myhealth@prevmedheartrisk.com. Also, check out the following resources: ·Newsletter Sign Up·Purchase an Appointmen Today!·PrevMed's Locals·PrevMed's Rumble·PrevMed's website·PrevMed's YouTube channel·PrevMed's Facebook page·PrevMed's Instagram·PrevMed's LinkedIn·PrevMed's Twitter ·PrevMed's Pinterest

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.

For more information, contact us at 859-721-1414 or myhealth@prevmedheartrisk.com. Also, check out the following resources: ·Newsletter Sign Up·Purchase an Appointmen Today!·PrevMed's Locals·PrevMed's Rumble·PrevMed's website·PrevMed's YouTube channel·PrevMed's Facebook page·PrevMed's Instagram·PrevMed's LinkedIn·PrevMed's Twitter ·PrevMed's Pinterest

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.

About David Rhew:Dr. David C. Rhew is the Global Chief Medical Officer (CMO) & VP of Healthcare for Microsoft. He is Adjunct Professor at Stanford University; holds six U.S. technology patents enabling authoring, mapping, and integrating clinical decision support into electronic health records; and has been recognized as one of the 50 most influential clinical executives by Modern Healthcare.Dr. Rhew received his Bachelor of Science degrees in computer science and cellular molecular biology from the University of Michigan. He received his MD degree from Northwestern University and completed his internal medicine residency at Cedars-Sinai Medical Center. He completed fellowships in health services research at Cedars-Sinai and infectious diseases at the University of California, Los Angeles.He has served as CMO and VP for Samsung; SVP and CMO at Zynx Health Incorporated; clinician/researcher at the VA Greater Los Angeles Healthcare System and RAND; and Associate Clinical Professor of Medicine at UCLA. Dr. Rhew has served on the National Quality Forum's Executive Committee for Consensus Standards and Approval, Chaired the Consumer Technology Association Health Technology Board, and sits on the Governing Committee for NESTcc (National Evaluation System for Health Technology coordinating center), the Medical Device advisory group for the FDA, CMS, and NIH.About Dan Desmond:Dan Desmond is the health systems architect for the Health Equity Consortium. He focuses on innovations at the nexus of public health, healthcare, payers, pharma, and community-based organizations. Dan has been advancing public health data reporting for over 25 years. Including work with health systems to improve workflows, operational efficiencies, and data quality. During COVID he oversaw the deployment of solutions to bring care to underserved, rural, and hard-to-reach populations. His team is now driving efforts for equitable community engagement leveraging Azure Confidential Computing to improve vaccination and wellness campaigns; public health surveillance; and HEDIS, QIP, and Star measures in a sustainable manner.About Bela Matyas:Bela T. Matyas is currently the Health Officer and Deputy Director of Health and Social Services for Solano County in California. He previously served as Chief of the Communicable Disease Emergency Response Branch of the California Department of Public Health (CDPH), after briefly serving as Chief of the Disease Investigations Section of CDPH. He also served for thirteen years as the Medical Director of the Epidemiology Program at the Massachusetts Department of Public Health after serving for four years as the Medical Director of Disease Control and State Epidemiologist for the Rhode Island Department of Health. Dr. Matyas received his medical degree from the University of California, San Diego School of Medicine and completed a residency in Occupational Medicine/Preventive Medicine at the Harvard School of Public Health, where he also received a Master of Science Degree in Epidemiology and a Master of Public Health.Things You'll Learn:Data utilization, technology integration, and AI are critical factors in streamlining processes and enhancing healthcare delivery.The HEC wants to ensure data security, respect privacy, and build trust with their communities.Healthcare, community-based organizations, and the public health sector must work together to tackle current healthcare issues and improve care.Data sharing and collaboration have been challenges for healthcare stakeholders so far.Too much data is not valuable, but with the help of AI and ML, the data can be cleaned and structured to be leveraged correctly.Resources:Connect with and follow David Rhew on LinkedIn.Connect with and follow Bela Matyas on LinkedIn.Visit the Health Equity Consortium Website.

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.

Lesley Weir, senior director, customer and product success at Veradigm, and Kate Wormington director, product management, analytics at Veradigm Payer Analytics, join us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Medicare Member Acquisition & Experience; and Social Determinants of Health.In this 31-minute podcast, they discuss the risk adjustment and quality changes in the final rules and their recommendations and strategies for organizations going forward. About Lesley WeirLesley Weir, senior director of customer and product success at Veradigm, has over 30 years' experience in the Medicare Managed Care industry, with specific expertise in operations, risk adjustment, and quality improvement. She has a demonstrated track record of assisting health plans in meeting operational and revenue goals, as well as developing innovative strategies to improve member's health and experience. Prior to her role at Veradigm, she held various leadership positions at multiple provider-owned Medicare Managed Care Health Plans and a large national plan.  She also spent six years working in the vendor space supporting Medicare Advantage plans across the country with their risk adjustment and quality programs.About Kate WormingtonKate Wormington, director, product management, joined Veradigm in January of 2023 leading theQuality Analytics solutions. For the past 20 years, Kate has focused on HEDIS® and quality reporting for both payers and providers.  Kate spent close to 10 years managing complex operations of a quality analytics program supporting HEDIS, CMS Star, IHA AMP, QARR, QRS, and Medicaid State measurement sets for innovative health care organizations.  She has deep experience leading a multi-state Client Success Support and Implementation team, supporting 27 clients across three products.  Additionally, Kate has led an NCQA Data Aggregator Validation (DAV) project team through Cohort 2, and was in the middle of Cohort 4, providing targeted HEDIS standard supplemental data using C-CDA files. She began as a software engineer specializing in software quality, with a Masters degree in IT.   She embraced the business side, utilizing product, project and client management skills. Wormington lives in Denver, Colo., originally from the UK, starting her career in health care working for the National Health Service.  About Veradigm Veradigm Payer Analytics (formerly Pulse8) is health care analytics and technology solution delivering complete visibility into the efficacy of your Risk Adjustment, Quality, and Pharmacy Benefit Management programs. Veradigm empowers health plans and providers to eliminate waste and achieve the greatest financial impact in the Medicare Advantage, Medicaid, and ACA Commercial markets as well as with Value-Based Payment models for Medicare. Advanced analytic methodologies and flexible business intelligence tools offer real-time visibility into member behavior and provider performance while also improving efficiency for payers and at-risk providers through high-speed clinical data exchange. Veradigm's patented Dynamic Intervention Planning offers a suite of uniquely pragmatic solutions that identify the most cost-effective and appropriate interventions for closing gaps in documentation, coding, and quality. For more company information or to schedule a demo, please email payersolutions@veradigm.com

On this episode of Inside Health Care, we interview two upcoming speakers at NCQA's 2023 Quality Talks event. First, we meet a global leader with a deep understanding of the need for health equity. Following that, we have an in-depth discussion with an amazing tech expert on digital transformation in the health care ecosystem.Dr. Garth Graham is Managing Director and Global Head of Healthcare and Public Health at Google/YouTube and Google Health. Among other significant positions, he's the former HHS US Deputy Assistant Secretary for Minority Health. He also headed up CVS Health from 2018-2020, making sure to provide testing and vaccinations to as many under-served communities as possible.Dr. Aaron Neinstein is an Endocrinologist and Technologist headquartered at the University of California, San Francisco. In his many roles, he's also Senior Director at the UCSF Center for Digital Health Innovation. He's a foremost expert in digitalization and moving IT and AI into the health care realm.In our Fast Facts segment, we discuss Alcohol Awareness Month with some stats from the NIAAA's free booklet, “Rethinking Drinking: Alcohol and Your Health.” And if you're in crisis, you can contact SAMHSA via their National Helpline, by texting 9-8-8, calling 1-800-662-HELP or going to their national “helpline” website. We also mention NCQA's “Unhealthy Alcohol Use Screening and Follow-Up” measure, part of our HEDIS measure package.

On this episode of Inside Health Care, we'll hear from two health care innovators. One developed a unique yet powerful approach towards resolving historic gaps in health equity. The other champions artificial intelligence as a key solution in the drive towards streamlined patient-centered care.And...both of them will be featured speakers at NCQA's annual Quality Talks event, set for May 3, 2023, in Washington, DC.Nzinga Harrison, MD, is Co-Founder and Chief Medical Officer of Eleanor Health, a tech-enabled, population-based provider of comprehensive, whole-person, substance use disorder care and mental health care. She is a vocal advocate and activist who emphasizes the need for U.S. health care to address systemic and ingrained harms of racism and marginalization faced by many communities in this country.This interview begins with Dr. Harrison to explaining one of her most profound concepts: that Racism can be considered – and treated – as an addiction.Suchi Saria, PhD, stands firmly at the crossroads of Artificial Intelligence and Modern Medicine. She is the Founder and CEO of Bayesian Health, and works at Johns Hopkins University, serving both as the John C. Malone associate professor and the Director of the Machine Learning, A.I. and Healthcare Lab.In this interview, you'll learn how A-I, Machine Learning, and even ChatGPT can soon propel us into a world of resolved Equity disparities and improved patient-centered outcomes.In our Fast Facts segment, we observe National Minority Health Month by exploring disparate asthma diagnoses in African-American populations. We also explore NCQA's asthma-based HEDIS measure, Asthma Medication Ratio [AMR].

Dr. Jeffrey Kang– Geriatrician, former CMO of CMS, former CMO of Cigna, former executive at Walgreens and ChenMed, and now CEO of at-home primary care startup Wellbe Senior Medical– joins for an in-depth conversation on how to usher value based care innovations in the healthcare system. As the first Chief Medical Officer of CMS, Kang pioneered HCC codes, HEDIS and CAHPS metrics, and much of the foundation of value based care in the United States. Join for a discussion on the role of private equity vs venture funding in disruptive healthcare entrepreneurship, the future of primary care, and health system reforms needed in value-based care. During the conversation, Kang discusses novel ideas around risk adjustment coding in Medicare Advantage, which he outlined in a Health Affairs Article in response to the landmark piece by Dr. Don Berwick (S3E1) and Dr. Rick Gilfilan. You can find his article here: https://www.healthaffairs.org/do/10.1377/forefront.20220706.909897/full/ --- Send in a voice message: https://anchor.fm/tdio/message

On this episode of Inside Health Care, we hear from a digital scientist and researcher eagerly finding tech solutions to promote immediate change in health care.Jennifer C. Goldsack is founder and CEO of the Digital Medicine Society (DiMe), a 501(c)(3) non-profit organization dedicated to advancing digital medicine to optimize human health. Jen earned her master's degree in chemistry from the University of Oxford, England, her masters in the history and sociology of medicine from the University of Pennsylvania, and her MBA from the George Washington University. And she's the first Olympian to appear on the podcast, a rower for the U.S. at the 2008 Beijing Olympics. Jen will also be a speaker at NCQA's 2023 Quality Talks event.Later, in our Fast Facts segment, we observe Endometriosis Awareness Month, with important information from Endometriosis.org. We also discuss NCQA's Cervical Cancer Screening measure, or CCS, part of our HEDIS measures. CCS contains a number of assessments for women who had cervical cytology and/or high-risk HPV testing within the last few years.

“The goal is to support consumers in making informed decisions about which plan to choose”HEDIS hones in on 5 domains of care and measures whether the healthcare services rendered are actually improving conditions. The domains include effectiveness of care, access or availability of care, experience of care, utilization and resource use, and information about the health plan.In the domain of access or availability of care, advancing health equity and improving quality of care for underserved populations is an up and coming topic that the NCQA is focusing on. There will be a requirement, tentatively set for 2024, for health plans to have race and ethnicity data on 80% of a health plan's population. Health plans should be auditing their member information now to identify incomplete information sets and develop a plan for incorporating the right data into race and ethnicity stratifications. This data can be sourced directly or indirectly. Direct data comes directly from the member. For example, from a survey, enrollment information, or even requested from provider's EMRs. Indirect data is the practice of using data for a purpose other than the reason it was originally collected, such as census data.Another change we can expect from the NCQA is the shift to acquire more electronic sources for data collection. They've started to develop specific measures, Electronic Clinical Data System sets, ECDS. It's not required today for the Medicare Advantage population, but this should be on every health plan's radar because it will be a NCQA requirement in the future.HEDIS data is valuable beyond HEDIS. Forward-thinking plans can leverage the output of HEDIS data to support CAHPS and HOS. The data can be pushed downstream to other areas of the business to provide member-level insights like member compliance for care management teams or member communications. This is where risk adjustment—closing gaps, health management, communications, and member experience intersect. This should be each health plan's future goal—to have a holistic model where all business units are on the same page, fueled by the same data and working together towards the same goal. About Our GuestAlyse Schwartz is the Director of HEDIS Analytics for Advantasure. Alyse holds a Master of Science degree in public health with a focus on epidemiology. She's an experienced researcher and has been in the quality improvement space for over 10 years. 

Don and Shahid discuss NCQA's Health Innovation Summit (November 2022) and FHIR Dev Days (June 2022). They explore these events as examples of how to interpret what you hear at conferences, in industry media, and even on podcasts like this.  The discussion covers a lot of ground including: What is NCQA? What is HEDIS? What does it mean to move from Electronic Clinical Quality measures (ECQM) to Digital Quality Measures (DQM)? Can FHIR really do all that!? Specified, but not implemented (this is important) Why is it hard to innovate and sell innovations in the quality measure space? How are health equity and social determinants of health factoring into quality measurement? It's a fun conversation, but... take it with a grain of salt. 

Bryce Platt is super focused on his pharmacist career but also invests in real estate. His real estate portfolio allows him to serve his healthcare purpose and take risks in his career.In this episode, Bryce talks about the disastrous beginnings of his house hacking journey and the lessons that came out of it. He also explains the house hacking strategy and gives tips for pharmacists who want to try it out. Listen and be inspired by his story!Key Points from This Episode:Bryce talks about his life in Kansas City.Why Bryce picked pharmacy and how his career started.His advice for younger pharmacists: invest in your education and network.Bryce has found a way to get real estate investing to serve his healthcare purpose.How his house hacking journey began and the lessons he has learned.Bryce explains the house hacking strategy for pharmacists and other healthcare professionals.Where should pharmacists who want to house hack start?What is Bryce's goal in the future and what are other areas of real estate or investing that he would like to venture into?Tweetables:“I see reading as a bigger mentor than anybody I ever had.” [00:10:29]“There are all those kinds of things that are risks in your business and if you only have that one income source, you don't have control of that. [00:20:22]“I could see commercial investing as the way to make it even more passive. [00:35:20]Links Mentioned:Bryce Platt on LinkedInThe Two-Hour Job SearchThe House Hacking StrategyAbout Bryce Platt, PharmDBryce Platt, PharmD is a consultant pharmacist at MakoRx and a real estate investor. He earned his Doctor of Pharmacy degree from the University of Kansas. He is a disciplined, growth-minded pharmacist who implements time-saving procedures and process improvements and constructs patient health programs. He used a concierge service to land a 4-by-4 condo in North Carolina, where he plans to take on 3 rent-paying tenants to live for FREE! Bryce is experienced in Medicare, Medicaid, commercial programs, quality improvement efforts such as HEDIS and Star measures, and interprofessional group collaboration. His expertise includes designing and implementing new programs and products that enhance patient health and lower healthcare costs. Bryce is a pharmacist that has created multiple programs that utilize pharmacists to enhance patient health and lower healthcare costs. He completed a post-doctoral fellowship in Population Health Management with Omnicell and Campbell University College of Pharmacy and Health Sciences in July 2019. The main sponsor of our podcast is Rx Real Estate Investment. They make everything we do possible, and our conversations and interviews would not be available without their support. If you want to diversify your retirement portfolio and get into commercial real estate investing, working with Rx Real Estate Investment may be a great match for you. Check out the website at www.rxrei.com.

In this episode, we are joined by Andrew Borgschulte, Principal Product Marketing Manager at Surescripts, to discuss CMS star ratings and HEDIS scores and why these measures are so meaningful. Tune in to learn how interoperability can support health plans in achieving higher star ratings and HEDIS scores, and how to improve access to patient health information in a provider's workflow. Hear insights on how access to the right data and analysis influences patient care and health outcomes. This episode is sponsored by Surescripts.

God has given each of us as believers a story to share with the world.   Today's guest, Janet Whisnant Harllee, talk show host of "Faith In An Ever Changing World," discusses the importance of sharing your faith story with others to bring about encouragement, Inspiration, and hope while sharing the love of Jesus.   Please join us to hear examples of why YOUR story might make a difference in another's life.   *****   Welcome to Empowering Lives With Purpose. And I'm your host, Kimberly Hobbs. I am the founder of Women World Leaders. And we are so happy that you have joined us today. Today. Let's welcome our guest, Janet Harllee. Welcome, Janet, we are so happy to have you.  Janet Harllee   Thank you, Kimberly, thank you for giving me this opportunity.  Kimberly Hobbs   Of course, of course and ladies today. This is really fun because Janet has a program where others are invited on to share their stories. And I'm going to introduce her in just a moment. But I just wanted to say a little bit about who we are women, world leaders, the name of our podcast today is empowering lives with purpose. And it is our desire ladies to inspire you encourage you in the Word of God, and also to walk out that beautiful purpose that God has just for you. God tells us in His word that we are a masterpiece Ephesians 210 says we are God's masterpiece, we are created anew in Christ Jesus to do that very good things that he has planned for us long ago. And ladies, we know that you have a beautiful purpose. And whether you're walking it out now, or you have those reservations of walking it out, we want to help you we want to propel you forward in your faith, to walk out that purpose and serve the Lord wholeheartedly. And so as we have some of our guests on that is our purpose that they can help inspire you through sharing their stories of how they came to walk with Jesus and share their purpose. And when they share with you. Hopefully that will just jog something inside of you to say, Okay, Lord, if they can do it, I can do it. Right. So, Janet, I just want to share a little bit about our guest, Janet Harley today. She is a storyteller, and she's a speaker, a broadcaster and an author. And she has a passion to share God's truth and deliver it to her audiences, where she encourages, inspires and entertains with messages of faith in an ever changing world. Her other experiences include theater, radio, television, and she's currently the host of her broadcast, which is faith in an ever changing world, which gives encouragement and hope, as she interviews with others to share their faith story. And also pastors who share various faith topics with faith focus. She enjoys encouraging people through coffee breaks, and she loves making new friends. And Janet Harley is available on YouTube. So Janet, again, we welcome you. And thank you for being here. We, you're so welcome. We each have a story to tell ladies. And the stories could be ranging from how we give birth and pains and trials that we've had, you know, we all have different stories that we share with people. But as Christ followers, ladies, those stories are of the utmost important, what has he done in your life? What are our Faith Journeys? What is your faith journey, and the goal of our faith journey is to deepen our relationship with God. Right. And by sharing our faith story, and telling our story, we encourage others to share their stories. And God says in Revelation 1211, And they overcame him by the blood of the Lamb. And by the word of their testimony, we overcome the enemy, and all that he's trying to do in our life. When we proclaim our testimony to the world. God says that in his word, and that is how important it is. Janet, you have a story. So how did you get started in encouraging others to share their story? Let's hear a little bit about your story. Janet Harllee   Well, I retired a couple of years ago at the age of 70 and And I've never really thought about retiring, Kimberly, I enjoy what I was doing. And the Lord has blessed me with good health. And so, but at 70, I thought, well, it's just time. But you know, you never retire because God's work never stops. So I wondered what was going to be next? My next chapter, what, what, Lord, what do you have for me? Now, what can I do? And one of my speaker topics was faith in an ever changing world. And I added encouragement and hope. Because for the broadcast, he put on my heart to, to do a Facebook page. And it's really his Facebook page, not mine. And he wanted me to help others or to get other people to share their stories, because in how faith, either how faith had gotten them through a certain situation in their life, or their testimony, that we each have a testimony a story. And when we tell our story, we tell HEDIS. Amen. So I started the PageRank. So just let it go around in my head for a while, you know, and in September last year, and this September will be a year that the broadcast has been going on Facebook. And so I've just pray every day that the Lord will use me will show me what he wants me to do. Because when you retire, when I retired, I repurposed. I retired to repurpose. And I just think that the Lord has says he has put this on my heart, that this is what he wants me to do at this particular time. Kimberly Hobbs   Oh, my goodness, Janet, you are so delightful. And I love that when you retired, you said you repurposed? Yeah. How awesome. Is that? Right? That? I said, I want to be like you when I. When I'm at that age to retire, I'm gonna say no, Lord, let me repurpose it, because serving Him is amazing, right? Janet Harllee   That's right. That's right. And we are, we are to do that. That certainly is our purpose is to encourage and empower each other, especially as women, Kimberly Hobbs   especially right as older women. And so ladies, your job on earth here is never done. Don't you think about retiring? Because God says no, he's gonna use you. You're here for a purpose. Remember that? If anything in this podcast today, you're here for a purpose, ladies. And by sharing your faith story, it touches it touches other people's hearts and helps them see their story through your story. Okay, so as they're seeing and listening to you, they identify with what you're saying. That's the importance of sharing the story. They can have compassion, they can be inspired. But they can also say, Wow, if she did it, I can do it. Right. Right. So it's through sharing these stories that also brings us closer to God, ladies, and I think God for Janet hardly that she saw a purpose in this. And she decided, You know what, she's going to go and gather those stories that God brings across her path to share with the world. So thank you, Janet, so much for doing that. So much. So I have another question for you. So tell us how you would encourage someone else to share their God's story. Janet Harllee   Well, stories connect us on so many levels, Kimberly, they are inspirational to to us. They encourage, they are empowering. And it's important for us to share those stories because we can certainly apply as you have said help other women. Women because we go through a lot of the same kinds of trials. And I'm a member of a group testimony Tuesdays on Facebook. And so we Every Tuesday we share testimony. Well, I shared a testimony Yesterday, it was a testimony of obedience because my sister and I became caregivers for my parents. And you know, when when the roles switch and you become the parent, it's, it's difficult, it's emotional. It's tiring, but it's also the most rewarding of anything I ever do. And my parents were such godly parents. And so it was just so in sharing that through the other comments you see, of other people, they can relate. Maybe they've been a caregiver too, and they knew what I was talking about. And so, in our stories in our storytelling, we certainly want to share this. And a lot of times, women think that they don't have a story. And they, but you do, yes. Um, now my story about how I came to know the Lord. I don't have a heart wrenching story to share as Sunday because I was blessed to grow up in a Christian home. But I do, it's my story. And I enjoy telling you, and as I've gotten older, and in this stage of life, where I am right now, in my last quarter of life, I am more closer to God than I ever have been. And each day, I just seem to be even closer to him. Kimberly Hobbs   So is that saying true that your later days are your glory days? Janet Harllee   Oh, yes, I tell you, he has just been another can look back and see how faithful and how he has worked in my life. From the pit pitfalls and consequences that could have happened. And Kimberly Hobbs   he prepared you for such a time as this, he prepared you, that you you know, you may have not had like you said that heart wrenching story. But yet he knew that you were going to be compassionate. And you are going to encourage others that we have those crazy, you know, stories of what they've been through those heart wrenching moments, you know, that are and you encourage them, to talk about it, to share it to express it to others, in hopes that it will draw them closer to our Lord and Savior. And that is one of the best ways to share your story as you are you're drawing others closer to God by letting them listen into your life being vulnerable being open, right? Be a friend. Yes, it'd be kind of godly examples. That's what we're called to do. And you talked about obedience to, you know, you were obedient to take care of your parents, like, you know, you can be doing a lot of other things in your retirement years. Right. Janet Harllee   Absolutely. Still working. This was while I was still working. Wow. So yeah, we had to move. And, of course, I needed a job and a place to live. Me and my husband. So Robert found an apartment that was brand new, nobody had lived in it. So we we got to got a place to live. I called a lifelong friend. And she was taking a new position and needed someone. So I had a job. I mean, it's just things like that how things fall together. When we obey. Kimberly Hobbs   Oh, that is so true. That did you hear that? Ladies? When you walk in obedience with the Lord, He's going to guide your steps, things are going to come together for you. If you think everything's in array right now, check your obedience to the Word of God. Put it up against the scriptures. Are you walking in obedience to Him? Are you doing your own thing? Yeah. So Janet, you said it right. Obedience is key to unlocking the blessings that God has in our lives. And he blesses. That's right. That's right. He sure does. So God gives us examples, ladies all over his word about how we should share our testimonies and why we should share our testimonies. And one of those is John 439, where it talks about the Samaritan woman, and she had an encounter with Jesus. And then she went out and she shared that encounter. She shared that story of how it transformed her life. She was an AHA of this wonderful Savior that forgave her for what she was doing knew everything about her. And so she ran out and told all of her fellow neighbors her story. And in that the town believed in Jesus. And it's all because of this woman testifying lives were transformed. So that's what we're called to do Janet Harllee   I love that story. Amen. It's just and that's what we should do. And with joy, Kimberly Hobbs   with joy. So one more verse I want to share is First Chronicles 16, eight, where it says, Oh, give thanks to the Lord call upon his name, make known his deeds among the people. Does he say, keep quiet about everything God did in his word? No, it says, Make known his deeds among the peoples. So ladies, we have a job to do. Janet, I know that through interviewing all of these women and men that you interviewed, because you do both you do men and women, you've heard some amazing stories. Yeah. So can you encourage the women by sharing maybe some of those that have had an impact on not only you, but others that have really made a difference and why they made a difference? Janet Harllee   Absolutely. There are many, but there are a couple of women that come to my mind right away. One woman had three boys, and they of course, her husband. And one night they were awakened with fire in their home. And so they were trying to get out and get the children out. And I she was badly burned. And still have scars today, but of the burn. But she passed out during a while she was in the ambulance, and didn't wake up for six weeks. And but God healed her it took a long time. But the the very, very another sad part of it was she did lose, they could not get her youngest son out. So he did perish in the fire. So she speaks to women today about losing those who have lost a child, and all you know the emotions, and she has a podcast and called Purple thoughts. And if any women listening wants to know about it, and to know more about it, please, we'll give you the information to get in touch with me a little while. But she is just such a wonderful, inspirational woman and speaks a testimony all the time, into the halls of how God has been so faithful and good and how he still is being faithful and good. The other day, I noticed she showed a picture of her getting in there taking her into the ambulance, and then a picture of her today. How alive she is and how beautiful she is. And Kimberly Hobbs   She had to take a step forward to faith right? Yeah, absolutely. And not be in that place. I mean, because we all know if we've gone through sickness, you know, we can wallow in our pity of woe is me for a long time. Yeah. And it took a lot to overcome what she did, but she stepped down and shared her faith story and what she's doing now and I know you have more, share some more of that story. Janet Harllee   Oh, one more, one more real quick, about a lady who was kidnapped at the age of five, and found at the age of 10. And during those five years, she was abused every day, by her kidnapper. She now has has turned her life around. Of course there's so much that can be said about her because of his She was so young. And to have this happen to her. At such a young age, that's all she knew was the behavior and the the language that she heard from this man. And so that's all she knew. And when she was found at the age of 10. She was so relieved she was Happy to be away from that environment. But social services took over and so forth. And at some point they they did it to her into school. And in the fifth in the fifth grade, she had never been to school at all. And so she didn't know how to act didn't know how to react, to interact with other children, and the teachers, but she, she got through. And then later a lady came in her life that introduced her to the Lord. And so her life, of course changed. And her faith every day now is spent helping other women who have been in similar situations, and how they can come to know the Lord and how she forgave her kidnapper, and how she brought him to the Lord. And didn't get to meet her mother. And I didn't say this, but she was abandoned at the hospital by her mother. So she was abandoned, kidnapped. It's just amazing how God got her through this situation. And now, how her how he's using her life to help other women. Wow, wow, is just amazing. So these are encouraging stories, amazing stories. And I can't imagine being in this situation, because it nothing like that has ever happened to me. But it just, it just inspires me to, to be more grateful, and more thankful to God about house so faithful and good in my life. And how I can help other women and men to share their stories to encourage and bring hope to others. Kimberly Hobbs   Right. Wow, Janet, and thank you, thank you for encouraging this woman to come forward and share that story. And even you sharing it today, how many lives are being touched, just listening to this. And knowing that when she came to know Jesus, she took her whole life story, and she put it into purpose in serving Him. And how powerful is it because others listening may have just come out of something tragic, just like that. They can identify with the pain and the hurt and the suffering. And then you get their ear because they'll listen to you because they relate to you. And you can share with them, you know, the overcoming that when we know Jesus, and we're following Him in His steps. So we have a story to tell of turn to Jesus and give him all your hurts and pains. They'll listen to you at that moment because they're identifying with you. Yes. So don't you doubt ladies for a moment that your story isn't important. Just like Janet said. She didn't grow up with a unbelievable story. She grew up and God was preparing her life for such a time as this to help others share their stories. Do you see this? Like, it just goes on and on and on. And we don't know what time in our lives God is going to use us or when he wants to use us every day of our life, by the way. So honestly, we are so appreciative of what you do Janet and encouraging others to share their story. Yes. And so tell me how I you know we have to close again wrapping up. It's just like our time with alive. It does it goes so fast. But I would like for you to share a couple of closing words to encourage the woman to share her story. And also tell us how ladies can get a hold of you Janet. Janet Harllee   Okay. First of all, I'd like to share my life scripture is found in Proverbs 356. Trust in the Lord with all your heart and lean not on your own understanding. In all your ways acknowledge him, and he shall direct your paths. No matter what age you are women, no matter what age we are, that he shall direct our paths and one other one. Which is it At this particular time in my life, it's how he is going to be with us, even when our hairs turn gray. And my now is turning gray. And I love it Kimberly Hobbs   With age comes wisdom, Janet. Janet Harllee   That's right. That's exactly right. Kimberly is wisdom. And but I just pray every day for his wisdom, and discernment. And just stay true to God, trust God, in all things. Kimberly Hobbs   Amen, that that Scripture is so special to me too, because that's my mom's verse. And you know, I always hear or, you know, I can hear her with her little finger up in the year, Trust the Lord with all your heart. You know, like that's always saying that, so it's a great one. So how can ladies get in touch with you, Janet? Janet Harllee   All right. Of course, I have a YouTube and you just type in my name, Janet Harley. And the email that I have is Janet storyteller@gmail.com. Kimberly Hobbs   Hey, man, I love that. Okay. And Janet is also a woman world leader, we are so grateful that she has come on board to serving and just being a part of just a unity of women that are going out into the world with their special purposes, doing what God has called them to do. And I thank you for that. Janet again, to serve with you is a pleasure. Janet Harllee   Oh, it's been a pleasure with us. Well, thank you so much. Kimberly Hobbs   Oh, you're so welcome. Ladies, I just in closing, want to share Luke 839, which says return to your home and declare how much God has done for you. Proclaiming throughout the whole city how much Jesus has done. Oh, my goodness, right. He tells us go out into the city ladies proclaim it. It doesn't mean just be quiet and just tell somebody here on the corner, you know, in secret? No, it says proclaim it that means be loud about it. Proclaim what he has done with for you ladies share your story. It's so important that is the purpose of empowering lives with purpose is to get women on here to share their stories. So others can be inspired. And we hope that we're doing that for you. And another way that women world leaders loves to inspire is we do some books each year. And one of the books that we put out is tears to triumph. And it is releasing pain to receive God's restoration. So by some of the women that have shared in this amazing book, their stories of pain of suffering, it has inspired others to find Jesus. And we are so this book went to number one best seller. And number one international best seller, tears to triumph. It's available on our website, women world leaders.com. It's also available on Amazon, but we'd prefer you get it through women, world leaders. Ladies, this is a book that you will just you will cry through this book, but you will be inspired. And also we have another amazing tool for you ladies. And this is voice of truth women were leaders puts out a publication by monthly magazine. I see Janet is holding up hers. For those watching on YouTube. Yes, yay. Well, voice of truth is your tool ladies to inspire you encourage you strengthen you in the Lord filled with the gospel message of Jesus and every addition. Also, we have many ways that you can get involved with women were a leader as you can find us through voice of truth, of course, and be inspired to share your story somehow, someway, maybe, right? Maybe do a podcast with us. Whatever it it is that God's putting on your heart. We give opportunities here in this ministry, for you to get involved and share your beautiful purpose with the world just as God has asked you to do as to all of us to do some ladies and close. Again, I want to say thank you to our guests, Janet. I love you Janet, you are just beautiful treasure. Thank you so much. God bless you ladies each and every one of you and again I just pray that something today touched your heart and that you will go out into the world and proclaim what God has done share your story flames there is a world out there that is hurting and needs to be inspired through Jesus Christ live The good side. So ladies, from our heart, from his heart to yours, we are women, world leaders and all content is copyrighted and cannot be used without expressed written. I bless you all and have a wonderful day.    

Lance talks about Medicare STAR Ratings on the #HealthCast and gleans from his experience with success and failure within the 4 STAR threshold. He also provides advice to health plans that didn't hit their mark for STARs and the importance of maintaining a strong culture and remembering that your teams busted their arses on HEDIS, CAHPS, HOS, Supplements Data, and Audit.1.) Be direct with your leadership team if changes in personnel are forthcoming but do NOT publicly scapegoat your staff.2.) Bring in consultants that have actually managed healthcare operations and understand the technical specificity for STAR Measures. There are many brilliant Harvard/Yale consultant with 160 IQ's but limited healthcare knowledge.3.) Focus on member experience. Drill down to the zip code level. Understand your base and what makes them tick. What type of media do they respond to. What social determinants of health programs are relevant to them?

“One area of opportunity that a lot of health plans overlook, is taking a step back and looking at data that's right in front of them with a new perspective..”The weight of the CAHPS survey has steadily increased over the years from 8% in 2014 to 32% of the overall Star Rating in 2021. Scoring is complex and there's no one size fits all strategy. Two health plans the same size can do the same thing and get different results. The reason for this is attributed to the unique nature of every member experience in different member populations. There are a number of variables that contribute to positive CAHPS performance. Although CAHPS performance can't be pinned to one effort, the health plans that are most successful have a wholistic strategy that involves multiple departments and synergies between their member communications and outreach. Every single thing that's printed on paper, published on websites, sent via email, or communicated verbally—matters. Carefully crafting and optimizing a targeted member journey is essential to successful CAHPS. It's often forgotten that health plans are surveyed not just on their own interactions with members, but also their agents and provider networks. Education and onboarding partners to deliver a member experience is just as important as training customer service representatives. All member touch points are a reflection of the health plan.In order to improve the member journey, plans must evaluate their available data from multiple perspectives. For example, it's no longer sufficient to evaluate appeals and grievances through the narrow lens of whether it was an appropriate denial or not. Today, plans need to also analyze complaint data from a quality vantage point and determine it its more expensive to have an abrasive member experience. About Our GuestAmy Weiser is an accomplished healthcare executive with 20+ years of experience in health plans and facility and practice management. Weiser has experience with Medicare Advantage, Dual Special Needs Plans, MMP, and Medicaid lines of business. She has had responsibilities that have included Star and Hedis oversight, operations, member and provider materials and engagement, medical management leadership over care management and utilization departments, as well as experience starting a new quality and patient experience department for a large physician network.

In this BONUS episode of Inside Health Care, you'll find the full interview with Louisiana Medicaid leaders on a new framework for improving Health Equity at the state level.In this interview, NCQA Assistant Vice President for State Affairs Kristine Toppe moderates a discussion with state Medicaid quality leaders from Louisiana. They discuss a new report, funded by the California Health Care Foundation. The paper follows an earlier one, as Kristine will explain, with both reports geared to provide new tools for states in improving Health Equity. Specifically, the discussion here focuses on improving Medicaid-based managed care.Kristine's guests in this interview are Kolynda Parker, Medicaid Deputy Director, Louisiana Department of Health, and Amanda Dumas, Chief Medicaid Officer, Louisiana Department of Health. Following this, a chat with Harry Alba, NCQA's Director for Corporate and Foundation Relations, telling us all you need to know about the upcoming NCQA Health Innovation Summit, live in DC, October 31-November 3, 2022.Finally, you'll hear some Fast Facts in observance of Pain Awareness Month. This time around, we focus on lower back pain. We also discuss NCQA's HEDIS measure to reduce unnecessary ordering of imaging when simple lower back pain presents with no indication of underlying conditions.

We begin this episode with a special appearance from NCQA President Peggy O'Kane, giving us exciting news about NCQA's first annual, live, in person, 4-day Health Innovation Summit! Join us October 31-November 3, 2022, in Washington, DC. Go to https://www.ncqasummit.com to register. For our featured interviews this week, we discuss NCQA's Person-Centered Outcome Measures.Imagine a clinician asking you what you feel, what you think might be wrong, and just…listening. And then the clinician says…what would you like to be able to do that you can't do now? What are your goals? And what can I do to help you get there?Person-Centered Outcome Measures have already begun to ask these questions and change the health care landscape. On this episode of “Inside Health Care”, we take a deep dive into the Person-Centered Outcome measures and what may be a revolutionary reorientation of the traditional doctor-patient relationship.For more on this, we speak with three people involved with this important NCQA project. First up, we talk with NCQA Senior Research Scientist Dr. Caroline Blaum. Then we hear from Patient Partner Ireland Hawkins, a retired researcher and caregiver, now a patient herself with a patient's perspective. After that, we hear from Sherry Nolen, a Patient Partner with a very clear caregiver perspective.For more information contact Dr. Caroline Blaum at pcomeasures@ncqa.org.Later in the show, we observe September's National Prostate Cancer Awareness Month. NCQA has a number of HEDIS measures related to cancer and cancer screenings. Go to www.NCQA.org and search “cancer” for more information.

On this episode of “Inside Health Care”, we talk with Eric Gremminger, CEO and Co-Founder of ERPHealth. Eric is an Internationally Certified Alcohol and Drug Counselor and a nationally recognized leader in the behavioral health space. Since 2014, Eric has trained behavioral healthcare professionals around the country on how to use patient reported outcome measures to personalize clinical curriculums and inform policy and procedure.Eric's company, ERPHealth, develops tech tools and platforms for collecting and delivering patient-reported data from behavioral health treatment and therapy. The mission of his company, ERPHealth “is to save and transform lives through individualizing behavioral healthcare.” As you'll hear, his own story drives him to smooth the journey for anyone seeking a way out of addiction.As we mentioned in the interview, some NCQA HEDIS measures speak to alcohol or other drug dependencies. Please contact us for further information.In our regular “Fast Facts” segment, we observe Childhood Obesity Awareness Month with CDC statistics that touch on the Health Equity gaps in childhood nutrition. Click here for one of NCQA's HEDIS measures that help track childhood nutrition. For more about NCQA's HEDIS measures on obesity in adults and kids, go to www.NCQA.org and search “HEDIS OBESITY.”

Join Health Affairs Insider.This week, the National Committee for Quality Assurance (NCQA) updated measures in the Healthcare Effectiveness Data and Information Set (HEDIS). This year, the organization included measures related to health equity for data and quality measurement.NCQA Executive Vice President Eric Schneider joins Health Affairs' Rob Lott on today's episode of Health Affairs This Week to discuss the measurement changes.  Currently, more than 70 percent of our content is freely available — and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone.Related Links: HEDIS MY 2023: See What's New, What's Changed and What's Retired (NCQA) A New Effort To Address Racial and Ethnic Disparities In Care Through Quality Measurement (Health Affairs Forefront) Subscribe: RSS | Apple Podcasts | Spotify | Castro | Stitcher | Deezer | Overcast

In this episode, we are joined by Richard Resnick, CEO of Cureatr, a tech-enabled, medication management optimization clinic, to discuss the challenges associated with patient discharges, transitions of care, and medication management. Tune in to learn why these are such pain points for providers and what they can do to overcome these challenges and improve patient care.This podcast is sponsored by Cureatr.

Welcome to the Follow The Brand Podcast recap of Season 1.  I am your Host, Grant McGaugh. In Season 1 we introduced you to the concepts of personal branding in a different way in which you gain a point of view from our various guests on how they leverage their brand for career success.  I want to challenge you to get out of your way and find your voice.Today I will introduce you to my behind-the-scenes producer Daniela Gilet as she and I review the myriad stories of Season 1 that spells out a platform for your success with your brand.We are all worthy and capable of developing our brand by following key principles spelled out during the season through personal stories.  Our goal is to share, empower, and educate which are the ethos of the success of the Follow The Brand Podcast. Integrity, Honesty, and authenticity are the principles of our next guest Daniela Gilet is a corporate recruiter turned data analytics enthusiast. She currently possesses over 5+years of experience in HR/Recruitment practices and policies, and 3 years in working with bothstructured and unstructured data in the healthcare industry. Daniela currently works as a Data Engineerfor a healthcare solutions organization where she is responsible for maintaining the datatransformation, data normalization, and data ingestion for provider risk scoring. Before joining to hercurrent organization, she worked as a Data Analyst under Quality Improvement for a managed careorganization where she was responsible for creating robust dashboards, and reports that were used totrack Healthcare Effectiveness Data and Information Set(HEDlS) performance for contracted providergroups in the health plan.Her accomplishments:Quality/HEDlS: Created a dynamic dashboard that leveraged membership data and procedure/diagnosecodes to track provider performance in closing HEDIS care gaps year over year. This tool was presentedand recognized by c-suite executives.Conducted claims analysis to identify the impact of contracted vendor outreach efforts in closing caregaps as it pertains to HEDIS.Operations: Created a Service-Learning Agreement (SLA) tool to aid internal departments in identifyingresources (staff) that were out of scope for contractual obligations.Daniela is also the Host of The Life & Business Trailblazer Podcast, formed in March 2018 to create anintentional space around entrepreneurship, and lifestyle management for creatives and workingprofessionals. Daniela is currently pursuing a Doctorate in Public Health (DrPH in Health Education)where she is preparing to become a Chief Data Officer who will utilize her experience and data analysisto help drive insight and public health decisions around Social Determinants of Health in underservedcommunities.