Podcasts about ncqa

In this episode of Quality Matters, host Andy Reynolds welcomes Bryn Rhodes and Rob Reynolds of Smile Digital Health to unravel two foundational, yet widely misunderstood, technologies in health care: Clinical Quality Language (CQL) and Fast Healthcare Interoperability Resources (FHIR). With decades of leadership in health care standards, Bryn and Rob share hard-earned insights, persistent misconceptions and what the future holds for digital transformation in such areas as clinical reasoning and quality measurement.Listen to this episode to discover:Why CQL and FHIR Are Often Misunderstood and Why That Matters: CQL enables knowledge and logic sharing, while FHIR facilitates data exchange. Together, they empower precise and scalable healthcare interventions.CQL's Human Readability is More Than a Feature; It's a Gateway:  Learn how CQL's intuitive language design bridges clinical and technical teams, reduces errors in translation and is already proving to be a strong match for AI-based tools and systems.Why FHIR Alone Doesn't Guarantee Interoperability: Hear why true interoperability requires coordinated expectations between parties, including common terminology and agreed use cases.Business Strategy Meets Standards Adoption: Learn why treating interoperability as a strategic imperative (not just compliance) can unlock innovation, lower costs and drive better population health outcomes.CQL Engine News: NCQA Chief Technology Officer Ed Yurcisin updates the quality community on the role of CQL engines, why no engine covers all use cases and how NCQA's open-source engine is moving the industry forward.This conversation is a must-listen for health care leaders, B2B strategists and informatics professionals navigating digital transformation. It's packed with actionable ideas, tech-forward insights and a human-centered approach to quality's future. Key Quote:“I'm delighted you're hearing FHIR and CQL used together because that wasn't always the case. People in the past used them separately and thought these things are completely distinct. Both of them have their power and bring the value separately, but you need both of them to achieve greater value. If you have FHIR, you have the ability to share the data. We can express questions. ‘What about this, about the data?' We can do that in a shared, interoperable way with CQL.But if the data isn't interoperable, the ability to share questions doesn't do much because you can't get the data that those questions are about. So hearing people talk about those things in the same sentence, that's fantastic. That's exactly where we need to be.“ -Rob Reynolds Time Stamps:(02:00) The Relationship Between FHIR and CQL(08:20) Common Misconceptions About CQL and FHIR(12:57) NCQA's Commitment to CQL(17:40) Advice for Adopting CQL and FHIRDive Deeper:Episode 18 of Quality Matters with Ed YurcisinEpisode 19 of Quality Matters with Ed YurcisinConnect with Rob ReynoldsConnect with Bryn Rhodes

In this episode of Quality Matters, Dr. Richard Bergenstal, Executive Director of the International Diabetes Center, joins host Andy Reynolds to explore the evolving landscape of diabetes care—from the legacy of A1C to the promise of continuous glucose monitoring (CGM).Rich shares lessons from decades of clinical leadership, research and quality improvement, including his advisory role in NCQA's updated Diabetes Recognition Program. He explains how CGM, new metrics like the Glucose Management Indicator and a focus on patient experience are reshaping how we define and deliver high-quality diabetes care.Listen to this episode to discover:Why the A1C Era Was Just the Beginning. Learn how A1C transformed diabetes care—and why it's no longer enough. Richl explains why A1C is a measurement tool, not a management tool, and how CGM fills that gap.The Rise of CGM and What It Means for Quality. Understand why CGM use has surged sixfold in two years, and how it empowers patients with real-time data, alerts and confidence. Discover how CGM metrics like Time in Range and GMI are becoming the new standard.The Power of Visualizing Glucose Data. Explore how tools like the Ambulatory Glucose Profile (AGP) help clinicians and patients detect patterns, personalize care and move from data to action.Why Quality Measures Must Evolve. Learn how NCQA's updated Diabetes Recognition Program adds HEDIS measures to reflect contemporary care standards and whole-person health.What's Next in Diabetes Care. Hear Dr. Rich's optimistic, collaborative vision for  the next decade of helping people who have diabetes live better lives.This conversation is essential for quality leaders, clinicians and health plan professionals who want to stay ahead of the curve in diabetes care, digital health and patient-centered quality improvement.Key Quote:The A1C set up the need for the next technology. Why did finger stick glucose come about? Because the average A1C said, “You need to do better.” But nobody wants to poke their finger multiple times a day. So A1C led to finger sticks. Finger sticks led to CGM and now CGM has changed the dialogue. The A1C era had its role, but you look for the next thing to get to the next level. That's what I see CGM as. -Rich Bergenstal, MDTime Stamps:(02:14) The Era of A1C(04:22) What is Continuous Glucose Monitoring (CGM)(06:43) Bridging the A1C and CGM Eras(10:45) Addressing Skepticism and Myths about CGM(18:37) The Future of Diabetes Care Dive Deeper:NCQA's Diabetes Recognition ProgramRecent Quality News About DiabetesConnect with Rich Bergenstal 

In this episode of Quality Matters, Jules Reich, NCQA Senior Health Care Analyst in Population Health, and Grace Glennon, NCQA Director of Digital Quality Informatics, join host Andy Reynolds to discuss the latest tool in the long crusade against tobacco use: NCQA's new HEDIS measure, Tobacco Use Screening and Cessation Intervention (TSC-E).This measure replaces an outdated survey-based approach. It also facilitates the transition to digital measurement by using the Electronic Clinical Data Systems (ECDS) reporting method to capture, track and help health plans act on data better and faster.Listen to this episode to discover:·        Why It's Time to Modernize Tobacco Measures. Learn why NCQA replaced its legacy tobacco survey measure, and how TSC-E aligns with updated clinical guidelines and evidence-based interventions.·        The Full Scope of Tobacco Use. Understand how the new measure covers a wide range of nicotine delivery systems—from cigarettes and vapes, to hookahs and dissolvable gels. Also learn why NCQA counts vaping in the measure of tobacco use, but not in the measure of tobacco cessation.·        The Power of Structured Data in Quality Improvement. Discover how the ECDS reporting method promotes standardized, sharable data across health systems, and why that shift supports more actionable insights, better patient care and data interoperability.This conversation is key for quality leaders, digital health pioneers and public health champions who are interested in the modernization of quality measurement, advancing data standards and helping providers reduce tobacco use in the populations they serve.Key Quote:“ Most people would recognize cigarettes, pipes, cigars, maybe chewing tobacco. A lot of people have seen e-cigarettes and vaping devices out and about.But there's also hookers and water pipes. There's cigarillos, small cigars. There's snuff, there's dissolvable gels, orbs. There's a lot of products to list.This measure was developed with all of that in mind. We hope to institute a measure that recognizes the complexity of that, and that providers in different cultural contexts, different regions are able to use the same way.”Jules Reich Time Stamps:(03:08) The Relationship Between Tobacco Screening and Cessation(06:32) Who's Included: Ages 12 to 98 and Beyond(09:10) What's Included: Vapes? It Depends.(11:30) The Difference ECDS Reporting Makes(15:24) The Future: From ECDS to Digital Quality MeasuresDive Deeper:NCQA's Tobacco Cessation HEDIS MeasureConnect with Jules ReichConnect with Grace Glennon

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

Over half of Americans now live with at least one chronic condition, yet our healthcare system still revolves around episodic, reactionary care instead of continuous, coordinated support.We talk with Dr. Jaewon Ryu—former CEO of Geisinger and now CEO of Risant Health—about how integrated delivery systems are reshaping the way care is paid for and delivered. With decades of experience spanning medicine, law, government, and leadership at some of the most respected healthcare institutions, Dr. Ryu offers a rare inside look at what it takes to scale value-based care in a fragmented system.We cover:

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

Could primary care at home unlock better health and lower costs for American families? Rebekah Gee, a physician and policymaker turned entrepreneur, joins us to talk about the big bet her company Nest Health is making on home-based primary care. It's a model that makes sense for families and delivers results. In the first year of operations Nest doubled primary care visits, reduced ER visits, and increased childhood immunizations.We discuss:The sound economics behind the Medicaid expansion in LouisianaWhat she learned from her mentor, astronaut John GlennHow to close the primary care gap for children and parents Whether ultra processed foods are the next tobaccoRebekah shared about an exchange with Elon Musk on the short sightedness of Medicaid cuts:“So Nest came out with our savings numbers. We put out some really good information about the health of children and the opportunities. And Elon Musk retweeted it. So as a result of that, we actually got a lot of press. But I wrote back to him and said, ‘I'm glad you like this concept. And just remember, don't cut health care for children because we'll be paying far more for that than you will ever save.' ”Relevant LinksRead more about Nest HealthWatch: Dr. Rebekah Gee on what entrepreneurs need to know about MedicaidLearn about Alaska's Nuka system of careEvidence from the Nurse Family Partnership about the impact of home-based careAbout Our GuestDr. Rebekah Gee is the founder and CEO of Nest Health, a technology-enabled whole-family primary care provider providing care at home and virtually to Americans who struggle to receive comprehensive care. Previously, Dr. Gee served as Secretary of Health for the State of Louisiana. In that cabinet-level role, she led the expansion of Medicaid. As Secretary, she was responsible for nearly half the state budget including Medicaid, public health, aging and adult services, licensure, sanitation, disability services, and a nearly 2,000 bed state hospital system. As Secretary, she developed a first-in-the-nation subscription model for the drugs that cure Hepatitis C that is being used as a national and international model for increased drug access and affordability.Dr. Gee has served as an advisor to multiple Governors, presidential campaigns, and policy efforts at the state and national level. Her board service includes medical advisory support of public companies Select Quote and 3D systems. She has also served as a board member or advisor to Ready Responders, Ouva, Noble, NCQA, NQF, IHI, the Penn Center for Behavioral Economics, and the Duke-Margolis Institute.Connect With UsFor more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email claudia@theother80.com and follow us on twitter @claudiawilliams and LinkedInSubscribe to The Other 80 on YouTube so you never miss our video extras or special video...

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

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

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

In this episode of the Becker's Healthcare Podcast, Brook and Jocelyne from Verifiable dive into the critical connection between provider network growth, payer collaboration, and the modernization of credentialing systems. They explore how outdated legacy systems hinder patient access and provider onboarding, and share actionable strategies for healthcare leaders to improve compliance, reduce delays, and prepare for upcoming NCQA changes. With real-world examples — including Midi Health's rapid nationwide expansion — this discussion offers a forward-looking roadmap for building more efficient, scalable, and patient-centered networks.This episode is sponsored by Verifiable.

Summary Dr. Amy Vertrees hosts a discussion with Sarah Bellenger, a CRNA with extensive military and civilian healthcare experience. Sarah discusses her journey from military service to civilian practice, and the development of her app 'ManageYou'. Sarah Bellenger shares her 25-year nursing career experience, including service at the White House, military deployments, and transition to civilian practice. She emphasizes the importance of team-based care and the evolving role of CRNAs, particularly in rural healthcare settings. The discussion explores the challenges in anesthesia care team models, with Sarah explaining how CRNAs work independently in rural settings while collaborating with anesthesiologists in urban areas. She notes that the industry faces a significant staffing shortage, with a need for various provider types to ensure adequate coverage. Sarah introduces her app 'ManageYou', developed to address the widespread challenge of managing healthcare credentials. The app, available in both app stores, helps healthcare providers track and manage their professional documents, certifications, and licenses. She mentions that credential management is a $39 billion industry, and document mismanagement can cost facilities approximately $9,000 per day in lost billables. The discussion concludes with Sarah outlining future developments for ManageYou, including enhanced security features and potential integration with national credentialing systems. She emphasizes the importance of making credential management more efficient and accessible for healthcare providers. Chapters Introduction and Background Dr. Amy Vertrees introduces Sarah Bellenger, a CRNA with extensive military experience who developed an app for credential management. Sarah shares her 25-year nursing career journey, including service at the White House and multiple deployments. Evolution of CRNA Practice Sarah discusses the differences between military and civilian CRNA practice, emphasizing the importance of independent practice capabilities, especially in rural healthcare settings. She explains how military training prepares CRNAs for autonomous practice. Anesthesia Care Team Models Sarah explains the various anesthesia care team models, discussing the collaboration between CRNAs and anesthesiologists, particularly in urban versus rural settings. She addresses the industry-wide staffing challenges and potential solutions. ManageYou App Development Sarah describes the development of ManageYou, inspired by personal experiences with credential management challenges. She explains how the app helps healthcare providers organize and track their professional documents and certifications. Security and Future Development Sarah outlines the security measures implemented in ManageYou and discusses future developments, including enhanced features and potential integration with national credentialing systems. Action Items Sarah Bellenger mentioned the launch of ManageYou app in both Google Play and App Store for healthcare providers to manage their credentials Sarah Bellenger indicated plans to implement new security features for the app that exceed current standards Sarah Bellenger proposed integration with NCQA and other national credentialing systems for streamlined verification processes Sarah Bellenger recommended starting credential documentation with high-priority items like diplomas and frequently renewed certifications like CPRLinktree: http://linktr.ee/manageyouWebsite: www.manageyouapp.comLinkedIn https://www.linkedin.com/company/manage-you/ Instagram https://www.instagram.com/manageyou_app Facebook https://www.facebook.com/Manageyouapp1

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

“We need to be more ambitious….” Margaret “Peggy” O'Kane transformed healthcare quality measurement in America when she created NCQA 35 years ago. As she reflects on what it has meant to create the foundations for quality measurement, she is also clear that the complex state of healthcare requires leaders across payers, health systems, employers, and […]

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 a recent interview, Ed Yurcisin, Chief Technology Officer of the National Committee for Quality Assurance (NCQA), shed light on key advancements that aim to streamline quality measurement, improve interoperability, and accelerate the shift toward value-based care (VBC).Healthcare IT Today caught up with Yurcisin at the 2024 NCQA Health Innovation Summit in Nashville, TN.Learn more about NCQA athttps://www.ncqa.org/Find more great health IT content athttps://www.healthcareittoday.com/

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

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

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

Special Guest: Dr. Richard Safeer -- Author, Speaker, Workplace Health Pioneer, and Thought Leader Show Highlights · The power of journaling in sustaining healthy habits and positive thinking · The value of journaling during the workday to support health and well-being. Biography Richard Safeer, MD, earned his BS in Nutritional Biochemistry at Cornell University under the tutelage of T. Colin Campbell, author of the China Study, before attending medical school at State University of New York at Buffalo. Dr. Safeer is the Chief Medical Director of Employee Health and Well-being at Johns Hopkins Medicine, where he leads the Healthy at Hopkins employee health and well-being strategy. He also holds faculty appointments in the School of Medicine and Public Health at Johns Hopkins University. Prior to arriving at Hopkins, Dr. Safeer practiced family medicine in Northern Virginia. He was then on faculty at the George Washington University, serving as the Residency Director of Family Medicine in his last year at the institution. He was the Medical Director of an Occupational Health Center in Baltimore and Wellness Director for the Mid-Atlantic region of the parent company, just before starting at CareFirst BlueCross BlueShield in Baltimore, Maryland as the Medical Director of Preventive Medicine. He has been credited by some for bringing ‘wellness’ in to the realm of responsibilities of the managed care industry. He also led CareFirst BCBS to be among the first cohort of health plans to be accredited for Wellness by NCQA. He holds faculty appointments in both the Johns Hopkins School of Medicine as well as the School of Public Health. He continues to see patients one day a week in the Pediatric Cardiology department. Dr. Safeer is a fellow of the American Academy of Family Practice, The American College of Lifestyle Medicine, and the American College of Preventive Medicine. He served on the board of directors for the American College of Lifestyle Medicine. He is on the New England Journal of Medicine Catalyst Insight Council. Dr. Safeer has hiked and camped in the Andes, Alaska, Australia and across the Western United States. He lives in Columbia Maryland with his wife and three children, and their dog Kami. Website: RichardSafeer.com Book: https://amzn.to/3bG1q1D Training Program CreatingAWellbeingCulture.com A Cure for the Common Workday A Cure for the Common Company Social Media https://www.linkedin.com/in/richardsafeer/Support the show: http://www.cooleyfoundation.org/See omnystudio.com/listener for privacy information.

What data and quality related policy changes are on the horizon for healthcare? And is TEFCA really having a breakthrough moment? Healthcare IT Today sat down with Eric Musser, Vice President of Federal Affairs at the National Committee for Quality Assurance (NCQA) to find out. NCQA operates in the space between government, payers, plans, and providers. As such, they are uniquely positioned to both influence policymakers and help the healthcare industry adapt to policy changes. Healthcare IT Today jumped at the opportunity for an exclusive sit-down interview with Musser at the 2024 NCQA Health Innovation Summit that was held in Nashville, TN. You don't want to miss Musser's response when we ask him to explain his statement that “TEFCA is having a breakthrough moment”. Learn more about NCQA at https://www.ncqa.org/ Find more great health IT content at https://www.healthcareittoday.com/

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

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

In this episode, Kristin Cerf, President and CEO of Blue Shield of California Promise Health Plan, discusses the plan's recent four-star NCQA rating and the innovative approaches that led to this achievement. She shares insights on the importance of preventative care, data-driven strategies, and impactful community partnerships aimed at improving healthcare access for Medicaid members across California.

In this episode, Kristen Cerf, President and CEO of Blue Shield of California Promise Health Plan, discusses the plan's recent four-star NCQA rating and the innovative approaches that led to this achievement. She shares insights on the importance of preventative care, data-driven strategies, and impactful community partnerships aimed at improving healthcare access for Medicaid members across California.

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

What does it mean to transform healthcare quality measurement through digital innovation? In this episode of the Care Catalyst series hosted by Cognizant Product Director Chenny Solaiyappan, NCQA CPO Krishna Kandula speaks on the organization's transformative initiatives in the healthcare industry. Krishna shares his journey from a technologist to a healthcare quality and risk management expert, and how his experience has informed his work at NCQA. The discussion delves into the importance of HEDIS (Healthcare Effectiveness Data and Information Set) and NCQA's shift towards digital quality measurement and data aggregation and validation. Krishna explains how these initiatives are aligned with CMS's strategy to transition all quality measures to a digital format, enhancing data accuracy, interoperability, and ultimately, patient outcomes.

Send us a textUnlock the secrets to revolutionizing your healthcare benefits with insights from Josh Richter, a senior sales executive at Medical Associates, recorded live from the Iowa State Sherm Conference. Discover how HR professionals can transition from cumbersome traditional plans to flexible self-funded and level-funded options. Josh illuminates the rising importance of Individual Coverage Health Reimbursement Arrangements (ICHRAs) and tackles the thorny issue of prescription drug costs. Learn how Pharmacy Benefit Managers (PBMs) are key to cost management and why local providers like MedOne Benefits can be game-changers by passing rebates back to employers.Our conversation doesn't stop there. We dive into the importance of expert advice in health plan management to ensure employees receive top-quality care. With a meticulous quality control process involving NCQA and CMS ratings, customer feedback, and direct reviews, Medical Associates sets high standards. Hear about the critical roles of the quality control manager and customer service director as they stay current with healthcare trends and regulations. Finally, we wrap up our conference experience with heartfelt gratitude to our guests and a reminder to stay engaged with us on social media for more insightful discussions. Tune in for an episode packed with actionable takeaways for navigating the evolving landscape of healthcare benefits.Support the showRebel HR is a podcast for HR professionals and leaders of people who are ready to make some disruption in the world of work. Please connect to continue the conversation! https://twitter.com/rebelhrguyhttps://www.facebook.com/rebelhrpodcasthttp://www.kyleroed.comhttps://www.linkedin.com/in/kyle-roed/

Health Affairs' Jeff Byers welcomes Brad Ryan, MD, Chief Growth Officer at NCQA, to the program to discuss the evolving state of EHRs, who owns the data, whether providers are excited about data standards, and what opportunities could be out there as health care embraces more digital efforts and arrangements.Health Affairs released an ahead-of-print article this week by Gillian K. SteelFisher and coauthors examining the public awareness and perceptions of Paxlovid as well as discovering that a majority of Americans have limited awareness of the at-home COVID-19 treatment. Order the September 2024 issue of Health Affairs.Related Articles:Digital Quality Transition Hub from NCQAElectronic health records giant Epic Systems sued over alleged monopolistic practices (Stat+)

Tune in for today's industry updates.

Tune in to this episode of Health Views featuring Margaret E. O'Kane, founder and president of the National Committee for Quality Assurance (NCQA). Margaret delves into the fascinating NCQA origin story, her commitment to embedding quality in healthcare, and how NCQA is pioneering new approaches to evaluate virtual care, mental health and advance health equity.

The healthcare system is in freefall with rising costs, worse care, and frayed patient-provider relationships.Is value-based care the cure?Join us in this week's HealthBiz Brief, as Emily Young, President of Tufts Medicine, and Courtney Fortner, President and CEO of Navvis, as they detail how their partnership is expanding value-based care with an eye on improving quality, affordability, and experience.

Join Dr. Alex Li, Chief Health Equity Officer at L.A. Care Health Plan, as he discusses key questions on health equity. From why addressing disparities is gaining momentum to L.A. Care's journey towards NCQA accreditation, explore the challenges and solutions in advancing equitable healthcare, with insights on the role of AI.

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

Point-of-Care Partners (POCP) Dish on Health IT hosts, Pooja Babbrah and Jocelyn Keegan welcome special guest Laura McCrary, President and CEO (Chief Executive Officer) of KONZA National Network. KONZA was recently designated as one of the first five Qualified Health Information Networks, or QHINS (Qualified Health Information Networks), to participate in the Trusted Exchange Framework and Common Agreement (TEFCA)Laura McCrary speaks with hosts about: Why KONZA pursued QHIN statusInsight into the QHIN processHow KONZA's status as a Health Information network since 2010 forms their approach as a QHINKONZA's initial Membership mix, and What's new or surprising in the TEFCA Common Agreement version twoBefore digging into the meat of the episode, Jocelyn Keegan introduced herself briefly as the payer practice lead at POCP, program manager of HL7 Da Vinci Project and devotee to positive change building and getting stuff done in healthcare IT. She added that her focus at POCP is on interoperability, prior authorization and the convergence of where technology, strategy, product development and standards come together.Jocelyn ended her introduction by saying that she has had the honor of seeing Laura McCrary present on several occasions and that her pragmatic approach is refreshing and that she is looking forward to hearing how KONZA will be building on their already vibrant HIE (Health Information Exchange) footprint as a QHIN. Next Laura introduced herself sharing that she has been working on interoperability strategy in Kansas and then expanding to nationwide over the last 4 decades. She started her career as a special education history teacher. Early in her career she realized that while these children were in her care, she should have some basic information about medications or conditions so she could be informed and able to ensure everyone was well cared for. Of course, nobody shared medical records with teachers and parents didn't have access to their kid's patient records either. Making sure special education teachers or at the very least the school nurse could access necessary clinical information at the point of care became a passion of hers which led to an early success in her career which was working with the University of Kansas Medical Center setting up one of the first telemedicine programs in the public-school systems. Because of this work, since the early 2000's, elementary kids in Kansas City, KS inner-city public-school systems have had access to basic health and telemedicine services. The telemedicine project helped Laura realize that technology really could bridge access gaps if we built and employed a robust technology infrastructure.When asked about KONZA's mission and reasons for becoming a QHIN, Laura shared that the name “KONZA” is named after a Kansas prairie that is one of the most beautiful prairies in the nation. The way KONZA originated in Kansas around 2010 is a bit different than how other HIEs started. Most states at that time received federal funding through the American Recovery and Reinvestment Act to establish health information exchanges.Kansas was different in that instead of standing up a state-sponsored exchange, they actually encouraged a private-public partnership and opened the floor for any organization who wanted to do business as a health information exchange in Kansas could so as long as they meet a set of very rigorous accreditation requirements, which included some pretty innovative ideas for that time.For example, one of the things that was required was that the health information exchange needed to share all information with patients. As early as 2012, Kansas HIEs were required to have a personal health record for patients where they could access any data that was in the health information exchange. QHINS must also do this by offering “individual access services” and KONZA has already been doing this for over a decade. In addition to sharing data with patients, Kansas also required data sharing of HIPAA (Health Insurance Portability and Accountability) approved treatment, payment, and healthcare operations data with payers as it relates to their members.  Laura continued by sharing that today, 4 exchanges do business in Kansas, and they all work together as well as connect to other exchanges. KONZA also expanded to be able to serve patients across state lines as Kansas residents cross over into Missouri quite often to consume healthcare. Because of this history and background, Laura shared that becoming a QHIN was a natural progression and a way to support their mission to make sure all participants have access to their own or their patient's data. Pooja asked Laura about the process of becoming a QHIN. Pooja acknowledged the stringent requirements for QHINs and mentioned challenges discussed at the ONC Annual meeting in December.Laura shared KONZA's experience, saying they initially thought it would be like Kansas certification requirements. However, the application process involved demonstrating sustainability, financial viability, high trust certification for security, and proper information sharing using IHE protocols. KONZA became a candidate QHIN in February of the previous year, requiring the development of a project plan addressing technology conformance testing and demonstrating business viability.Laura emphasized the challenge of meeting high-level requirements, including safety, security, project management, and board governance. Notably, QHINs must have 51% of their Board of Directors as members, ensuring those participating in the network make decisions about the business model. KONZA reached 49% and welcomed a new member from a public health organization in January. The ongoing process involves meeting the remaining requirements to become a fully certified QHIN.Laura said the process of becoming a QHIN is a continuous work in progress. While they successfully crossed the finish line and are in production, she emphasized the need for ongoing changes to advance interoperability and data sharing. Laura highlighted the importance of QHINs working together as colleagues and federal leadership setting expectations for the national network. After four decades of working on the project, she expressed great satisfaction with the current state of progress.Pooja inquired about the impact of the diverse functional areas of the first group of QHIN designees on their operations. She expressed curiosity on behalf of Point of Care Partners, highlighting KONZA's background as a health information exchange in Kansas and seeking insights into how this background influenced KONZA's role as a QHIN.Laura responded by emphasizing the significance of diversity among QHINs as a valuable asset. She expressed excitement about the potential for innovative solutions to emerge from the diverse backgrounds of QHINs, enabling a departure from a one-size-fits-all approach. Laura expected the development of exciting and innovative solutions unique to each QHIN's diverse background.Pooja then invited Jocelyn to share her thoughts. Jocelyn expressed appreciation for Laura's insights, noting that knowing more about Laura's background made sense. She highlighted the importance of Laura's background in approaching long-term transformation. Jocelyn commended the incremental progress and permanent change advocated in the industry, aligning with Laura's pragmatic approach.Jocelyn acknowledged the mix of QHINs as fascinating and emphasized the importance of meeting people where they are. She recognized the relay race nature of the journey, with December marking the start of a new phase. Jocelyn predicted the challenge of creating compelling business cases and exploring the evolving business model for QHINs. She expressed interest in seeing the progress reports as end users transition from the HIE world to the TEFCA world.Laura emphasized the importance of KONZA serving as the QHIN for Health Information Exchanges (HIEs) and growing out of the HIE space. She expressed the belief that onboarding HIEs to their QHIN is crucial for expanding access to a broader set of data, benefiting patient care. Laura highlighted the critical role HIEs play in meeting the healthcare needs of communities, states, and regions.To ease this onboarding process, KONZA actively reached out to HIEs. Laura shared her personal commitment by mentioning that she had personally spoken with every HIE in the last six months. Additionally, KONZA planned to initiate HIE office hours to engage with HIEs and discuss the onboarding process to the QHIN. Laura conveyed a strong sense of responsibility, stating that if HIEs were not successfully onboarded to QHINs, she would personally feel like they had failed. She recognized the significant value and commitment HIEs have provided to their communities and stressed the importance of building upon their established connections and capabilities.Jocelyn initiated a discussion on expanding endpoints and the role of payers in TEFCA. She acknowledged Laura's insight into the base requirement in Kansas that involved having payers at the table, filling gaps in understanding about payer participation in national programs. Jocelyn expressed interest in understanding the implications of active payer participation, especially with recent rules requiring payers to provide data to providers.Laura provided a comprehensive response, highlighting the common inclusion of payers in HIE networks and the evolving landscape outlined in TEFCA requirements. She emphasized that recent rules, including prior authorization, point towards increased payer participation in the QHIN model. Laura praised ONC's efforts and leadership, acknowledging the challenge of absorbing the vast amount of information released.Laura discussed the significance of two specific SOPs (Standard Operating Procedure) dropped on Friday related to delegation of authority and healthcare operations. She encouraged stakeholders to focus on these documents, emphasizing the critical role they play in bringing clinical and claims data together. Laura outlined the historical challenge of integrating clinical and claims data, noting that TEFCA offers an opportunity to bridge this gap.Notably, Laura highlighted the requirement for payers participating in the QHIN model to provide adjudicated claims. She acknowledged that while this transformation may take time, conversations with payers indicated openness to sharing crucial data that providers might not have. Laura expressed excitement about the groundwork laid in the SOPs, anticipating an amazing transformation in healthcare. She encouraged innovative companies to explore the delegation of authority, foreseeing its profound impact on healthcare transformation.Pooja highlighted the collaboration between CMS and ONC in recent rule drops and mentioned the inclusion of FHIR (Fast Healthcare Interoperability Resource) in the latest regulations. Jocelyn asked for comments on this, pointing out varying levels of maturity in QHINs' FHIR programs. She emphasized the shift towards API (Application Programming Interface) and codified data over documents, aiming for automation and reducing human involvement. Jocelyn expressed interest in Laura's perspective, considering the existing collaborations and partnerships.Laura explained the importance of EHRs (Electronic Health Records) being FHIR-enabled for effective data sharing with QHINs. She clarified that while QHINs can be FHIR-enabled, the critical factor is whether EHR vendors support FHIR. Laura highlighted the necessity for EHR systems to have FHIR endpoints and publish them in the RCE (Recognized Coordinating Entity) directory for effective data retrieval. She stressed that both FHIR endpoints and resources are crucial for successful data exchange. Regarding facilitated FHIR, Laura expressed excitement about its implementation by the end of Q1. She mentioned the role of facilitated FHIR in responding to payers and highlighted the importance of the healthcare operations SOP. Laura also discussed the bulk FHIR initiative by NCQA, expressing enthusiasm for participation. She emphasized the significance of FHIR in sharing minimum necessary data, addressing the challenges posed by lengthy patient care documents. Laura underscored FHIR's role in providing relevant information to physicians and caregivers based on their specific needs.Pooja, the host, moves to the closing segment, asking cohost Jocelyn and guest Laura for final messages or calls to action. Jocelyn commends Laura on FHIR progress and highlights the importance of maturity and bulk FHIR for automation. She mentions an upcoming Da Vinci Community Roundtable discussion on the clinical data exchange FHIR guide and encourages engagement with Laura for early participation in payer use cases.Laura emphasized the profound opportunities with QHINs, including potential in public health and COVID response. Laura invites those interested in discussing the future of healthcare data and transforming patient care to reach out via LinkedIn, email, or to call her. Pooja expressed gratitude to guest, Laura McCrary for joining The Dish on Health IT and to listeners for tuning in. 

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

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

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

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

In this illuminating podcast episode, Ed Yurcisin, Chief Technology Officer at NCQA, sheds light on the organization's pivotal role in defining quality standards in healthcare and their ongoing journey into digitization. Discover the critical significance of data interoperability and adopting FHIR standards in the healthcare landscape. Ed Yurcisin emphasizes how these initiatives can catalyze improved care coordination and advanced data analysis. Dive into the potential advantages of bulk FHIR, exploring its transformative impact on data exchange and analytic capabilities. Ed Yurcisin leaves us with a resounding message—the transformative promise of interoperability and data standards is the key to reshaping the entire healthcare industry. Ready to explore the future of healthcare? Connect with this episode to gain valuable insights from a key industry figure. Stay tuned for potential follow-up discussions because the journey to reshape healthcare through interoperability and data standards is just beginning!  Resources: Follow and Connect with Ed on LinkedIn Follow NCQA on LinkedIn Visit NCQA's Website

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

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

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

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

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

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

I cut this clip out of episode 407 with Vivek Garg, MD, MBA, from Humana; and it's actually a really nice follow-on from the show last week with Scott Conard, MD, where we talked about the blowback that happened with clinicians at a clinic. This clinic had put into effect a bunch of the comprehensive primary care kinds of things that Dr. Garg talks about in this summer short. But what happened in Dr. Conard's case is a new practice manager tried to go back to the olden days, and, spoiler alert, it was a kerfuffle. All the docs and the rest of the clinicians staged what sounded like a “mutiny on the bounty” moment from the way Dr. Conard described it. So, this summer short you're about to hear and the one from last week again share one key point: Doctors, advanced practice clinicians, medical assistants, pretty much everybody on the team really likes a well-executed, operationally excellent transformed primary care model. And it produces better patient care. I was reading Dr. Robert Pearl's book Uncaring the other day, and he summed up the reason why, I think, these transformed primary care practices do better. He was quoting Atul Gawande, and here's the quoted quote: “The public's experience is that we have amazing clinicians and technologies but little consistent sense that they come together to provide an actual system of care, from start to finish, for people. We train, hire, and pay doctors to be cowboys. But it's pit crews people need.” I interviewed Dr. Pearl, by the way, so stay tuned for that show coming up. In this summer short, Dr. Garg digs into one common objection to more comprehensively comprehensive primary care, and that is that by improving care, we decrease throughput and, therefore, access to primary care, especially in areas where there are not enough primary care doctors.   You can learn more at humana.com, centerwellprimarycare.com, and the Humana report.     Vivek Garg, MD, MBA, is a physician and executive dedicated to building the models and cultures of care we need for loved ones and healthcare professionals to thrive. He leads national clinical strategy and excellence, care model development and innovation, and the clinical teams for Humana's Primary Care Organization, CenterWell and Conviva, as chief medical officer (CMO), where they serve approximately 250,000 seniors across the country as their community-based primary care home, with a physician-led team of practitioners, including advanced practice clinicians, nurses, social workers, pharmacists, and therapists. Dr. Garg is the former chief medical officer of CareMore and Aspire Health, innovative integrated healthcare delivery organizations with over 180,000 patients in over 30 states. He also previously led CareMore's growth and product functions as chief product officer, including expansion into Medicaid primary care and home-based complex care. Earlier in his career, Dr. Garg joined Oscar Health during its first year of operations as medical director and led care management, utilization management, pharmacy, and quality, leading to Oscar's initial NCQA accreditation. He was medical director at One Medical Group, focusing on primary care quality and virtual care, and worked at the Medicare Payment Advisory Commission, a Congressional advisory body on payment innovation in Medicare. Dr. Garg graduated summa cum laude from Yale University with a bachelor's degree in biology and earned his MD from Harvard Medical School and MBA from Harvard Business School. He trained in internal medicine at Brigham and Women's Hospital, received board certification, and resides in New Jersey.   02:31 Does advanced primary care reduce access to patients? 03:01 Are five-minute visits with patients really access? 04:17 Will advanced primary care provide outcomes that make certain PCP responsibilities unnecessary?   You can learn more at humana.com, centerwellprimarycare.com, and the Humana report.   @vgargMD discusses #advancedprimarycare on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Scott Conard, Brennan Bilberry, Stacey Richter (INBW38), Scott Haas, Chris Deacon, Dr Vivek Garg, Lauren Vela, Dale Folwell (Encore! EP249), Eric Gallagher, Dr Suhas Gondi

Okay … let me get real here for a sec. For a few reasons, I wanted to chat with Vivek Garg, MD, MBA. Dr. Garg is CMO (chief medical officer) of primary care at Humana. Dr. Garg is an inspiring and incredibly articulate individual, and I like to both learn from and also be kept on my toes by the likes of such folks. But also, yeah, I'm suspicious of vertically consolidated payers. I mean, you listen to this podcast. I don't need to recap what the financialization of the healthcare industry has done to patient care. But you heard my manifesto in episode 400. It's about trying to find the right path forward and being open to exploring options here. It's considering what doing well by doing good actually means. It's contemplating whether to celebrate some good stuff going on in the industry even if there's some not-so-good stuff going on in that same sector or even in that same company. Bottom line: We're living in the real world here, and utopia is not on the table, at least anytime soon. So, that means there is always going to be one thing that we are always going to have to have to weigh in our consideration set, in our assessment equation that I talked about in my manifesto in episode 400. What's this one thing? It's self-interested, shareholder-centric goal setting. In other words, just because I spot a self-interested, shareholder-centric goal doesn't mean I'm automatically gonna get out my red Sharpie and cross off the whatever with a sour expression on my face because … yeah, if I did that, a whole lot of Americans are not gonna get, even incrementally, better healthcare. The right equation to determine if something is net-net good is always going to be nuanced. The equation should weigh the impact of the self-interest, which is always going to be there, against the impact on patient care and patient financials and how the whole thing impacts clinicians at a local level or maybe a national level, depending on what's going on. I'd also suggest that there's no real broad strokes here, because the equation for any given initiative or pilot or approach is really singular. I think it'd be a big mistake to lump together, for example, all payviders across the country and assume that their impact is all the same. Or all Medicare Advantage plans. Or anybody doing advanced primary care. All of these words/groups I just referenced are relevant to the conversation today. You have some payviders, for example, doing all kinds of crap with dummy codes and/or anticompetitive contracts and/or steering only to their own medical groups which they staff inadequately and/or blanket denials of anything that will throw off their medical trend calculations and/or prescribing and care pathways coinciding with their own highly financialized PBM (pharmacy benefit manager) formularies. But then, on the flip side, you also have some interesting things going on that help patients and their communities. A key ingredient of these interesting things is taking into account longer time horizons. Longer time horizons are actually pretty key here for anybody trying to do anything preventative or anything involving forming patient relationships. Also, of course, you have those who are doing some combination of the good stuff and the not-so-good stuff; and one of the reasons why the not-so-good stuff becomes so ingrained is that risk adjustment (especially if you're a payvider) across the board has anything but a longer time horizon. So, let's dig into what Dr. Vivek Garg has going on at Humana Primary Care, which includes CenterWell Senior Primary Care and also Conviva Care Center. I ask Dr. Garg some pretty hard questions about balancing the tension between being a payer with a PBM with an incentive to deny care and a provider organization seeing patients that is also beholden to those same shareholders. Dr. Garg taught me a new term, and that's the “dyad model,” where you have doctors and admins working together or clinicians and admins working together. You get the clinical team to shadow the administrative team, and you get administrative team to shadow the clinical team. You teach doctors and others the business of medicine, and you teach admins what it's like to be a clinician or a patient on the other end of some of those policies. Now, if you have a good memory, you are probably also recalling that Eric Gallagher from Ochsner (EP405) talked about this exact same concept (ie, working together, ie, the scrubs and the suits coming together into this dyad leadership model). There's a quote from Denver Sallee, MD, in episode 402 with Amy Scanlan, MD, talking about pretty much this exact same thing. And furthermore, this whole getting doctors up to speed on the business of medicine is gonna be the topic of an upcoming episode with Adam Brown, MD, MBA. So, yeah … this is becoming a thing—the idea of teaching clinicians the business of medicine. But the opposite should also get some focus—teaching admins the medicine of medicine. Dr. Garg cites three pillars to improving an organization's ability to sustainably deliver better healthcare, and these three pillars are (1) to focus on the patient experience, (2) to focus on outcomes, and then (3) to engage the clinical teams and really protect them, to protect this precious resource that doctors and other clinicians actually are. Taken together, these three pillars coincide with the pivotal question here. And that pivotal question is: How much is any given entity actually investing in clinical leadership? Because in combination, great clinical leadership plus the three pillars (ie, a focus on experience, outcomes, and clinical engagement), you put all those things together and it adds up to each individual who works in the place to harness their own intrinsic motivation—to be able to explore and double down on and actually achieve the reasons why they went into healthcare to begin with and spent years of their lives in school in order to do so. Dr. Garg mentions the latest Humana report in the show. And then I mention how I interviewed Steve Blumberg from Guidewell (AEE12) about the 2020 Humana report. Also mentioned on this show is episode 312 with Doug Eby, MD, MPH, CPE, from the Nuka System, and episode 405 with Eric Gallagher from Ochsner.   You can learn more at humana.com, centerwellprimarycare.com, and the Humana report.     Vivek Garg, MD, MBA, is a physician and executive dedicated to building the models and cultures of care we need for loved ones and healthcare professionals to thrive. He leads national clinical strategy and excellence, care model development and innovation, and the clinical teams for Humana's Primary Care Organization, CenterWell and Conviva, as chief medical officer (CMO), where they serve approximately 250,000 seniors across the country as their community-based primary care home, with a physician-led team of practitioners, including advanced practice clinicians, nurses, social workers, pharmacists, and therapists. Dr. Garg is the former chief medical officer of CareMore and Aspire Health, innovative integrated healthcare delivery organizations with over 180,000 patients in over 30 states. He also previously led CareMore's growth and product functions as chief product officer, including expansion into Medicaid primary care and home-based complex care. Earlier in his career, Dr. Garg joined Oscar Health during its first year of operations as medical director and led care management, utilization management, pharmacy, and quality, leading to Oscar's initial NCQA accreditation. He was medical director at One Medical Group, focusing on primary care quality and virtual care, and worked at the Medicare Payment Advisory Commission, a Congressional advisory body on payment innovation in Medicare. Dr. Garg graduated summa cum laude from Yale University with a bachelor's degree in biology and earned his MD from Harvard Medical School and MBA from Harvard Business School. He trained in internal medicine at Brigham and Women's Hospital, received board certification, and resides in New Jersey.   07:27 What does comprehensive primary care look like, and what can we expect from it? 07:39 Is the comprehensive primary care model the single biggest tool to help improve health? 10:41 How does a competitive ecosystem affect a comprehensive primary care model? 15:44 What is the impact of physicians and clinicians on the delivery of comprehensive care? 19:25 EP312 with Doug Eby, MD, MPH, CPE, of the Nuka System. 20:22 “What we need to do with the technology is actually support and enable the team.” 21:42 Why it's important to create “space” in your comprehensive care model. 24:56 What three areas does every organization need to pay attention to? 31:03 Why the opportunity for alignment is greater than the potential for conflict. 32:48 Why long-term orientation is a key to success, even in an ecosystem that's more short-sighted. 34:30 AEE12 with Steve Blumberg.   You can learn more at humana.com, centerwellprimarycare.com, and the Humana report.   @vgargMD of @Humana discusses comprehensive #primarycare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #hcmkg #healthcarepricing #pricetransparency #healthcarefinance   Recent past interviews: Click a guest's name for their latest RHV episode! Lauren Vela, Dale Folwell (Encore! EP249), Eric Gallagher, Dr Suhas Gondi, Dr Rachel Reid, Dr Amy Scanlan, Peter J. Neumann, Stacey Richter (EP400), Dawn Cornelis (Encore! EP285), Stacey Richter (EP399)