Karen and Jeff outline primary care’s distinguishing focus on patient relationships, the strain on the primary care workforce, and technology’s promise to ease burdens. The discussion connects the dots between workforce sustainability, AI-driven efficiency, payment reform, and NCQA’s vision for next-generation primary care.

Karen highlights the underappreciated fact that only 5% of health care spending goes to primary care, despite public perception that the figure is—and should be—higher. Jeff describes a dawning era of proactive, data-driven care delivery. He also previews NCQA’s plans to build upon the successful Patient-Centered Medical Home model of primary care.

Highlights

• The Human Core of Primary Care: Continuity and trust are what make primary care special, even as practice settings change.
• Workforce Challenges and Opportunities: Clinicians report high stress and burnout, yet relationships with patients keep them engaged. Building systems that protect these relationships—and make primary care careers attractive—is critical to sustainability.
• Economics and Incentives: Guests discuss new payment models, state-level initiatives and federal efforts to rebalance incentives and support primary care in new ways.
• Looking Ahead: The foundational Patient-Centered Medical Home model gets an update in 2026. Plus, Karen calls for a seismic shift to resource primary care as a common good.

This episode is essential listening for healthcare executives, policymakers, and clinicians committed to strengthening primary care as the cornerstone of quality improvement.

Key Quote:

If you want to boil it down to the simplest terms, it's taking primary care from a reactive model—Call me when you're sick; I'll put you on my schedule; Come in and see me—to a proactive model.

I am paying attention to a population of patients. They're mine. They're on my panel. And now maybe they're also tied to some accountability arrangement in value-based care, where performance comes into play.

And so I'm going to be proactive for a lot of reasons. One, it's the right thing to do for patients. But I also want to make sure my patients are getting preventive services they need, they are taking the medications I prescribe, they are going to the referral I recommended. And I'm getting the information back from that physician, and my team is acting on that. It's all of those things that should be ubiquitous in primary care.

-Karen Johnson, PhD

Time Stamps:

(01:07) The Changing Landscape of Primary Care

(06:42) Challenges in the Primary Care Workforce

(08:49) How Technology is Impacting Primary Care

(15:59) Future Directions and Innovations

(18:11) NCQA's Plans for 2026

Dive Deeper:

State of the Primary Care Workforce 2024 (HRSA)

The Pulse of Primary Care (JGIM)

Connect with Karen Johnson

Connect with Jeff Sitko

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Together, they reflect on Peggy’s 35-year legacy of building the nation’s first quality measurement and accreditation programs, and discuss the future of NCQA under Vivek’s leadership. From embedding quality measurement into medical practice to tackling fragmentation and misaligned payment incentives, this episode captures both the persistence required to drive change and the optimism for what lies ahead.

Peggy shares candid reflections on the quality movement’s achievements, including the creation of national standards and her push to make quality measurement more clinically relevant. Vivek offers personal insights shaped by his family’s health care journey, his career in value-based care, and his vision for advancing interoperability, chronic condition management and specialty care integration.

This conversation, Passing the Quality Torch, is a must-listen for health care executives, policymakers and clinicians committed to building on quality’s decades of success to create a more data-driven and sustainable health care system.

 Highlights: 

• Origins and Transformation of Quality Measurement: Peggy recounts the shift from outdated peer review models to building the first national measurement and accreditation systems, setting the foundation for modern health care standards.
• Leadership, Persistence and Collaboration: The conversation highlights the need for resilience and adaptability in driving change, plus the need for teamwork within and across disciplines.
• Technology’s Role in Reducing Burden: Both leaders emphasize how tech-driven solutions can streamline medical practice, remove inefficiencies and reduce clinicians’ burden.
• Chronic Condition Management and Specialty Care Integration: Vivek underscores the need for longitudinal care strategies and better coordination between primary and specialty care.

Key Quote:

“We have an opportunity to work together with the community to say, 'Let's plant our flag. What is that next aspirational vision?’ Because the standards are part guidepost and part instruction manual. But they reflect this commitment across the community that we can be better, and we can define what that looks like. And some of us are gonna go for it. So I'm excited about all of those areas.”

-- Vivek Garg, MD

Time Stamps:

• (02:42) Reflections on 35 Years of Quality
• (6:59) Peggy’s Prescription
• (10:50) Vivek’s Path to NCQA
• (15:52) Vivek’s Vision for the Future
• (18:27) We All Have a Role in the Transformation to Come

Links:

Connect with Vivek Garg

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Together, they unpack the meaning of disability in health care, the importance of self‑identification and how NCQA is working to improve outcomes for people with disabilities. The conversation bridges academic, policy and real-life perspectives, making a compelling case for why disability is central to quality improvement.

Listen to learn about:

• Disability and Destiny: One in four Americans has a disability. That prevalence understates everyone who will have a disability.
   
• Defining and Measuring Disability: Policymakers and disability advocates agree that people with disabilities should define their own disability status. Measures of population health and quality must adjust accordingly.
   
• NCQA’s Contributions and Innovations: New standards for Health Outcomes Accreditation and the Disability Description of Membership measure in HEDIS 2026 show disability can be a valuable lens for assessing quality.
   
• Designing for Inclusion: From curb cuts in sidewalks to adjustable exam tables, accessibility is a design principle that improves life for everyone—not just those who identify as disabled.

This episode is an essential resource for quality advocates, policymakers, accreditation professionals and others committed to improving care for all. It underscores that disability is not a niche issue but something that affects nearly all of us, eventually. By accounting for disability, health care can be better and more accessible for everyone.

Key Quote:

“The reason to use words like illness and impairment is someone may have a functional limitation but not identify with the term disability. That's common in some groups, like older adults, where having some physical limitation may lead to experiences similar to someone who would identify as being disabled. But that person might not identify with the term disability.

Different people identify with different terms that underlie that same need for accommodation and access. Someone may consider themselves disabled but not have that same limitation—because of technology, the way the physical space has been built or laid out—may not actually experience that functional limitation.

So wording needs to be broad and encompassing to capture the range of experiences within the disability community.”

 -Rupa Valdez, PhD

Time Stamps:

(01:46) Understanding Disability in Health Care

(03:40) Challenges in Measuring Disability Care

(07:30) Addressing Ableist Bias

(12:29) Building Better Standards and Measures for Disability Care

(18:52) Tips on Improving Care for People with Disabilities

Dive Deeper:

NCQA Health Outcomes Accreditation

HEDIS Disability Description of Membership (DDM)

Connect with Rupa Valdez

Connect with Polina Lissin

Connect with Elizabeth Ryder

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

To illuminate what makes virtual care safe, effective and sustainable, Misty and Claire unpack NCQA’s new Virtual Care Accreditation program. They explore five essential standards that define excellence in virtual primary and urgent care—and share insights from Everlywell’s experience piloting the standards. Misty and Claire make a compelling case for treating virtual care as a permanent, integrated part of the health care continuum.

Listen to learn about:

• Quality and Patient Safety in Virtual Care: Virtual care must meet the same clinical and ethical standards as in-person care. Misty and Claire explain how high standards ensure rigorous quality improvement and patient safety across remote modalities.
• Fixing Fragmentation Through Care Coordination: Virtual care can either bridge or widen gaps in the system. Effective care helps prevent “referral loops” and ensure seamless handoffs between virtual care and in-person providers.
• Equity Beyond Access: Equitable virtual care means more than logging in; it’s about language, culture and more. Misty shares ideas on how to tailor care to patients’ preferences, regardless of zip code or income.
• Clinician Experience Matters: Virtual care can reduce burnout, but only if it’s intuitive and sustainable. Hear how effective standards for virtual care support clinicians with better workflows, realistic panel sizes and time to recharge.
•  

Key Quote:

“ As a clinician, I can tell you that handoff is everything. A great virtual encounter means nothing if the patient falls through the cracks afterwards or gets on this continuous referral highway, and is never able to get off of it. So NCQA really ensured for us that virtual providers have defined workflows for referrals. We had to make sure that this was really buttoned up, as we didn't want anybody to get stuck on that referral loop or fall through the cracks. We wanted to make sure that the patients experience continuous care versus fragmented care. And it's really about making sure virtual care doesn't create silos, but that it strengthens that bridge between virtual care and in-person care.”

 -Misty Milby

--

Time Stamps:

(04:26) Misty’s Dream for Virtual Care

(08:35) Quality and Patient Safety

(10:03) Expectations for Care Coordination

(11:32) Assessing Equitable Access

(13:34) Goals for Patient and Clinician Experience

(16:29) Standards for Sharing and Exchanging Data

--

Dive Deeper:

NCQA Virtual Care Accreditation

Connect with Misty Milby 

Connect with Claire Mendelson

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

With decades of experience spanning academic medicine, hospital administration and retail health care, Troy brings candor and clarity to the challenges facing American health care and the promise of primary care reform.

Troy’s insights are both sobering and hopeful, pointing to a future where coordinated, data-driven primary care can finally fulfill its promise.

Highlights:

• ·Diagnosing a System Under Pressure: The limits of fee-for-service payment and why employer-sponsored insurance is reaching a breaking point.
• Building the Foundation for Better Care: The critical role of primary care in medicine’s value-based future.
• Spotlighting Innovation Across the Map: Real-world examples of successful primary care transformation, including Catalyst Health in Texas and Southcentral Foundation in Alaska.
• Reimagining Accreditation for Modern Needs: Reflections on NCQA’s Patient-Centered Medical Home and future redesigns.
• Clearing the Policy Bottleneck: Observations on policy inertia and how policymakers can accelerate change.

This episode is a timely and thought-provoking update for healthcare executives, policymakers and clinicians committed to building a more sustainable, efficient health care system.

Key Quote:

The only way you can see a health care system that works in the future is if it's value based—that it’s prospective payment and risk on the providers for the elaboration of care provided.

If we believe what most people write about these things, we've got 25 to 30% waste as a result of the fee-for-service system.

If we move to a value-based approach, that's money that's going to fund the system, that extra third that we can put back into real health care. So you need a value-based approach.

-- Troy Brennan, MD

Time Stamps:

• (3:12) Employment-Based Health Care is Unsustainable 
• (7:29) The Value-Based Future and Primary Care
• (10:00) Payment Disparities and Policy Inertia
• (22:00) Technology and Data Analytics in Advanced Primary Care
• (28:18) Peggy’s Reflection

Links:

Connect with Troyen Brennan

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Aiming to help listeners navigate behavioral healthcare’s complexities, Kate outlines four essential dimensions of the field. She also explores how validated clinical tools and emerging technologies, such as wearables, can help measure what matters in behavioral health. She makes a powerful case for moving beyond fee-for-service toward value-based payment models that incentivize coordinated care and reach vulnerable patients.

Listen to learn about:

• Understanding Gaps in Access: Fragmented systems and funding silos make care hard to reach, especially for people who need care the most.
• What’s Exciting—and Worrisome—About Digital Technology: Digital innovation expands the reach of the behavioral health workforce and enables smarter, scalable care. But ongoing attention to accuracy and privacy is essential.
• The Need for Value-Based Payment: Fee-for-service “breaks” behavioral healthcare and fails vulnerable people most of all. Value-based care offers the path to quality, equity and sustainability.

Key Quote:

“We cannot exist with fee-for-service. We have to move to a value-based approach.

You've seen progression in behavioral health with payers and states moving towards value-based payments that are holding providers accountable for quality.

That gets me excited because that's going to help us move the needle and fund the level of resources we need to help people get better.”

 -Katherine Hobbs, MD, MPH


Time Stamps:

• (03:16) Assessing In-Person vs. Virtual Behavioral Healthcare
• (05:07) Wearables and Other Tech-Based Innovation
• (06:08) Understanding and Measuring Access to Behavioral Healthcare
• (10:56) Why Fee-For-Service Must Go
• (15:20) Excitement for the Future

Dive Deeper:

Connect with Katherine Hobbs

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

From the outset, Peggy is captivated by Anna’s clarity, conviction and optimism. Anna doesn’t just understand the technical challenges of digital transformation—she makes them accessible and inspiring. With a natural gift for storytelling and empathy for patients and providers alike, Anna explains why interoperability and value-based care are not just buzzwords but essential pathways to a better system. 

Anna’s personal anecdotes, including her father’s experience with AFib, bring urgency and humanity to the conversation. Peggy calls Anna an ally in the movement for quality, and it’s easy to see why: Anna’s vision is practical, inclusive and motivating.

Listen to learn about:

• Embracing Imperfection to Drive Innovation: Anna challenges the perfectionist mindset in the quality world, advocating for iterative improvement and a willingness to try, fail and learn.
• Reengineering Workflows for Better Care: Anna has a specific vision for redesigning administrative tasks like prior authorization so clinicians are free to focus on meaningful patient interactions.
• Proving the Power of Web-Based Reporting: Anna discusses an initiative that shows how API-driven reporting can scale quality measurement affordably and accurately.

This episode will resonate with clinicians, policymakers and technology leaders who are eager to rethink how care is delivered—and who appreciate the power of clear, passionate communication to drive change.

Key Quote:

 I know there's a better way to do this because you can see it in your mind how it can flow. It's just not the culture that's built into a fee-for-service world. 

We have to go on a cultural journey and exploration on why we're really here to do this work and figure out how do we get to those workflows that are going to: Number one, give us more space in our schedule for patients. Number two, get the patients who need the most care, be able to stratify patients and be able to monitor more. 

Getting that cultural mind shift is hard. And the quality outcomes could be better if we can get all this data together to make better decisions about a care plan. 

I'm really thankful for my dad's ability to outlive his father and so on because of modern medicine. We can do better. We can do so much better in the care we provide our patients.

-- Anna Taylor

Time Stamps:

• (06:22) Value-Based Care and Misaligned Incentives
• (09:45) Anna’s Story: Technology, Data, and Her Father’s Care
• (12:48) How Digitalization Helps Primary Care
• (17:59) Embracing Imperfection and Driving Innovation
• (27:45) Peggy’s Reflections

Links:

Connect with Anna Taylor

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Drawing on Josh’s experience in clinical care and informatics, the conversation reveals how states and standards bodies can work together to ensure innovation serves people—not just systems.

Listen to this episode to discover:

• AI with a Human Touch: Josh shares how Missouri is designing AI systems that center citizen experience, protect privacy and preserve empathy in care delivery.
• Cross-Agency Collaboration as a Catalyst: Learn how Missouri’s unified health data strategy breaks silos and builds trust across public health, social services and mental health care systems. 
• Workforce Readiness in the Age of AI: Explore how upskilling and retention strategies are helping Missouri address staffing shortfalls and prepare its workforce for a future of data-driven care.
• The Sunny Side of AI: Hear why optimism, not fear, is driving Missouri’s approach to innovation, and how thoughtful, ethical design can unlock better outcomes at scale.

This episode is essential listening for health IT leaders, policymakers and quality professionals who want to understand how proactive states are turning AI into a force for good, through a commitment to protecting the human element in health care.

Key Quote:

“ What I really like to challenge the listener to think about is, what's the sunny side of this story? What's the optimistic and positive ways we can use these solutions? What's the positive version of the future around quality and safety? Because these tools are enabling that.  

Never have we had the ability to extrapolate against data like we do now. Never have we had the chance to do deep, meaningful research against large data sets. Never have we had a chance to spread and educate populations and accelerate innovation and learning like we do now. With the right focus and the right priorities, we can narrow that to areas that will drive meaningful change and better the lives of everyone we engage with.”

 -Josh Wymer, DNP

Time Stamps:

• (02:06) Missouri's Health Data Consortium
• (04:58) AI's Growing Role in Health Care
• (10:06) Workforce Readiness for AI
• (12:22) NCQA's AI Initiatives
• (18:19) Preserving the Human Element in Health Care

Dive Deeper:

“The ‘Show Me State’ Shows How AI Can Succeed

Josh Wymer at the Health Innovation Summit

Connect with Josh Wymer

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Marc notes that many of health care’s challenges are design problems—and design problems can be solved. The conversation highlights trailblazing models like hospital-at-home and the need for better data availability at the point of care. Marc’s optimism about the next five to ten years is rooted in the belief that we have the tools, data and momentum to improve not just a handful of care processes, but thousands.

Topics Marc and Peggy explore include:

• How a Transactional Mindset Undermines Quality: Marc sees what he calls “transactional” care as a design flaw that reduces care to disconnected snippets, leaving patients confused and providers unable to coordinate or focus on wellness.
• Clinical Decision Support as a Design Solution: Embedding quality into the care process is preferable to measuring quality after-the-fact.
• The Limits of Traditional Quality Measurement: Retrospective scoring frustrates clinicians and fails to drive real-time improvement. A better way is possible!
• Redesigning Hospitalization: Marc highlights how better logistics, financial models and care coordination—like hospital-at-home—could reduce unnecessary stays and improve transitions of care.

Key Quote:

 It really is a question of how do you build quality into the care process, not measure it in. We all know that measuring into a manufacturing or a creation process is a limited strategy. It only goes so far.

And the Toyota Production System, the Danaher Business System, other very successful models are predicated on, How do you build quality into the process as it's happening, have the ability to pull the chain and stop the production line if something isn't working, and continuously improve it?

How do you stop and say, Okay, why are so many of our patients not being fully treated for their congestive heart failure? What is in the way? How do we improve it?

-- Marc Overhage, MD

Time Stamps:

• (02:57) Fragmentation and Transactional Care
• (07:04) Incentives and Profit Maximization
• (10:52) What Real-Time Data Helps Clinicians Achieve
• (19:34) Turning Clinical Insight into Actionable Care Plans
• (23:30) Encouraging Innovation and Trailblazing
• (29:12) Peggy’s Reflections

Links:

Connect with Marc

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Listen to this episode to discover:

• Interoperability is a Tool, Not the Goal: John compares interoperability to a power drill—valuable only when it helps achieve better care outcomes.
   
• Economic Incentives and Bipartisan Momentum: Learn why following the money reveals the true levers of change. From value-based purchasing to performance bonuses, John shows how economic feedback loops accelerate improvements in data quality.
   
• Good Pipes, Bad Water: Explore the disconnect between robust data pipelines and poor data flowing through them. John breaks down why measuring the quality of data is essential for progress.
   
• Why Quality Measurement is the Real Catalyst: John argues that quality measurement, not interoperability, is what drives meaningful change. Discover how improving data quality can yield long-term benefits across the health care ecosystem, far beyond quality improvement.

This episode is essential listening for health IT leaders, quality professionals and policy makers who want to understand the deeper purpose behind the quest for data quality and how it’s shaping the future of care.

Key Quote:

We don't really want interoperability for its own sake. Free flow of information if it's never used by the destinations isn't useful. It doesn't improve care. It doesn't bring down costs.

When you go to Home Depot or Lowe's and buy a power drill, what are you really trying to buy? You want holes in the wall. Interoperability is the tool or the power drill that delivers the holes that we want, and the holes are better, more efficient care that reduces costs.

I mean, can we envision a future where health care costs go down year over year? It sounds almost impossible. It sounds like a fantasy land. I think that's going to be within reach within the next 20 years.

 -John D’Amore

Time Stamps:

• (03:21) Interoperability's Incentives, Means and Ends
• (06:42) Good Pipes, Bad Water
• (09:38) Next-Generation Data Validation
• (12:06) Correcting Myths and Misconceptions
• (14:17)  Quality Drives Interoperability, Not Vice Versa

Dive Deeper:

NCQA’s Improving HEDIS Data Quality in a Digital World

NCQA’s Data Aggregator Validation

HEDIS Compliance Audit

Connect with John D’Amore

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Farzad and Peggy explore the structural flaws in our system, from fragmented care and fee-for-service incentives to the undervaluing of primary care. They discuss how ACOs, Medicare Advantage and data-driven models can help shift the system toward better outcomes and lower costs.

Peggy and Farzad explore:

• The Issue of Incentives: Farzad argues that while good care happens daily, it often occurs despite the system—not because of it. Misaligned financial incentives and lack of structural support hinder progress.
• The Key to Accountable Care: Access, point-of-care intelligence, care transitions and targeted wraparound services form the core of Farzad’s actionable framework for improving outcomes.
• Medicare Advantage and ACOs: A nuanced discussion of how MA and ACOs compare, what each gets right, and how to align incentives across Medicare.
• What Works? A call for smarter learning networks that identify and spread what’s truly effective in improving care and reducing cost.

This conversation offers a timely and practical roadmap for advancing value-based care. Farzad’s clarity, humor and strategic insight make complex topics accessible—and energizing. Whether you’re a policymaker, provider or health system leader, this episode delivers ideas worth implementing. 

Key Quote:

The most expensive thing in health care is the thing that no one wants. It isn't the fancy doctor's office or the upgraded scan. It's the hospitalization.

Hospitalizations are ridiculously expensive and the cost has been going up. There's classic charts that show inflation and TVs are down 98% in cost, and hospitalizations are up. Like, the thing in the American economy that has had the most inflation over the past two decades is hospitalization. And no one wants that. No one wants to be hospitalized. 

And, look, if you need to be hospitalized, you're gonna be hospitalized. That's where we can break apart that concept of not needing a hospitalization is the highest quality hospitalization. What's the highest quality hospitalization? The one you didn't have!

-- Farzad Mostashari, MD

Time Stamps:

• (01:20) Distinguishing Incentives in Health Care
• (06:25) Unlocking the Potential of Primary Care
• (09:31) Thinking Holistically About Accountability 
• (15:22) Measurement, Medicare, ACOs and More
• (26:07) The Doctor’s Role in the Era of AI
• (33:04) Peggy’s Reflections

Links:
Connect with Farzad Mostashari

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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 FHIR

Dive Deeper:

Episode 18 of Quality Matters with Ed Yurcisin

Episode 19 of Quality Matters with Ed Yurcisin

Connect with Rob Reynolds

Connect with Bryn Rhodes

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Susan explains models of care that emphasize accountability for both cost and quality. She and Peggy explore how two-sided risk, smarter reimbursement and more coordinated primary care can lead to better outcomes and lower costs. Susan shares new evidence on Medicare Advantage’s impact and highlights what it will take to scale accountable care models across the health system.

Peggy and Susan explore:

• Introducing the Value-Based Vanguard: Some physician groups have figured out how to deliver superior outcomes at lower cost.
• How Two-Sided Risk Works and Why It’s Hard to Scale: Two-sided risk arrangements are succeeding but can’t spread fast enough.
• Barriers to Expanding Value-Based Care: A discussion of the domains where organizations need skills and sophistication in order to succeed in value-based care.
• Medicare Advantage’s Promise and Perception Gap:  What the 56 percent of Medicare enrollees who are in MA get and what MA’s critics miss.
• What’s Next for Accountability and Reform: Navigating provider shortages, risk adjustment and the next iteration of ACOs.

This conversation offers a timely and practical roadmap for advancing value-based care.

Key Quote:

Health economists will tell you there's no entirely benign set of financial incentives. All financial incentives have consequences.

But then there's a question of what's better and what's worse. So the old saw is what happens if you have a system that pays surgeons for amputations? You get a lot of chopped-off legs because the financial incentive is on the surgeon to amputate.

This remains true today in the United States. A surgeon who performs an amputation of a limb of a diabetes patient is paid much, much more than the person who is basically working hard to help the patient with prediabetes avoid a moving to full-blown diabetes — let alone down the road to serious complications such as amputation.

-- Susan Dentzer

Time Stamps:

• (02:08): Setting the Stage for Change
• (05:29): Comparing Incentives in Different Payment Systems
• (08:21): Why Expanding Value-Based Care is Hard
• (11:01)  Misunderstanding a Model That Works
• (16:31)  Expanding the Value-Based Vision
• (20:13) Peggy’s Reflections

Links:

Potential Spillover Effects on Traditional Medicare When Physicians Bear Medicare Advantage Risk

Medicare Risk Arrangement and Use and Outcomes Among Physician Groups

Connect with Susan Dentzer

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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, MD

Time 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 Program

Recent Quality News About Diabetes

Connect with Rich Bergenstal

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Will shares his vision for a more cohesive health care system that works based on aligned incentives, meaningful measurement of patient outcomes and savvy implementation of value-based care.

Peggy and Will discuss:

• The ‘Systemness’ Solution: Will emphasizes that while American health care has the right components—technology, talent and intent—it lacks the integration to make them work together. Systemness means aligning care delivery, data and incentives to function as a cohesive whole.
• Measurement Makeover: Current quality metrics often miss what matters most to patients and providers. Will calls for fewer measures that are focused on outcomes, not just process checks. Digital measurement can help, but fragmented data remains a challenge.
• Reimagined Reimbursement Prioritizes Primary Care: Will envisions a future where primary care providers take on meaningful financial risk for the cost and quality of care. This approach could help simplify incentives, foster collaboration with specialists and drive better outcomes.
• From Waste to Wellness: Health care wastes billions of dollars on administrative complexity. Meanwhile, prevention—arguably the most cost-effective strategy—struggles to gain traction due to delayed ROI. Will argues that aligning incentives around long-term health is essential to reducing waste and improving outcomes.

Will concludes by assessing Medicare Advantage as a model of high-value care. Listen to the whole conversation for a warm, witty tour of quality’s accomplishments and prospects.

Key Quote:

We just have to make this simpler. We’ve got to make it easy for doctors to do the right thing and to create the right relationships and to set the right paths.

I think most people would agree a model where primary care docs have some meaningful accountability for the populations they serve would be better than what we have today.

And if we as a system decided that's the direction we're going to go and make that the North Star, I think we in a much shorter time could get efficient, higher quality, and deliver better outcomes at lower cost, and deliver more equitable care for all Americans.”

Will Shrank, MD

Time Stamps:

• (01:06) A Systematic Approach to a Better Future
• (04:12) Challenges in Quality Measurement
• (09:24) Payment Models and Primary Care 
• (13:55) Addressing Waste 
• (24:49) Medicare Advantage and Value-Based Care
• (28:43) Peggy’s Final Thoughts

Links:

Studies by Will Shrank (Google Scholar)

Connect with Will

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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 Measures


Dive Deeper:

NCQA’s Tobacco Cessation HEDIS Measure

Connect with Jules Reich

Connect with Grace Glennon

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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 Seibert

Time 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 Care

Dive Deeper:

Blog: How Peer Support Can Help Close the Gaps in Behavioral Healthcare
Blog: Measurement-Based Care in Behavioral Health
Quality Matters Episode 13: Getting Clear About Behavioral Health
Connect with Julie Seibert

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Join Peggy and Rita as they explore:

• The Problem with "More": Why a health care culture focused on technology and volume over patient needs leads to runaway costs and poor results.
• The Stent Story: How a widely adopted procedure in cardiology gained traction without initial evidence of patient benefit, and the uphill battle to integrate rigorous clinical trials.
• Mary Caldwell's Odyssey: A cautionary tale illustrating the dangerous cascade of unnecessary testing and interventions, based on a desire for reassurance rather than clinical need.
• Re-evaluating Statins: Rita’s unconventional view on the use of statins in asymptomatic people. She advocates lifestyle changes over medication when the evidence of benefit is thin.
• Rebuilding Trust: How the fee-for-service payment model erodes the patient-doctor relationship and how regulatory reforms can shift incentives towards patient wellbeing.

Rita reminds us that health care quality isn't about more tests or interventions. It’s about thoughtful, patient-centered decisions and a commitment to "first, do no harm." This episode is a must-listen for anyone curious about improving health outcomes and reducing waste in health care.

Key Quote:

Most statins are prescribed for people that have not already had a heart attack or have established coronary disease. In that higher risk group, there is some benefit to taking statins. It's not huge but there is some benefit.

But most people I see, and most people taking statins, are not in that category. They're healthy people that want to prevent a heart attack and want to live longer. They definitely are not going to feel better. 

Rita Redberg, MD

Time Stamps:

• (02:09) Misconceptions in Medicine
• (10:01) Mary Caldwell: A Cautionary Tale
• (13:35) Choosing Wisely Campaign: A Step Towards Better Care
• (16:32) Debating the Use of Statins
• (21:31) Trust, Incentives and the High Cost of US Care
• (27:05) Technology, Teams and Trust

Links:

JAMA Internal Medicine “Less is More”

Choosing Wisely

Connect with Rita

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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 Winders

Time Stamps:

1. (04:00) Diagnostic Delays: Spirometry and Systemic Barriers
2. (05:44) How Age and Comorbidities Obscure Asthma
3. (08:00)  Challenges of Misdiagnosis and Access to Specialists
4. (10:28) The Three Legs of Effective Asthma Care
5. (18:20) NCQA’s Measurement Strategy for Asthma

Links:

NCQA White Paper: Improving Outcomes for People with Asthma

Connect with Tonya Winders

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

• 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, MD

Time 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 Measurement

Links:

Connect with Sachin 

Learn More About SCAN

Connect with Peggy

Learn More About NCQA

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Ryan shares fresh ideas from the Leavitt Partners roadmap to reshape digital health infrastructure by embracing scalable, internet-based standards and dismantling policy barriers. At the core of this conversation is that effective data exchange must be powered not only by modern standards, but by trust among people and institutions. 

Ryan’s suggestions include:

·   Implementing APIs at scale to reduce manual processes and administrative waste. The same APIs that power everyday apps can streamline data exchange between payers and providers, replacing faxes, phone calls and redundant forms.

·   Certifying data exchange—not just software functionality. Instead of dictating how systems are built, federal policy should focus on certifying APIs, allowing EHR vendors the flexibility to innovate while helping ensure that data flows freely.

·   Establishing “tables of trust.” Regional collaboration among payers, providers and government agencies can test new digital infrastructure in real-world settings and be the model for national expansion.

Digital quality transformation will require more than just tech upgrades—we must rethink relationships, trust and policy levers. Listen to this episode to learn how the Trump administration could support a data-driven revolution in health care quality.

Key Quote:

“I’ve been doing this for a long time, almost 30 years. But when I go into my doctor’s office and I still have to fill out a clipboard with a piece of paper on it with information I know they already have, it is painful. 

The best representation of whether we are making progress is, I don’t want to ever go into a doctor’s office and fill out a clipboard. If I could just not fill out my health history, my demographic information, whether information should be sent to my doctor—if all that is just in the doctor’s system—I would say we have made progress. Because at that point it will be real to the individual. 

Think about it in terms of digitizing all of the health care data and making sure it is with the right person, at the right time, in the right place to make the right decisions. When that happens, we’ll know we’ve made significant progress.” 

Ryan Howells

Time Stamps:

(02:27) Why Implementing Health Care APIs is Hard

(05:32) Tables of Trust: A Case Study from Utah

(07:03) Scaling Trust and Interoperability

(13:12) Eliminating Manual Processes 

(18:23) Solving Diverse Use Cases 

(19:36) Encouraging Early Adoption of APIs

Links:

NCQA Recommendations to the Trump Administration 

Leavitt Partners Recommendations: “Kill the Clipboard!”

Connect with Ryan Howells

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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 Musser

Time 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 Administration

Listen to Eric’s Episode on Data Sharing

Connect with Eric

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

We begin with health economist Sanjula Jain, who challenges conventional thinking around value-based care and urges a shift toward a more intuitive concept: “value for money.” With real-world examples (think hotels and Costco), she explains why the US health economy needs stability, and what it would take to rebuild trust and deliver real value to patients.

Next, Brittany Cunningham, of Vanderbilt University Medical Center, shares how My Health Bundles help employers rein in costs while improving patient experience and provider satisfaction. Her team’s approach flips the traditional payment model on its head—designing care first and payment second.

And obstetrician Tiffany Inglis, of Elevance Health, takes us inside a groundbreaking program that pairs OB/GYNs with dedicated practice consultants. The result? Dramatic improvement in maternal health outcomes that could affect a staggering 12% of the nation’s births.

Each voice in this episode offers fresh, actionable insight. Together, they offer a roadmap toward a more sustainable—and humane—health care economy. 

Key Quote:

“ Value for money is the ultimate consumer of the service is going to determine that value based off what they are paying. Value-based payment, it's different because value-based payment is ultimately a reimbursement scheme that doesn’t change the total cost of care. Value-based payment is really a policy scheme focused on the provider level, which doesn't even affect the patient or consumer. It's one pool of dollars that is being reallocated. Providers are just reallocating those dollars and actually reducing the total cost of care. Who is benefiting doesn’t actually translate down to the patient or the consumer.”

Sanjula Jain

Time Stamps: 

• (00:25) The Macroeconomics of Health Care
• (8:40) Value-Based Care in Action With Health Bundles
• 14:30) The Economics of Prenatal Care

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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 Harrington

Time 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 Forum

Connect with Stacy Grundy

Connect with Rachel Harrington

Connect with Kristine Toppe

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Our conversation begins with Dr. Ben Oldfield, a primary care physician, who sheds light on the startling prevalence and hidden complexities of CKD. Why is it so hard to detect, even with simple blood and urine tests? And why does this condition, despite its extensive impact, often get lost in the shuffle of busy health care visits?

We’ll unpack the challenges of diagnosing and managing CKD, exploring the emotional weight the diagnosis carries for patients and the hurdles clinicians face in communicating about it. Discover why CKD is a “loaded term” and how we can shift the narrative from fear to empowerment.

But that’s not all. We’ll also tackle the big picture: How CKD fits into the broader landscape of cardiovascular, kidney, and metabolic (CKM) disorders. Could a holistic approach to these interconnected conditions revolutionize patient care?

The conversation ends with Ben’s thoughtful observations on how classic literature, particularly epic poetry, helps doctors make sense of health care’s emotional complexities, connect with patients and find empowerment in the face of life and death.

Join us as we explore how we can move CKD from the sidelines to the front lines of quality improvement, and how collaborative, longitudinal care can make a real difference.

Key Quote:

“Thinking about chronic kidney disease is a longitudinal process. It's only half the story to make the diagnosis in a snapshot in time. 

What's the follow up like? How are we doing with the patient over time? Because oftentimes quality measures can look at things in a snapshot in time. 

Chronic kidney disease really begs us to think more longitudinally.”“

• Benjamin Oldfield, MD

Time Stamps:

• (02:54) The Silent Nature of CKD
• (07:05) Quality Measurement and CKD
• (11:08) The Link Between CKD and Cardiovascular Kidney Metabolic syndrome
• (13:06) CKD and CKM as Quality Priorities 
• (15:45) Narrative Medicine and Personal Insights

Links:

NCQA Kidney Health Toolkit

Connect with Benjamin Oldfield

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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 Community

NCQA Digital Hub 

Connect with Ed Yurcisin

Connect with Amol Vyas

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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 Yurcisin

Time 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 Coalition

Links:

• Connect with Edward Yurcisin
• NCQA Digital Hub 
• Bulk FHIR Quality Coalition

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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 Cunningham

Time 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 Care

Links:

MyHealth Bundles’ Impact

Connect with Brittany Cunningham

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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, MD

Time 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 Initiatives

Links:

Connect with Aaron Neinstein

Learn more about Notable

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Sanjula combines sharp analysis with relatable analogies. Her insights into the difference between maximizing and optimizing value—and why the latter could save the health economy—offer a framework for health care enterprises seeking competitive advantage in a negative-sum game.

The episode also spotlights the human element of health care economics, from patients delaying care due to unaffordable costs, to the flawed assumption that higher prices mean better outcomes. Sanjula doesn’t mince words: The current system is failing and incremental policy tweaks aren’t cutting it. But her optimism shines through as she calls on employers, voters and innovative thinkers to drive change. 

Key Quote: 

“Think about the airline industry and retailing, large consumer brands. They're constantly having to think about value and there ends up being fewer players. 

It's going to be interesting to see who is up for competing. Those who don't figure out a way to change their approach are going to be at a disadvantage. Nobody wants to say, “You are going to fail.” No one likes to talk about the bad things coming our way. But I view it as a warning. 

Hopefully some players are starting to think differently and understand nuances of their markets and how they can optimize. Because the optimization equation is going to look different for everybody.”

-Sanjula Jain

Time Stamps:

(02:05) Understanding Health Care Costs and Value

(03:51) Value for Money vs. Value-Based Care

(06:20) Optimizing vs. Maximizing Value

(11:10) What Most People Get Wrong About Value

(13:24) Quality Measurement and Digital Solutions

Links:

NCQA on Value-Based Care

Connect with Sanjula Jain

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

The conversation cuts through labels and buzzwords to remind listeners that equity is about giving everyone an opportunity to be as healthy as they can be. The wide-ranging discussion references rural health, maternal care and veterans health as areas where an equity lens can help improve outcomes.

Panelists offer practical solutions grounded in data and accountability. Camille Burnett emphasizes the importance of collecting and using the right data to close care gaps, while Tosan Boyo challenges health systems to move from talk to tangible results. Daniel Dawes provides hopeful perspective, framing today’s challenges as part of a historical cycle that calls for persistence, innovation and a focus on structural solutions.

This episode is both a source of inspiration and a call to action. Health equity, as Bryan Buckley reminds us, is an enduring pillar of high-quality care. The work is hard, essential and ongoing. 

Key Quote: 

“Everyone talks about health equity. People believe they understand it. People are constantly hearing about it. We've talked about health equity quite a bit in the past five years. But then I don't want health systems to start losing the thread as to, 'Oh, we talk about it, therefore it's happening.' 

What we're doing is fundamentally about morbidity and mortality. Our work is to ensure that no population is dying or getting sicker than the other. We want to make sure no one is dying or getting sicker at a higher rate than anywhere else.”

Tosan Boyo

Time Stamps:

(01:01) Defining Health Equity

(04:09) The Distinction Between DEI and Health Equity

(06:10) The Connection to Digital Measurement

(07:38) Historical Perspective

(09:30) From Activity to Productivity

(10:54) Equity’s Enduring Connection to Quality

Links:
Quality Matters Ep. 11:  Hospital President: Health Equity Verifies Quality
NCQA Health Equity Resource Center
 

Connect with Bryan Buckley

Connect with Tosan Boyo

Connect with Camille Burnett

Connect with Daniel Dawes

Connect with LaShawn McIver

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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 Framework

Connect with Julie Seibert

Connect with Tom Tsang

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

The panel unpacks technical and operational challenges surrounding interoperability, such as integrating fragmented data sources and transforming raw reports into insight practitioners can use at the point of care. Panelists compare HIEs and QHINs to highways, illustrating how these systems enable cross-border data sharing. But delivering actionable information, rather than overwhelming clinicians with reports, remains a challenge. Solutions such as Bulk FHIR and cloud-based technologies are highlighted as promising ways to help data reach its best, highest use.

The discussion closes with an appeal for greater collaboration and participation in initiatives like the NCQA Bulk FHIR Quality Coalition to test modern quality measures. As Laura McCrary points out, the interoperability challenge isn’t just technological—it’s cultural and contractual. By aligning incentives and fostering trust between stakeholders, health care can evolve from fragmentation to seamless, person-centered care. 

Key Quote: 

"Bringing data together for a particular patient so we have a comprehensive view for clinical care, quality assessment, predictive modeling, whatever it might be–it’s still the golden ring that I'm trying to get to.

We have standards and that's great, and those continue to improve.

It's pretty amazing the volume of data and the number of people that we're able to access and share data between payers, providers, other participants in the healthcare ecosystem."

Marc Overhage, MD

Time Stamps:

(2:55) Data exchange is all about trust.

(4:38) QHINs are the superhighways of health data exchange. HIEs are the on- and off-ramp.

(5:25) QHINs were created to work around geographic limitations of HIEs.

(6:12) QHINs’ challenge is providing information in a way that practitioners can use.

(7:21 ) To understand where data exchange can go wrong, focus on the interfaces between steps.

(9:12) Data exchange agreements often require legal expertise as much as technical expertise.

(11:13) The industry faces a big binary choice about how to organize quality information.

(12:46) Bulk fire and cloud computing are a powerful combination.

(14:31) Join the Bulk FHIR Quality Coalition.

Links:

Bulk FHIR Quality Coalition

Quality Matters Ep: 07

Quality Matters Ep: 08

Connect with Aneesh Chopra

Connect with Laura McCrary

Connect with Marc Overhage

Connect with Abdul Shaikh 

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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 Boyo

Time 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 Summit

Links:

Connect with Tosan Boyo

CMS Universal Foundation

Tosan Boyo at Quality Talks 2022 

Institute of Medicine: Crossing the Quality Chasm

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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 Guzman

Time 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 trust

Links:

NCQA’s Health Innovation Summit

Connect with Vanessa Guzman

Connect with Khanh Nguyen

Connect with Lynn Todman

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

The conversation further examines the growth and impact of the program since its inception in 2015. Dr. Inglis highlights measurable indicators of success, including double-digit reductions in low birth weight and preterm births. The discussion addresses implications of integrating value-based care into obstetrics, showcasing how this model not only improves outcomes for mothers and babies but also fosters an effective, sustainable health care system.

Key Quote: 

“For me, the surprise has been the impact you can have by taking this approach of value-based care, tied to quality, and then aligning it to provider supports. The member gets better care, the provider gets their value-based care contract stuff taken care of, and the plan gets a better outcome for mom and baby. It's the triple win, a good outcome for everyone. And I think the thing that caught me most off guard was just the scale at which we can improve outcomes and see better care.”

• Dr. Tiffany Inglis

Time Stamps:

00:43 Elevance Health OB Practice Consultants Program’s Impact on Maternity Care

01:45 The Role and Growth of OB Practice Consultants

05:10 The Relationship to Other Quality Initiatives  

08:36 Challenges and Misconceptions in Value-Based Care

12:17 Tips for Implementing Value-Based Care

Links:

Connect with Dr. Inglis
NCQA Health Innovation Awards
NCQA Birth Equity Accountability through Measurement (BEAM) Program

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

We explore how integrating claims data with clinical data enhances quality, underscoring the critical importance of trusted networks for data exchange. Laura dispels common myths surrounding HIEs and QHINs, while offering practical tips for health care organizations curious about connecting to these essential systems.

Additionally, we examine national efforts to expand connectivity and ensure that all health care organizations are part of a growing, robust data infrastructure. This episode serves as a handy guide for how to leverage HIEs and QHINs to participate in more capable and coordinated health care ecosystem.

Key Quote: 

“There is a lot more information available. It really is both a blessing and a curse. In the past, there was no information available for the doctor. Now there's so much. The first problem was how did we actually move the data from Florida, say, to New York? It's been solved through QHINs. As we solve one problem, we've created a new one, which is there's too much information available. We've got to address this new problem.”

-Laura McCrary, Ed.D

Time Stamps:

• (01:48) Challenges and Change in Data Exchange
• (03:48) Myths and Realities of HIEs and QHINs
• (07:35) Connecting Different Kinds of Data
• (10:27) Dimensions of Trust
• (14:29) Reducing Burden with Digital Measurement
• (16:06) Future of HIEs and QHINs

--

Links:

NCQA resources on digital quality

Learn about KONZA

Connect with Laura

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Amol explains TEFCA’s function as a voluntary, national network (analogous to the postal service in its role as a connector) and highlighting implications for the free flow of HEDIS data. Eric provides insight into TEFCA’s bipartisan roots in the Cures Act of 2016, emphasizing TEFCA as a model of public-private partnership and standards-based improvement. 

Key Quote: 

“I think TEFCA has kind of been the underdog in health policy for a while now. Value-based care, patient safety, whole-person care, all those things are really salient topics that are brought up a lot. I think TEFCA is about to have its moment and I'm excited to see it come to greater fruition. I'm really happy to see all the progress we've made. It's going to take a full government, full industry approach to make this work for people. I think we're well on our way,”

-Eric Musser

Time Stamps:

(00:28) Understanding TEFCA

(01:42) New SOPs and Their Impact

(06:36) Public Policy Perspective on TEFCA

(10:00) Public-Private Partnership in TEFCA

(12:10) Looking Ahead with TEFCA

Links:
Bulk FHIR Quality Coalition

Digital Hub

Connect with Amol

Connect with Eric

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Rebecca offers an in-depth look at the sociotechnical shifts required for this evolution, sharing practical strategies to help organizations navigate this complex process. Discover how to overcome common obstacles, and learn about the real financial benefits that can convince even the most skeptical CFOs to invest in this transition.

Rebecca also provides a candid assessment of the industry's current state of readiness, emphasizing the importance of starting early for long-term success. She discusses why progress has been slower than expected and shares her updated timeline for widespread adoption.

Key Quote: 

“I'd want my billboard to say: “Digital quality, you can do it.”  Big things like this, big transformations that impact so much of the organization, they can be daunting, but we've seen plans make substantial progress that are clearly going to do very well. It can be done. Every quality team has it in them to guide this transformation and derive benefit. Just start now and have the confidence that you're able to do it, that there are a lot of resources that help you.”

-Dr. Rebecca Jacobson

Time Stamps:

(00:00) Introduction to Digital Quality Measurement

(01:03) Understanding the Industry's Readiness for Digital Transformation

(02:17) Challenges and Benefits of Digital Transition

(09:53) The Role of AI and Machine Learning

(14:55) Current Progress and Future Directions

Links:

Connect with Rebecca

Learn more about Astrata

Join the NCQA Industry Council

Explore the NCQA Digital Quality Hub

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. Ford also tackles the disconnect between local and national levels, advocating for leveraging local expertise and strengthening local programs before seeking federal support. The episode concludes with practical insights on integrating social needs into healthcare delivery and the importance of addressing these determinants to foster a sustainable healthcare system. Dr. Ford dives into what makes a successful organization in public health, focusing on the critical role of data. From the challenges of data standardization and sharing to the importance of good governance and leadership, this episode offers invaluable insights. This conversation is a must-listen for anyone passionate about creating a comprehensive healthcare system that truly considers the full spectrum of social determinants of health.

Key Quote: 

“We are not going to doctor ourselves out of the healthcare crisis. If we really want to address healthcare crises in this nation, we need to understand how are people living, what they're missing. We need to ask questions around how people live their lives. It’s cheaper to give somebody a food prescription than it is to treat an amputee from diabetes. So if we ask the questions on the front end of what people need, we’re better able to serve them from a clinical perspective.”

-Dr. Sandra Elizabeth Ford

Time Stamps:

(00:51) The Necessity of the Playbook

(02:48) Expanding Data Gathering and Sharing

(10:32) Challenges and Solutions in Data Management

(15:55) Common Misconceptions in Healthcare

Links:

Learn more about the Playbook

Connect with Dr. Sandra Elizabeth Ford

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

The conversation addresses the challenges the current political climate poses and its potential negative impacts on LGBTQ health. We highlight the necessity of robust privacy protections to prevent the misuse of SOGI data and the role of the entire healthcare team in safeguarding this information. Additionally, we share insights into new resources from the US Department of Health and Human Services to enhance demographic data quality. Calvin emphasizes recognizing LGBTQ individuals as people with unique stories and the importance of methodological data collection. For further guidance, recommendations include resources from the Office of the Assistant Secretary for Planning and Evaluation at the US Department of Health and Human Services. 

Key Quote: 

“These are intimate areas of people's lives that we're dealing with in health care, and HIPAA was enacted to protect that information from exploitation and misuse. so it's incredibly sad to see state actors intentionally misusing the law. To take personal health information from patients, from families, from healthcare institutions, not just that incredible intrusion into the provider patient relationship, but then also to Press charges against healthcare providers, for providing medical care in accordance with their training and expertise. It's an incredible violation of HIPAA and something that should concern all of us, regardless of whether we're transgender or we provide care to transgender people.”

-Kellan Baker, Executive Director of the Whitman-Walker Institute

Time Stamps:

(00:44) Understanding SOGI Data

(03:26) Challenges and Misconceptions about SOGI Data

(05:51) Legal Issues and Misuse of SOGI Data

(11:01) Finding Trust in Healthcare Systems

(13:12) The  Future of SOGI Data Collection

Links:

Connect with Kellan Baker

Connect with Dr. Carl Streed

Learn more about the Whiteman-Walker Institute 

Learn more about the GenderCare Center at Boston University School of Medicine

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Focusing on initiatives by Oscar Health, Tam highlights efforts to build culturally competent care networks and improve data-driven solutions for marginalized groups, including African Americans and the LGBTQ community. 

The episode emphasizes the importance of trust, transparent data sharing, and personalization in healthcare to address disparities and enhance patient experiences.

Key Quote: 

“If there was one ask I could have of those in a place of influence to help create standardization around provider data, it's share the attributes of the physician that are important to the patient and hold us accountable for doing what's right with that information.”

-Tam Ward

Time Stamps:

(02:32) Oscar's Approach to Culturally Competent Care

(04:57) Challenges and Solutions in Provider Data

(08:46) Building Trust in Healthcare

(10:58) Focus on LGBTQ+ Community

Links:

Connect with Tam 

Visit Oscar Health

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Secretary Kinsley emphasizes North Carolina’s novel, bipartisan approach to improving care. The discussion covers innovative strategies for staffing the 988 crisis hotline and the unusual integration of the health care system and the prison system. Secretary Kinsley ends with reflections on leadership in an era of identity politics and his advice for quality advocates everywhere. 

Key Quote: 

“We are very excited to have, after 10 years been able to finally expand Medicaid. And not only have we gotten it done, we've gotten it done well.  The other thing that's particularly exciting was a near billion-dollar investment in behavioral health. That is just so consequential to overall health and well-being, something that had also been forgotten and neglected for too long,”

-Secretary of the North Carolina Department of Health and Human Services Kody Kinsley

Time Stamps:

(01:48) Medicaid Expansion: A New Era

(05:11) Bipartisanship and Community Engagement

(06:37) Challenges and Solutions in Behavioral Health

(11:56) Innovative Approaches to Health Care and Justice

(13:23) Social Determinants of Health: A Holistic Approach

(21:09) Taking Pride in One’s Holistic Identity and Quality Gains

Links:

Learn more about Secretary Kinsley

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

The episode culminates with actionable strategies to propel health equity forward, highlighting the importance of culturally tailored solutions and comprehensive interventions. We explore the power of honest dialogues about racism, power, and privilege, and discuss how lifelong learning and diverse experiences, akin to team sports, can drive systemic change. 

Join us for this enlightening conversation that underscores the critical need for continuous improvement and authentic community partnerships to pursue health equity.

Key Quote: 

“The thing about health equity is that it’s the right thing. Everyone wants to do the right thing. And it requires all this expertise and all these stakeholders. It has the community expertise. It requires the clinicians on the staff who have the frontline experience. It requires people who do quality improvement. It includes the data people. I mean, everyone has a role.” - Dr. Marshall Chin

Time Stamps:

(00:00) Achieving Health Equity Through Innovation

(05:55) Equity and Intersectionality in Healthcare

(14:28) Advancing Health EquityThrough Lifelong Learning

Links:

Resources Marshall Chin recommends in the episode include:

Health Care Payment Learning & Action Network.

Achieving Health Equity tools from The Robert Wood John Foundation

What Should Antiracist Payment Reform Look Like?

Cruelty and Health Inequity (abstract)

The book The Sum of Us: What Racism Costs Everyone and How We Can Prosper Together , by Heather McGhee, and discussed here

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Each episode brings together thought leaders, industry experts, and innovators to discuss the latest trends, best practices, and challenges shaping the future of healthcare. With a focus on convening voices from across the industry, "Quality Matters" provides a platform for meaningful conversations and collaboration.

Whether you're a health plan leader, a health IT professional, or simply someone passionate about improving healthcare outcomes, tune in to gain valuable insights and actionable strategies for driving positive change in healthcare delivery.

Because when it comes to healthcare, quality truly matters. Join us on "Quality Matters" as we shape tomorrow's healthcare today.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

A value-based model helps patients envision what their lives could be a few months, or even years, down the line. And that’s the point at which clinicians can help patients develop a treatment plan to get them from point A to point B. That may be the best way to keep a patient healthy, boost their interest in their self-care and prevent repeat visits for the same problem.

So the questions stand regarding graduate medical education. How do you teach med school students the value of quality? How do you train them to follow a model of value-based care? And if your hospital’s HEDIS scores are low, how much of that is because of the residents? What's the correlation between medical residencies and health care quality?

Michael Kanter, MD, is a professor and chair of Clinical Science at the Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, California. In his work within Kaiser Permanente’s health care system, he’s overseen the quality of care provided by 22,000 physicians to 12.2 million patients. He also was responsible for development of Kaiser’s national quality strategy. An expert in patient safety and clinical quality, he developed policy-based and software-based programs that decreased the number of missed or delayed diagnoses and increased patient engagement.

Jung Kim, PhD, MPH, is Assistant Professor for Health Systems Science at the Kaiser Permanente Tyson School of Medicine, and a protégé of Dr. Kanter. Dr. Kim explores approaches to health care and healing, including studies on the roles of acupuncture and other East Asian practices as complementary or alternative medical treatments for cancer, H-I-V and other conditions. As we’ll hear in our interview, Dr. Kim also investigates innovations in medical education residency programs, including analysis of email communication among medical students and new learning strategies for medical education.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

The first 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], part of the National Institutes of Health [NIH].

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 adapt
• Health plans can adopt the NCQA HEDIS measure on Alcohol Screening and Follow Up – now publicly reportable, bringing potential financial incentives to health plans
• Implementation guides available in Core Additional Links
• NCQA resources for patient screening
• Free training from NIH: NIAAA’s Healthcare Professional’s Core Resource on Alcohol

The other 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.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. John Glaser is Executive in Residence at Harvard Medical School Executive Education. Previously he was Chief Executive Officer of Siemens Health Services. He is former Chair of the Global Agenda Council on Digital Health in the World Economic Forum, and former Senior Advisor to the Office of the National Coordinator for Health Information Technology. He’s also a member of NCQA’s Board of Directors.

Dr. Glaser will also be at NCQA’s second annual Health Innovation Summit in October 2023. In addition to helping open the Summit, he’ll sit on a C-suite panel alongside NCQA President Peggy O’Kane and other industry leaders, discussing, among other things, the transition to a digital health ecosystem.

Centene is the largest Medicaid Managed Care Organization in the U.S., as well as the largest carrier on the Health Insurance Marketplace.

Nicole McLean is an accreditation manager for Centene, and she spends much of her time working with NCQA on our LTSS programs. But which services are included in LTSS? What could they be? Well, as Nicole will tell you, in order to evaluate which services and supports people need, you first have to learn about...the patient.

Later in our Fast Facts segment, we observe August as National Immunization Awareness Month. First, we present some tips from the CDC for providers' offices on how to talk about vaccinations to young patients and their families. We also mention NCQA's HEDIS "Childhood Immunization Status" measure.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Our Data Aggregator Validation program now forms the backbone of Cozeva’s services. Cozeva currently provides health care data solutions to nearly 37,000 providers across 16 states. For more details on NCQA's data analysis work, check out our Data Measures Roadmap.

Dr. Khanh Nguyen is Chief Executive Officer of Cozeva. Khanh has a doctorate from the University of California San Francisco School of Pharmacy, focusing on health policy and management. She has over 15 years of experience in creative payer-provider collaborations. Khanh is an expert in data crunching, discussing how improving and easing the flow of health care data will then improve efficiency for both payers and providers.

Dr. Rosh Singh is Cozeva’s Chief Technology Officer. In his over eight years with Cozeva, Rosh was previously VP of Product Management, and before that, Director of Analytics. He has a PhD in Biomedical Engineering from Cornell and over 15 years experience combining product management with A.I. and machine learning. He creates what he calls “decision science,” finding hard- and soft-tech solutions that support multi-billion-dollar transactions.

Later on in our Fast Facts segment, we observe Gastroparesis Awareness Month with important information that could save a life. The episode also discusses NCQA's Colorectal Cancer Screening measure [COL], featured as part of our HEDIS package of quality health care measures.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Specialty practices that earn NCQA’s PCSP Recognition communicate more effectively with primary care, integrate services better with primary care and improve the quality of their care. Patients see the difference through reduced costs, better data and records management, improved identification and oversight of chronic conditions, and more face time with a more satisfied medical staff.

For this interview, we found one of our greatest advocates of the PCSP Recognition program, an extremely busy and dedicated medical team from Providence Heart Institute in Portland, Oregon. A number of years ago, they saw the need for PCSP, found solutions that worked conclusively and spread the word throughout their company about the effectiveness of the patient-centered specialty practice model of care.

Xiaoyan Huang, MD, Chief of Clinical Cardiology, leads clinical operations and care transformation for advanced heart failure, electrophysiology, general cardiology and interventional cardiology subspecialties. Danielle Christensen is Clinical Program Manager at the Providence Heart Institute in Oregon. With experience in both ambulatory and acute care settings, Danielle’s expertise spans business development and strategy, change management and development, and the optimized exchange of electronic health records.

Dr. Huang and Danielle led a session at NCQA’s first Health Innovation Summit in the fall of 2022. And they ran a fascinating and informative training webinar which is still available for download on our education website. The title of their course: “CCE Quarterly: Building with a Blueprint: Taking a Patient-Centered Specialty Practice from Medical Neighborhood to High Performing Network.”

The interview is hosted by NCQA’s Senior Vice President for Product and Customer Operations, Lori Ferguson.

Later on, in our Fast Facts segment, we observe National Minority Mental Health Awareness Month with important stats to share with colleagues and community. Among many of our products and measures addressing behavioral health needs, we mention is NCQA’s “Managed Behavioral Health Organization Accreditation” or MBHO, an important accreditation for employers.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Elevance Health, a large multi-state health insurance provider, is the largest managed care company in the Blue Cross Blue Shield Association. In September of 2022, an Elevance Health subsidiary, Simply Healthcare Plans of Florida, became one of the first health care organizations in the U.S. to earn accreditation in NCQA’s Health Equity Accreditation Plus program.

We interview Elevance Health Medicaid President Aimée Dailey alongside Staff Vice President for Medicaid Whole Health Kalunde Wambua to find out more about the company’s continued commitment to Equity improvement.

We also talk with one of NCQA’s 2022-2023 PCMH Certified Content Expert Quality Award winner, Susanne Campbell, Senior Program Administrator for the Care Transformation Collaborative of Rhode Island. We talked about the challenges of getting people on board with quality measurement. And we learned that, as measurement improves, customer focus improves, and health delivery becomes more efficient, all leading to solutions for resolving historic gaps in health equity.

Finally, in our Fast Facts segment, we observe the World Health Organization’s World Hepatitis Day, scheduled annually every July 28th. We include resources from the U.S. Department of Health and Human Services alongside an article from the NIH. Hepatitis awareness includes further reminders for childhood immunization, something NCQA measures in our HEDIS Measures package called Childhood Immunization Status, or C-I-S. The measure calculates the rates for a number of childhood vaccines and vaccine combinations. Among the vaccines in the list, alongside DTaP, MMR, and the flu, are vaccines for both Hep A and Hep B.

We're also proud to announce that Inside Health Care won two media industry awards, both announced in June 2023. We won a Merit award from the Digital Health Awards. We've also been named a Gold Winner 2023 by the Hermes Awards. Thanks to all our interviewees and leadership staff at NCQA for their support along the way.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. Alex Keuroghlian is an expert in Sex- and Gender-Informed Medicine and Sexual and Gender Minority Health Care. As a psychiatrist, Dr. Keuroghlian’s work often centers on patients suffering from post-traumatic stress disorder, or PTSD, especially within the LGBTQIA+ community. They hold numerous leadership and teaching positions at Massachusetts General Hospital and Harvard Medical School. They also support and educate health care centers and clinicians in gender equity with their leadership as Director of the Division of Education and Training at The Fenway Institute, and Principal Investigator of the National LGBTQIA+ Health Education Center, a HRSA-funded cooperative agreement to improve health care for LGBTQIA+ people at health centers around the country.

NCQA Senior Research Scientist for Health Equity Dr. Rachel Harrington discusses gender-equity needs and perspectives in health care. Her team develops improvements to NCQA's HEDIS measures updates. We discuss why it's been so difficult to gather health data on LGBTQIA+ populations.

Later in our Fast Facts segment, we include tips via the CDC from the GLMA on improving the provider experience for transgender patients.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In our first interview, we talk with Dr. Ava Jones, PhD and RN, the Director for Health Equity and Accreditation at United Health Care Community and State’s Florida Plan. Dr. Jones' workplace won an NCQA 2022 Health Innovation Award for the “UnitedHealthcare Community Plan of Florida Housing Navigation Program.” A healthcare navigator assists plan members with advice or suggestions on how to pursue a medical issue affecting them or their family. Dr. Jones explains the nature and importance of a housing navigator.

NCQA PCMH Recognition is like a seal of approval for quality assurance. A health care practice that earns that seal can be trusted for their dedication to delivering quality care—which means they’re dedicated to their patients. And having a Certified Content Expert, or CCE, almost guarantees a practice will continue its dedication to excellence for years to come.

NCQA’s 2022–2023 PCMH Certified Content Expert Quality Award Winner Deneane Anderson works for the Capital Area Health Network, also known as CAHN, in Richmond, VA. She’s been in the medical field for the past 15 years and has been a patient advocate for the past 14 years at CAHN and operates as the Transformation Manager of the PCMH Team at CAHN. Click the link for more information about becoming a PCMH CCE.

Our Fast Facts segment in this episode celebrates Pride month with background on federal protections for those people identifying as LGBTQ+, info on gender-affirming care and gaining health insurance. We then focus on NCQA’s efforts to update HEDIS measures to include language for Sexual Orientation and Gender Identity.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Our first guest is one the foremost experts in the U.S. on integrative medicine. He answers some difficult questions. How have some alternative therapies become legitimized? And what are the risks of unregulated therapies?

Benjamin Kligler, MD, MPH, is Executive Director of the Office of Patient Centered Care and Cultural Transformation (OPCC&CT) at the Veterans Health Administration. He is a board-certified family physician, working as a clinician, educator, researcher and administrative leader in the field of complementary and integrative medicine.

At NCQA’s 2023 Quality Talks, Dr. Kligler talked about “whole health” and how it relates to his work.

In our next interview, NCQA Chief Technology Officer Ed Yurcisin breaks down our newest development in digital health, our newly-announced requirements and open source software for interpreting and executing clinical quality language (CQL) so any organization or software developer can use HEDIS Digital Content Services.

Later in Fast Facts, we observe Osteoporosis Awareness and Prevention Month. We also discuss the NCQA has HEDIS measure, Osteoporosis Screening in Older Women, that assesses the percentage of women 65–75 years of age who receive osteoporosis screening.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

We first interviewed Dr. Pippa Shulman back in episode 76, which dropped in April 2022. Since then, Dr. Shulman's seen the growth and expansion of her business, Medically Home, the world’s first virtual hospital. Medically Home is a tech-enabled services company, providing all the necessary capabilities to safely shift medical care from hospitals to patients’ homes. Dr. Shulman is board certified in family medicine, preventive medicine, and hospice and palliative medicine. Dr. Shulman and her company were described in a January 2023 New York Times article titled “Your Next Hospital Bed Might Be at Home.”

Later in the show, we'll hear some fast facts regarding Stroke Awareness Month, including warning signs from the CDC and info about NCQA's Heart/Stroke Recognition Program (HSRP).

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. Garth Graham is Managing Director and Global Head of Healthcare and Public Health at Google/YouTube and Google Health. Among other significant positions, he’s the former HHS US Deputy Assistant Secretary for Minority Health. He also headed up CVS Health from 2018-2020, making sure to provide testing and vaccinations to as many under-served communities as possible.

Dr. Aaron Neinstein is an Endocrinologist and Technologist headquartered at the University of California, San Francisco. In his many roles, he’s also Senior Director at the UCSF Center for Digital Health Innovation. He’s a foremost expert in digitalization and moving IT and AI into the health care realm.

In our Fast Facts segment, we discuss Alcohol Awareness Month with some stats from the NIAAA’s free booklet, “Rethinking Drinking: Alcohol and Your Health.” And if you’re in crisis, you can contact SAMHSA via their National Helpline, by texting 9-8-8, calling 1-800-662-HELP or going to their national “helpline” website. We also mention NCQA’s “Unhealthy Alcohol Use Screening and Follow-Up” measure, part of our HEDIS measure package.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

And...both of them will be featured speakers at NCQA’s annual Quality Talks event, set for May 3, 2023, in Washington, DC.

Nzinga Harrison, MD, is Co-Founder and Chief Medical Officer of Eleanor Health, a tech-enabled, population-based provider of comprehensive, whole-person, substance use disorder care and mental health care. She is a vocal advocate and activist who emphasizes the need for U.S. health care to address systemic and ingrained harms of racism and marginalization faced by many communities in this country.

This interview begins with Dr. Harrison to explaining one of her most profound concepts: that Racism can be considered – and treated – as an addiction.

Suchi Saria, PhD, stands firmly at the crossroads of Artificial Intelligence and Modern Medicine. She is the Founder and CEO of Bayesian Health, and works at Johns Hopkins University, serving both as the John C. Malone associate professor and the Director of the Machine Learning, A.I. and Healthcare Lab.

In this interview, you'll learn how A-I, Machine Learning, and even ChatGPT can soon propel us into a world of resolved Equity disparities and improved patient-centered outcomes.

In our Fast Facts segment, we observe National Minority Health Month by exploring disparate asthma diagnoses in African-American populations. We also explore NCQA's asthma-based HEDIS measure, Asthma Medication Ratio [AMR].

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. Liz Kwo is Chief Medical Officer of Everly Health and an upcoming speaker at NCQA's 2023 Quality Talks event. Dr. Kwo is an expert in development and implementation of digitalization to improve diagnostics-driven health care. Her work—and her career—have been molded and guided by experiences both joyful and tragic. Today, she is dedicated to using all available technologies—old or new—to place the patient, and not the clinician, at the center focus of care.

Later in the show, we observe Kidney Health Awareness Month in our regular Fast Facts segment by talking up some new features of NCQA’s amazing Kidney Health Toolkit.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Jennifer C. Goldsack is founder and CEO of the Digital Medicine Society (DiMe), a 501(c)(3) non-profit organization dedicated to advancing digital medicine to optimize human health. Jen earned her master’s degree in chemistry from the University of Oxford, England, her masters in the history and sociology of medicine from the University of Pennsylvania, and her MBA from the George Washington University. And she’s the first Olympian to appear on the podcast, a rower for the U.S. at the 2008 Beijing Olympics. Jen will also be a speaker at NCQA’s 2023 Quality Talks event.

Later, in our Fast Facts segment, we observe Endometriosis Awareness Month, with important information from Endometriosis.org. We also discuss NCQA’s Cervical Cancer Screening measure, or CCS, part of our HEDIS measures. CCS contains a number of assessments for women who had cervical cytology and/or high-risk HPV testing within the last few years.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Thanks to all our podcast guests of the past 5½ years. We’re grateful for the discussions to come, including talks about gender equity, birth equity, remote care, hospital at home and behavioral health. And we’ll continue to explore them all... on Inside Health Care.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

After that, Inland Empire Health Plan Chief Quality Officer, Dr. Edward Juhn, talks about “algorithmic bias,” a software-based anomaly that may adversely affect population health metrics that drive research on equity. Both interviews were recorded live at NCQA’s inaugural Health Innovation Summit, held in late 2022 in Washington, DC.

Later, in our “Fast Facts” segment, we observe American Heart Month, with hints for keeping your heart healthy from NIH’s National Heart, Lung and Blood Institute. We also tell you about an NCQA HEDIS measure, Cardiac Rehabilitation, that assesses the percentage of adults 18 and older who attended cardiac rehab after a cardiac event like a heart attack, heart transplant or heart bypass.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

“Neighbors in Health” is a statewide Community Health Workers program delivered through a collaboration of payers, hospital systems and community-based organizations. Community Health Workers, in consultation with a Personal Health Assistant, support members while empowering them to take greater control of their health. The program also provides education and training to Community Health Workers, helping them earn certification and training in a number of necessary health care-related skills.

Later in the show, we observe February’s National Children’s Dental Health Month. I include tips on oral care for children from the American Academy of Pediatrics, as well as from the American Dental Association and its Mouth Healthy family-oriented website. I also mention NCQA’s Annual Dental Visit [ADV] HEDIS measure.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. Rucker is Chief Strategy Officer at 1upHealth. He earned degrees from Harvard, Stanford and the University of Pennsylvania School of Medicine, and has practiced emergency medicine for 30 years—but he’s best known for serving as the National Coordinator at ONC (that’s the Office of the National Coordinator for Health Information Technology), where he led development of the ONC’s 21st Century Cures Act Interoperability Rules.

Dr. Rucker’s presentation at the Health Innovation Summit was called “Evolving Measures from Paper to Fully Executable Software Using Digital Quality Measures and FHIR.” “FHIR” is pronounced like “fire” and stands for Fast Healthcare Interoperability Resources. These are digital standards established by Health Level 7 for the exchange of EHR information. In other words, FHIR holds the key to interoperability. As you’ll hear in our interview, digital health can, and should, be part of our already digitalized world.

Later in the show, we observe Birth Defects Prevention Month with some Fast Facts from the CDC on Fetal Alcohol Syndrome. We also discuss NCQA HEDIS measures that focus on AOD, alcohol or other drug abuse or dependence. Click here for more resources on treating alcohol use disorder.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Lisa Morris is Consana’s Executive Director of Clinical Services. Her goal is elevating pharmacists as key members of the care interdisciplinary team by focusing on medication optimization while creating a health care environment that fosters innovation and excellence.

Karmen Stephens, Vice President of Clinical Services, is responsible for Consana’s strategic direction and clinical development. Her primary clinical focus has been high-risk populations, with a particular interest in de-prescribing through comprehensive medication management in older adults and in patients with intellectual or developmental disabilities.

At our Health Innovation Summit in November 2022, Lisa and Karmen co-presented a seminar titled “Bridging Gaps and Improving the Care Experience for Transgender Individuals with Comprehensive Medication Management.” In this interview, they discuss the importance of open access to care for people suffering from gender dysphoria or going through gender transition.

Later, we observe Cervical Health Awareness Month in January and share statistics on Cervical Cancer screenings in the U.S. We also discuss NCQA’s HEDIS Cervical Cancer Screening measure.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

We want to hear from you. Do you have comments or feedback about this episode? Send us a note with ideas for topics for future shows or an innovative guest you think everyone should know about. We’d also enjoy hearing how you like the show! You can always reach us by emailing Communications@NCQA.org.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

John Palmieri, MD, is a Senior Medical Advisor at SAMHSA. He’s also Acting Director for the 988 and Behavioral Health Crisis Coordinating Office. This episode begins with a clip from the full interview with Dr. Palmieri, featured in our sixth mini-episode from our limited series "A View from the Summit". For more information and resources your community can use, click here to download the SAMHSA 988 toolkit.

Maria B. Stanfield is Director for Strategic Operations in Administration for the Detroit Wayne Integrated Health Network. This behavioral health-focused network, with hundreds of providers, serves over 75,000 adults and children in Detroit and surrounding Wayne County, Michigan. She discussed her company's approach to behavioral crisis management as well as her perspective on the national "988 Suicide and Crisis Lifeline".

Next, NCQA Recognition Programs Policy Manager Fatin Yousufzai gives us the inside scoop on strategies for practices seeking PCMH recognition.

Finally, our Fast Facts segment focuses on December's Safe Toys and Gifts Month observance, alongside a description of NCQA's “Children and Adolescents’ Access to Primary Care Practitioners" HEDIS measures. We also give information on the NCQA Phyllis Torda Health Care Quality and Equity Fellowship and how you may qualify to apply.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

We then discuss antibiotics stewardship with Dr. David Hyun, who directs the Pew Charitable Trust's antibiotic resistance project. The interview, conducted alongside NCQA's Assistant Vice President for Performance Measurement, Dr. Sepheen Byron, coincides with National Antibiotic Awareness Week. Later in the program, we offer "Fast Facts" on growing concerns for antibiotic over-prescription as well as details on NCQA's Antibiotic Stewardship Program, which includes an incredible How-To Toolkit.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. Raymond Osarogiagbon is the Chief Scientist at Baptist Memorial Healthcare Corporation, headquartered in Memphis, Tennessee. He is Director of the Multidisciplinary Thoracic Oncology Program and the Thoracic Oncology Research Group at the Baptist Cancer Center, and Principal Investigator of the Baptist Health System/Mid-South Minority-Underserved Consortium NCORP. Dr. Osarogiagbon’s research interests center around improving population-level outcomes of cancer care by improving care delivery systems and processes.

For training regarding lung cancer screenings, here are a few offerings to mention. First, as part of our 2022 Quality Innovation Series, NCQA offers the on-demand course titled “The Importance of Lung Cancer Screening”, led in part by our Vice President for Performance Measurement, Dr. Mary Barton.

In addition, consider these two webinars from the Academy of Oncology Nurse and Patient Navigators. One is from September 2022, titled “The Role of Oncology Nurse Navigators in the Implementation of the Updated Lung Cancer Screening Guidelines.” The other, released October 31st of 2022, is “Navigating the Updated Lung Cancer Screening Guidelines: The Role of Oncology Nurses and Nurse Navigators in the Implementation of a Lung Cancer Screening Program”.

Then we hear another interview recorded live at the Summit. This talk with Dr. Juan Espinoza discusses topics in and around the panel he co-hosted, titled “Digital Reshaping of the Diabetes Health-Care Ecosystem”. He appeared alongside, among others, Dr. Osagie Ebekozien, whose interview is posted as episode 7 of our limited series, “A View from the Summit”. Juan Espinoza, MD is a pediatrician at Children’s Hospital in L.A., where he focuses on developing medical devices, health information systems, and patient-generated health data. The guiding principle of Dr. Espinoza’s work is that data and technology have the potential to narrow the health gap faced by under-served communities all over the world.

Later in our "Fast Facts" segment, we give you quick stats from the CDC on Lung Cancer prevention.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Geisinger, an integrated delivery system with clinical enterprise, health plan, the Geisinger Commonwealth School of Medicine, and research and innovation functions, all operating in central and northeastern Pennsylvania. Dr. Ryu earned his B.A. degree from Yale University, and his M.D. and J.D. from the University of Chicago. He completed his residency training in emergency medicine at Harbor-UCLA Medical Center.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode, we’re talking about diabetes. But as often on this show, we’re not really just talking about diabetes. Diabetes is so prevalent in the U.S., it permeates the health care world, touching everyone from patients and payers to clinicians and home hospital workers. In this interview, we speak with not only an expert in diabetic care, but someone who sees care of the condition as an opportunity to talk about everything we’ve discussed this week at the Health Innovation Summit: from Health Equity to Digital Health.

Osagie Ebekozien MD, MPH is the Chief Medical Officer at the T1D Exchange. In this role, he directs a learning health network of over fifty U.S endocrinology centers and leads national diabetes population health research.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

This mini episode focuses on the efforts to make the exchange of digital health records and other data go from penciled pipe dream to streamlined reality. Dr. Don Rucker is Chief Strategy Officer at 1upHealth. He recently served as the National Coordinator at ONC – that’s the Office of the National Coordinator for Health Information Technology - where he led the writing of the ONC 21st Century Cures Act Interoperability Rules. At the 2022 Health Innovation Summit, Dr. Rucker spoke at a presentation called: Evolving Measures from Paper to Fully Executable Software Using Digital Quality Measures and FHIR.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Ms. Holder brings over 30 years of health care and health insurance expertise to her role leading the health insurance enterprise of UPMC, one of the largest Integrated Delivery and Financing Systems in the nation. As President and CEO of the UPMC Health Plan; President, Insurance Services and Executive Vice President, UPMC, Ms. Holder provides the strategic leadership and operational direction for a family of health insurance and benefits management companies offering coverage and benefits management to over 4 million members.

Ms. Holder appears at the Summit this year as part of our “C-Suite Leadership Forum” panel. She joined me to talk about health care quality and value-based care, as well as the two pillars of the Health Innovation Summit, health equity and digitalization of health.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this interview, I discussed solutions to inception of Kaiser Permanente’s advanced Care at Home program, which first launched in the Pacific Northwest and California regions in early 2020.

Dr. Mary Giswold is Chief Operating Officer at Northwest Permanente. She leads operations for this physician-led, self-governed, multispecialty group practice, providing care to the more than 620,000 members of Kaiser Permanente in Oregon and southwestern Washington.

Dr. Giswold practices as a general surgeon. Originally from Madison, Wisconsin, Dr. Giswold moved to the Pacific Northwest in 1998 to complete her surgical residency at Oregon Health & Science University and is still calling Portland home. Dr. Giswold is also a firm believer and an expert in the concept of “hospital at home”.

Dr. Stephen Parodi is executive vice president of External Affairs, Communications, and Brand at The Permanente Federation. He is also serves as an associate executive director for The Permanente Medical Group with responsibility for hospital operations, inpatient quality, patient safety, care of complex and special needs populations, skilled nursing facilities, home health, hospice, and advanced analytics. Dr. Parodi practices as an infectious disease physician, providing inpatient and outpatient consultation, HIV care and travel medicine services.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

NCQA Vice President for Public Policy & External Relations Frank Micciche joined us for insights into the goings-on here at the 2022 Health Innovation Summit. We spoke about the agenda, some key speakers, the parallel themes of Health Equity and Digital Health Solutions...and possible details on next year's event.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

At this year’s NCQA Health Innovation Summit, we heard some answers from Dr. Nancy Gin and Dr. Brenda Jackson, both of Kaiser Permanente. Together, the offered a presentation titled: Reducing perinatal risk, improving access, and reducing disparities through virtual perinatal care.

To minimize risk during the pandemic, Kaiser Permanente used its telehealth capabilities to pivot many prenatal in-person interactions to virtual encounters. It created a perinatal remote monitoring pathway: a blended perinatal care model that allows patients to have some prenatal appointments conducted by video and monitors vitals for pregnant people and their babies.

Dr. Nancy Gin is Executive Vice President of Quality and Chief Quality Officer for the Permanente Foundation, which oversees clinical quality for more than 23,000 physicians nationwide in 8 Kaiser Permanente regions caring for over 12.5 million members. She also serves as the medical director of quality and clinical analysis for the Southern California Permanente Medical Group (SCPMG), leading quality and patient safety for 4.7 million Kaiser Permanente members in Southern California.

Brenda Jackson DNP – a Doctor of Nursing Practice – serves as Senior Director of Clinical Care Improvement for Clinical Quality in The Permanente Federation. Her work has emphasized inter-regional, multidisciplinary collaboration to implement strategic advancement in patient quality, safety, and care experience.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of Inside Health Care, we talk with Dr. Jason Spangler, CEO of the northern Virginia-based Innovation and Value Initiative, or I-V-I. As this nonprofit’s website says, they work “with patients, employers, payers, and providers to assess what value means to them, and to serve as a laboratory for testing new methods to improve value assessment.” Dr. Spangler’s career has alternated between “big pharma” and nonprofits. So what does he say is the difference between “value” of care and “quality” of care? And what are value spillover and the value flower?

Later in the episode, we give you more insight into our new Health Innovation Summit. We talk with Frank Micciche, NCQA’s Vice President for Public Policy & External Relations, who looks a bit toward next year’s Summit. After that, you’ll hear from Akena Better, our Director of Events & External Relations and the hub of information for all activity at the Summit. And in our "Fast Facts" segment, we look at immunization and the fight against polio.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

• High quality care is equitable care. AND --

• There is no quality without equity.

This is evidenced by NCQA’s Health Equity Accreditation and Health Equity Accreditation Plus programs. In this episode, we meet representatives of one of the first nine health care companies to achieve both Health Equity Accreditations, Simply Healthcare, an Elevance Health Company.

We welcome Tammy MacDonald, Staff Vice President for Accreditation and Quality Programs at Elevance Health, and Holly Prince, President, Simply Healthcare Plans Medicaid at Elevance Health.

We also hear from NCQA Education Director Jennifer Dalessandro with details on our upcoming first annual Health Innovation Summit. For more on this year’s 4-day event, go to NCQASummit.com, and to sign up for information on the 2023 Health Innovation Summit, already in the works, click here.

In our Fast Facts segment, we observe Dental Hygiene Month. Click here for more information.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this interview, NCQA Assistant Vice President for State Affairs Kristine Toppe moderates a discussion with state Medicaid quality leaders from Louisiana. They discuss a new report, funded by the California Health Care Foundation. The paper follows an earlier one, as Kristine will explain, with both reports geared to provide new tools for states in improving Health Equity. Specifically, the discussion here focuses on improving Medicaid-based managed care.

Kristine’s guests in this interview are Kolynda Parker, Medicaid Deputy Director, Louisiana Department of Health, and Amanda Dumas, Chief Medicaid Officer, Louisiana Department of Health.

Following this, a chat with Harry Alba, NCQA’s Director for Corporate and Foundation Relations, telling us all you need to know about the upcoming NCQA Health Innovation Summit, live in DC, October 31-November 3, 2022.

Finally, you'll hear some Fast Facts in observance of Pain Awareness Month. This time around, we focus on lower back pain. We also discuss NCQA's HEDIS measure to reduce unnecessary ordering of imaging when simple lower back pain presents with no indication of underlying conditions.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this interview, NCQA Assistant Vice President for State Affairs Kristine Toppe moderates a discussion with state Medicaid quality leaders from Louisiana. They discuss a new report, funded by the California Health Care Foundation. The paper follows an earlier one, as Kristine will explain, with both reports geared to provide new tools for states in improving Health Equity. Specifically, the discussion here focuses on improving Medicaid-based managed care.

Kristine’s guests in this interview are Kolynda Parker, Medicaid Deputy Director, Louisiana Department of Health, and Amanda Dumas, Chief Medicaid Officer, Louisiana Department of Health.

Don't forget about the upcoming NCQA Health Innovation Summit, live in DC, October 31-November 3, 2022.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

For our featured interviews this week, we discuss NCQA's Person-Centered Outcome Measures.

Imagine a clinician asking you what you feel, what you think might be wrong, and just…listening. And then the clinician says…what would you like to be able to do that you can’t do now? What are your goals? And what can I do to help you get there?

Person-Centered Outcome Measures have already begun to ask these questions and change the health care landscape.

On this episode of “Inside Health Care”, we take a deep dive into the Person-Centered Outcome measures and what may be a revolutionary reorientation of the traditional doctor-patient relationship.

For more on this, we speak with three people involved with this important NCQA project.

First up, we talk with NCQA Senior Research Scientist Dr. Caroline Blaum. Then we hear from Patient Partner Ireland Hawkins, a retired researcher and caregiver, now a patient herself with a patient’s perspective. After that, we hear from Sherry Nolen, a Patient Partner with a very clear caregiver perspective.

For more information contact Dr. Caroline Blaum at pcomeasures@ncqa.org.

Later in the show, we observe September’s National Prostate Cancer Awareness Month. NCQA has a number of HEDIS measures related to cancer and cancer screenings. Go to www.NCQA.org and search “cancer” for more information.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Eric’s company, ERPHealth, develops tech tools and platforms for collecting and delivering patient-reported data from behavioral health treatment and therapy. The mission of his company, ERPHealth “is to save and transform lives through individualizing behavioral healthcare.” As you’ll hear, his own story drives him to smooth the journey for anyone seeking a way out of addiction.

As we mentioned in the interview, some NCQA HEDIS measures speak to alcohol or other drug dependencies. Please contact us for further information.

In our regular “Fast Facts” segment, we observe Childhood Obesity Awareness Month with CDC statistics that touch on the Health Equity gaps in childhood nutrition. Click here for one of NCQA’s HEDIS measures that help track childhood nutrition. For more about NCQA’s HEDIS measures on obesity in adults and kids, go to www.NCQA.org and search “HEDIS OBESITY.”

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this new position, Dr. Buckley will support NCQA’s Health Equity strategy across multiple departments to better integrate health equity concepts into existing programs and projects. In addition to teaching at Georgetown University’s School of Medicine, Dr. Buckley is on the board of the American Heart Association and an active member of the American Public Health Association. Dr. Buckley earned his Doctorate in Public Health from the T.H. Chan School of Public Health at Harvard University, the first Black male to graduate from that program.

We follow this interview with some fast facts on whether vaccination rates among various populations give further indications of gaps in Health Equity in the U.S. Click here for more on NCQA’s HEDIS measures on Adult and Child Immunization Status. And for more about this fall’s inaugural NCQA Health Innovation Summit, go to www.ncqasummit.com to register, sponsor, and plan your visit.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Danny Cawood, a Product Manager who oversees the product development for MCG Health’s interoperability solutions, joins us here to tell us exactly what’s wrong with health care today…and maybe how to solve it. Before joining MCG, Danny was a Product Owner for R&D solutions with Optum Technology. That’s where he focused on using advanced technologies to solve operational, clinical, and business problems, ranging from chronic care management to benefit administration and beyond. He holds a degree in Management Information Systems from the University of Minnesota.

Then we get the inside scoop from NCQA’s Director for State Affairs, Paige Cooke. With over 10 years here, including work in customer engagement and business development, Paige also holds degrees in Broadcast Journalism and Healthcare Communications. She joined us to tell us what the State Affairs team is up to – and what's on the horizon.

After that, our Matt's Facts segment examines U.S. hospital capacity with help from the American Hospital Association.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

A few months ago, there was a great roundtable discussion about approaches to care and treatment – and hopeful early diagnosis – for people with NASH. In April 2022, NCQA together with a team from Novo Nordisk published a white paper summarizing this roundtable. The paper was titled "A Rallying Cry: Improving Coordinated Care for People With Nonalcoholic Steatohepatitis."

In our interview, we hear from Donna Cryer, President & CEO of the Global Liver Institute, and Dr. Mary Barton, NCQA Vice President for Performance Measurement, exploring new ideas for optimal primary care for liver patients.

Donna Cryer, JD, is Founder and Chief Executive Officer of Global Liver Institute (GLI), the premier patient-driven liver health nonprofit operating with offices and partnerships across five continents. Moved by her own experience as a 27-year liver transplant recipient, Mrs. Cryer serves as a fierce advocate for the transformative potential of patient engagement in health policy, research, data, and system design.

Mrs. Cryer serves on numerous committees and boards, including the Boards of Directors for the Council of Medical Specialty Societies (CMSS), Sibley Memorial Hospital/Johns Hopkins Medicine, and the Color of Crohns and Chronic Illness (COCCI). She holds an undergraduate degree from Harvard and a Juris Doctorate from the Georgetown University Law Center.

Dr. Mary Barton, MD, serves as NCQA’s Vice President for Performance Measurement. In her role, Dr. Barton oversees the development, use and maintenance of techniques NCQA uses to evaluate health care quality. She ensures the scientific integrity of NCQA measurement and research. She also leads NCQA in winning and executing health care quality measurement contracts for federal and state governments.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In our fight to bridge the Health Equity gaps in the U.S. once and for all, NCQA launched the H.E.A.: the Health Equity Accreditation programs. Our first segment features a discussion with leaders from two health systems who agreed to pilot these programs starting in 2022: Dr. Nneka Sederstrom, Chief Health Equity Officer from Hennepin Health in Minneapolis, and from the multi-state Novant Health System, Senior Vice President & Chief Health Equity Officer, Dr. Chere Gregory.

Next up, we discuss gender equity with Dr. Kellan Baker, Executive Director of D.C.’s Whitman-Walker Institute. Dr. Baker’s career includes a focus on non-discrimination laws that help ensure that the benefits of the Affordable Care Act reach LGBTQ+ communities. Dr. Baker also served on the committee that recently established guidelines for appropriate gender labeling for the U.S. Department of Health and Human Services.

Finally, a segment on Birth Equity from 2019. This discussion marked the start of our own journey into Health Equity on Inside Health Care.

We meet Dr. Joia Crear-Perry, Founder and President of the National Birth Equity Collaborative. A physician, policy guru, trainer and speaker, Dr. Crear-Perry champions health equity with a focus on maternal and child health.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Abner Mason has spent decades working to reduce barriers to care faced by underserved people nationally and internationally, from the federal to the local level. He’s a policy guru, first working with the Governor of Massachusetts before advancing to roles with President George W. Bush’s Advisory Council on HIV/AIDS.

Lori Ferguson is now NCQA’s Senior Vice President for Product and Customer Operations. Lori leads a staff of more than one hundred in the implementation, delivery, and ongoing operation of NCQA’s products and programs. Her portfolio includes:

• NCQA’s flagship Health Plan Accreditation,
• Patient-Centered Medical Home (PCMH) Recognition,
• and Software Certification (for vendors implementing HEDIS® measures).

Previously, Lori served as a Senior Vice President for the Visiting Nurse Service of New York, working with both Managed Long-Term Care programs as well as structuring Management Services Organizations.

Later in the show, we use our "Matt's Facts" segment to recall October 6, 2016, the day the National Institutes of Health announced the formal designation of sexual and gender minorities (SGMs) as a health disparity population.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. Yared Alemu is Founder and CEO of TQIntelligence, which uses “unique human attributes like voice and speech to identify and treat behavioral issues in children.” Through quick but complex analysis of biomarkers, a mobile app interprets voice recordings and other data at the time of the appointment to help gauge if a child is in stress, suffering trauma, or even on the cusp of experiencing behavioral crisis.

Born and raised in Ethiopia, coming from a childhood of trauma and substance abuse, Dr. Alemu’s journey to sobriety over 30 years ago inspired him to become a therapist treating young people. He learned that before there can be treatment, there must be measurement to identify what’s going wrong and to figure out a gameplan for that troubled teen.

His company’s ultimate goal? Eliminating disparities in mental health treatment outcomes.

Ed Yurcisin is NCQA’s new Chief Technology Officer. In this interview, Ed outlines his new responsibilities and forecasts some exciting developments in NCQA’s future.

An experienced “C-suite” executive, Ed has served as CTO at Embedded Healthcare, which helps payers tailor payment models that lead to delivering better care at lower costs. Before that, he was Chief Product Officer for OnyxHealth, which he terms “Microsoft’s solution to the CMS Mandate.” He also served as Chief Data Officer at CareJourney, an influential leader in the healthcare data space, emphasizing digitalization as a key toward improving value-based models of care. In this interview, we learn what inspires him, what drives him, and what needs to be done to move the country towards better health care.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

One of the first health systems to qualify for our Behavioral Health distinction was New York-based Montefiore Medical Group. With their headquarters in the Bronx, Montefiore Health System includes more than 20 primary care locations in the Bronx and Westchester County. Over time, they realized how inseparable behavioral health care is from physical health care.

To talk about NCQA’s Behavioral Health Distinction, we welcome Dr. Jason Herrick, director of the Adult Behavioral Health Integration Program at Montefiore Medical Group, part of the Montefiore Health System. He’s also Assistant Professor for Pediatrics and Behavioral Sciences at the Albert Einstein College of Medicine.

Coordinated Health Care has so many pieces to it. From PCPs to specialists, from nursing staff doing triage to front desk staff trying to keep the engines running, there’s no lack of work to be done. So we pause now to spotlight a significant, and often unsung, element of health care: the Community Health Worker.

Community Health Worker Breanna Burke works as a CHW at Healing Hands Health Center in Bristol, Tennessee. She spoke to NCQA about the important role played by the Community Health Worker in a December 2021 webinar hosted by NCQA President Peggy O’Kane titled “Effective Community Health Worker Programs: Critical Inputs for Supportive Systems.”

Later, in our “Matt’s Facts” segment, we talk about risk factors associated with developing a mental health condition.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. Kellan Baker is a health services researcher with a PhD in health policy and management from Johns Hopkins University. Dr. Baker is currently Executive Director of the Whitman-Walker Institute. The Institute’s parent organization, Whitman-Walker Health, began as a Washington, DC, clinic that was especially known for its care for those infected with HIV/AIDS throughout the 1980s. And Whitman-Walker remains stalwart in providing both treatment for and support of LGBTQ communities throughout the country.

Dr. Baker is also a committee member of a U.S. Health & Human Services-supported study by the National Academies of Sciences, Engineering, and Medicine, titled "Measuring Sex, Gender Identity, and Sexual Orientation for the National Institutes of Health." This groundbreaking study helps establish a baseline for understanding the most fundamental hurdles facing LGBT patients, from defining distinctions between sexual orientation and gender identity to concretizing the need for better data collection to advance LGBT health equity and serve LGBT patients.

For a copy of the study, click here: https://nap.nationalacademies.org/download/26424

Dr. Baker was previously a senior fellow at the Center for American Progress, where he focused on regulatory policy across the U.S. Department of Health and Human Services, including nondiscrimination laws and ensuring that the benefits of the Affordable Care Act reach LGBTQ communities. He is particularly passionate about enhancing data collection and measurement in order to enhance health equity.

Our guest’s journey to health care – and to Whitman-Walker – is very unique and very personal. Dr. Baker is both a professional and personal expert in the needs of transgender people…and knows the need for active allyship and support throughout the healthcare system for those going through gender transition.

In our "Matt's Facts" segment, we offer self-care tips as part of Mental Health Awareness Month in May. For more information on maintaining good mental health [especially through the pandemic], click here for the National Institutes of Mental Health's recommendations. And click this link for information on NCQA's Distinction in Behavioral Health recognition program.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. Joshua Liao is an expert in the topic of value-based payment reform. A board-certified internal medicine physician with the University of Washington, Dr. Liao is Medical Director for Payment Strategy at U-W Medicine, and he holds a position in Health Systems and Population Health in their School of Public Health. He strongly believes that value-based payment structures not only could save providers money…they could save health care as we know it.

Dr. Siobhan Wescott, a Native American of the Athabaskan ethnic group, is Director of American Indian Health and professor at the University of Nebraska Medical Center. Raised in a tiny cabin just outside Fairbanks, Alaska, Dr. Wescott earned her Public Health degree from U-C-L-A and received her medical training from Harvard Medical School. As Dr. Wescott indicates, promoting Equity for any group ultimately supports Equity for all groups.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

NCQA’s PCMH is the most widely adopted recognition program of its kind in the United States. Over 10,000 practices have been recognized through our PCMH, with more than 95 organizations in support of the program. The NCQA PCMH Content Expert Certification program certifies individuals who demonstrate comprehensive knowledge of NCQA’s PCMH program. These professionals know the how and the why of supporting NCQA’s endeavors to improve quality through measurement. The 2022 NCQA CCE Award winners represent the best of the best in helping bring hundreds, if not thousands of patients to value-based health care.

This year’s winners are Kelsey Keith, Elizabeth Sledge, and Shannon Nielson.

Kelsey Keith is the PCMH Program Manager for the Northeast Georgia Physician’s Group. Kelsey earned her CCE from NCQA in July of 2014. In her current role, she manages all NCQA programs. Over the past 10 years, she’s transformed health care by helping over sixty ambulatory clinics in achieving PCMH; guiding 26 clinics to achieve NCQA’s Diabetes Recognition Program (DRP); and overseeing 7 Urgent Care Clinics in maintaining our Patient Centered Connected Care (PCCC).

Elizabeth Sledge has served as a Quality Consultant since 2016 at OSIS, a Cincinnati-based Health Center Controlled Network. A Licensed Practical Nurse, she is a NextGen EHR-Certified Professional and has been a PCMH CCE since 2016. She joined the OSIS team with over 17 years of clinical and administrative experience in multiple arenas, from community health and family practice, to internal medicine and immunology. In her role as a consultant, Elizabeth has supported health centers across the country in achieving and sustaining PCMH recognition as well as their Distinction in Behavioral Health, through operational change management and standardized workflow optimization.

Shannon Nielson is one of the owners of CURIS Consulting and Principal Consultant. Shannon previously served in roles as a “C-Suite Health Administrator”, including CIO, COO, and CQO, a Chief Quality Officer. Shannon has over 18 years’ experience working with health centers, hospitals, primary care centers and health care networks, helping them all to improve performance. As for her work with NCQA's PCMH program, Shannon has completed over 200 NCQA PCMH transformations, overseen performance assessments on over 150 community health centers, and assisted networks in developing clinically integrated networks.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. Sally Friedman is a chief endocrinology fellow in the Division of Endocrinology, Diabetes, and Metabolism at Vanderbilt University Medical Center in Nashville, Tennessee. Dr. Friedman is an expert in the use of “continuous glucose monitoring” in in-patient diabetes management. She’s been working on this topic with the Medical Learning Institute, which, in turn, is now working with NCQA on a continuing medical education program about diabetes and mealtime insulin. Dr. Friedman joins us today with an update on advances in “Meal-time insulin monitoring” and the overall progress in diabetes treatment and self-monitoring of patients at home.

Following this interview, we talk with Dr. Eliza “Pippa” Shulman, Chief Medical Officer of Medically Home, the world’s first virtual hospital. Medically Home is a tech-enabled clinical enterprise that provides the necessary capabilities to safely shift medical care from hospitals to patients’ homes. Dr. Shulman will be one of our esteemed speakers at NCQA's Quality Talks event, set for April 21, 2022. You can attend either online or live in Washington, DC.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. Eric Schneider is NCQA's recently-appointed Executive Vice President of the Quality Measurement and Research Group. In this role, he helps drive NCQA’s efforts to create a more equitable health care system and to advance the move to digital quality measurement. Before that, he served as a Health Quality expert for both The Commonwealth Fund and the RAND Corporation. He taught public health policy at Harvard Medical and was a practicing primary care internist for over 25 years.

But he was also co-Chair of NCQA’s Committee on Performance Measurement for nearly 10 years, so he’s no stranger to what we do here.

Tosan Boyo is Senior Vice President for Hospital Operations at John Muir Health in the San Francisco Bay area. He also served as a leader of the San Francisco COVID-19 Operations Center, where they had the lowest case rates and highest testing rates of any high-density city in the country. Born in Nigeria and later raised in the U.S., Boyo backpacked around the world, gaining a global take on how Health Equity leads to improved Quality for all. Come see him speak, in person in Washington, DC, or online, at Quality Talks 2022.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

But before that, we feature an exclusive interview with one of this year's speakers: Sami Inkinen.

Inkinen is CEO and Co-Founder of Virta Health, which provides treatment to sustainably reverse type 2 diabetes without medications or surgery.

But get this: Inkinen is not a clinician. He’s a technology and data pioneer, a venture capitalist entrepreneur and a physicist. After stints in a nuclear power plant followed by a few years at Microsoft, he co-founded real estate tech company Trulia. And after a multi-billion dollar buyout from an even bigger real estate juggernaut, Zillow, Sami found himself at a crossroads, both professionally and personally.

So, what in the world is he doing starting a new company in health care? You’ll have to hear his explanation…and join us for Quality Talks 2022 on April 21.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

And the health systems themselves would automatically grab all that patient info…and use it to fix what’s broken in the patient care system.

Sounds like a lot to ask for. But our guest on Inside Health Care has an answer. It’s called a Learning Health System. And at the leading edge of developing these Learning Health Systems is self-proclaimed “health data liberator” Dr. Shane McNamee.

Dr. McNamee is Chief Medical Information Officer for Smile CDR Inc., which developed a FHIR-based platform for collecting and sharing health data. He also volunteers as Executive Director for B-P-M Plus Health. They’re a company dedicated to improving global health by accelerating best clinical practices and helping health care entities develop better workflows using data, knowledge, and process standards.

Once you hear him speak, you’ll realize that Dr. McNamee is in the right place at the right time for the health care world.

Later in the podcast, we hear from Veronica Locke, Process consultant with the Health Care Service Corporation (HCSC) in Dallas, Texas. An NCQA veteran, she served as Senior Manager of Accreditation Policy for NCQA. When it comes to quality assessment and improvement, Veronica is a content champion. She’s here on this episode to tell us about two “tips and tricks” training seminars she’s offering in March 2022 through NCQA: one dealing with Delegation and the other with Credentialing.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. Davis' new project: The New York City Public Health Corps.

Dayna Bell, Executive Director for Health Care Quality at Aetna/CVS Health, joins later. A long-time NCQA veteran, she reminds us of the importance of being prepared. We talk “Accreditation Readiness,” and delivers details on the webinar of the same name.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In 2020, NCQA convened a Diabetes and Heart Failure Roundtable with a diverse panel of experts to confront the persistent challenges of care delivery and to drive improvement in the quality of care for patients affected by type 2 diabetes and heart failure. Findings from the discussion are presented in a white paper, Optimizing Care for Patients With Type 2 Diabetes and Heart Failure.

In this episode of Inside Health Care, Dr. Janani Rangaswami, Clinical Associate Professor at Thomas Jefferson University, and Dr. Mary Barton, NCQA’s Vice President of Performance Measurement, chat with NCQA’s Matt Brock about the paper’s findings, barriers to ideal care delivery and strategies for improvement.

Visit NCQA’s website to learn more about Optimizing Care for Patients With Type 2 Diabetes and Heart Failure.

Check out the corresponding Inside Healthcare Podcast for a deeper dive into the paper’s findings, barriers to ideal care delivery and strategies for improvement.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of Inside Health Care, Vanessa Guzman, CEO of SmartRise Health, chats with NCQA’s Matt Brock about aligning quality improvement between payers and providers. Vanessa discusses key components of a quality program for these two groups, and how to prioritize measures when participating in multiple value-based care arrangements.

Vanessa also discusses how payers and providers can engage patients to address gaps in care and how best to integrate social determinants of health as part of a quality program.

Learn more about the NCQA’S Digital Measurement Community here.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

This episode of Inside Health Care features a panel discussion about a joint study of chronic kidney disease (CKD) by NCQA, Duke University and the Centers for Medicare and Medicaid Office of Minority Health. Panelists are Matt Maciejewski, PhD, and Clarissa Diamantidis, PhD (Duke); Loida Tamayo (CMS); and Karen Onstad and Matt Brock (NCQA).

CKD is a gradual loss of kidney function that begins with asymptomatic kidney damage and may progress to kidney failure, requiring dialysis or a kidney transplant. Rates of diagnosed CKD in Medicare beneficiaries have increased over time; in 2017, 15% of Medicare beneficiaries over 65 had CKD. 37 million adults in the United States have CKD—and 90% of them don’t know they have it.

Although evidence suggests that estimates for the number of people with CKD are low, there is limited information about how many cases go diagnosed and why providers might miss it. The study linked laboratory and claims data to examine CKD recognition and severity (stage) in Medicare Advantage beneficiaries.

Click here to learn more about the joint study.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of “Inside Health Care,” Peggy O’Kane, NCQA President, talks with Frank Micciche, NCQA VP of Public Policy and Communications, about what she learned from 2020, including her rediscovery of the importance of public health and its links with the private sector.

Peggy and Frank also discuss NCQA’s priorities for 2021 and beyond: Digital quality measures, multicultural health care, telehealth and more.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of Inside Health Care, Dr. Douglas Jacobs, Chief Innovation Officer of Pennsylvania’s Department of Human Services, chats with Eric Musser, NCQA Deputy Director of State Affairs about his background, how Pennsylvania responded to COVID-19 and built equity inside the department in response to America’s racial reckoning in 2020.

Dr. Jacobs also talks about incentivizing Medicaid managed care organizations to close disparities, how NCQA’s Distinction in Multicultural Health Care fit into the department’s larger health equity goals and the biases of algorithms in health care.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of Inside Health Care, Vanessa Guzman, CEO of SmartRise Health, chats with NCQA’s Lawrence Green about accountable care organization (ACO)-payer partnerships, risk value-based payments and improving quality in cost-related metrics. Vanessa discusses ACO and payer priorities, successful ACO-payer models and the role of quality measures in an ideal strategy.

Vanessa also talks about the key elements for building an ACO-payer infrastructure to support quality in value-based arrangements and how data can help build partnerships for closing gaps in care and addressing social determinants of health.

Learn about NCQA’s Digital Quality Community here.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of Inside Health Care, Vanessa Guzman, CEO of SmartRise Health, chats with Matt Brock, NCQA Director of Communications, about the intersection of gaps in care, population health and quality reporting. Vanessa discusses the role of preventive health, behavioral health and social determinants of health in closing care gaps.

Vanessa also talks about leveraging data to close gaps in care and the role technology and artificial intelligence play in improving population health outcomes.

Learn about NCQA’s Digital Measurement Community and chat with us in the forum here.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of Inside Health Care, AmeriHealth Caritas’ Danielle Brooks, Director of Health Equity, chats with Dr. Michael Barr, NCQA Executive Vice President, about “The Return on Investment for Health Equity and Quality Improvement,” her presentation at this year’s Digital Quality Summit.

Danielle also discusses the disproportionate effect of COVID-19 on communities of color and how this might impact addressing health disparities, measures to take when collecting data to address health equity and the importance of having diverse ethnicities and voices in the room when developing health care products.

Learn more about NCQA’s Digital Quality Community here.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of Inside Health Care, Ashlee Wisdom, CEO and founder of Health In Her Hue, chats with NCQA’s Lawrence Green about the importance of connecting Black women with culturally competent health care providers, telehealth services and health information that centers Black women’s lived experiences. Ashlee addresses how the roots of America’s health care system align against the interests of Black women and how she’s helping to change the narrative around health equities.

Ashlee also discusses how she built Health In Her Hue, user and patient responses to the website and app and the limitations of technology for providing systemic change in health care.

Don’t forget to check out NCQA’s Quality Innovation Series, featuring talks and seminars from health care experts, live and on-demand. And rate Inside Health Care on your podcast streaming platform!

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of Inside Health Care, Peggy O’Kane, NCQA President, and Dr. Adrienne Mims, former Vice President and Chief Medical Officer for Alliant Health Solutions, current health care provider at Jencare Senior Medical Center discuss Dr. Mims’ multifaceted professional background, EHR use, solutions to health disparities and motivating chronically ill patients.

Dr. Mims also addresses how COVID has changed primary care for older patients, the emergence of telehealth and discussing end-of-life issues with patients.

Don’t forget to check out NCQA’s upcoming Quality Innovation Series, which features talks and seminars from health care experts, live and on-demand. And rate Inside Health Care on your podcast streaming platform!

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of Inside Health Care, NCQA’s Dr. Mary Barton, Vice President of Performance, chats with Matt Brock, NCQA Communications Director, about the implications of two major study retractions from prestigious medical journals during the COVID-19 pandemic. Dr. Barton talks about the level of expertise needed to review journal articles, ensuring data quality standards and the incentive for journals to publish groundbreaking studies first.

Dr. Barton also discusses how the novelty of COVID-19 is affecting the peer review process, the development and implementation of scientific knowledge and the challenges and benefits of collecting electronic clinical data in this digital age.

Learn more about NCQA’s Digital Quality Community here.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

NCQA’s Director of Federal Affairs Paul Cotton joins us again to talk about the Taskforce on Telehealth Policy and it’s efforts to map a future for the newly embraced way of delivering care.

The committee releases its final report today. You can check it out at
bit.ly/TTPFinalReport.

Inside Health Care, What to Expect

This discussion covers the Taskforce on Telehealth Policy, the issues the Taskforce considered and how each applies to providers, plans and, most importantly, patients. NCQA’s Matt Brock hosts. Check out the blog that goes along with this discussion.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

We’re calling it Policy Primer. We want to explain complex health care issues in a simple, readily understandable way for policy experts… and others who may not be brushed up on the details.

This time, NCQA’s Director of Federal Affairs Paul Cotton joins us to talk about the Taskforce on Telehealth Policy and it’s efforts to map a future for the newly embraced way of delivering care.

The committee releases its final report on September 15, 2020 at 2PM ET.
Register now at bit.ly/TelehealthReport.

Inside Health Care, What to Expect

This discussion covers the Taskforce on Telehealth Policy, the issues the Taskforce considered and how each applies to providers, plans and, most importantly, patients. NCQA’s Matt Brock hosts. Check out the blog that goes along with this discussion.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of Inside Health Care, Dr. Daniel Alford, Professor of Medicine at Boston University and Director of Safer/Competent Opioid Prescribing Education (SCOPE) of Pain Program chats with Lawrence Green, NCQA Communications Specialist about the SCOPE of Pain Program. SCOPE of Pain is a series of continuing medical education/continuing nursing education activities designed to help health care professionals safely and effectively manage patients with acute and/or chronic pain, when appropriate, with opioid analgesics.

Dr. Alford discusses the inception, goals, focus, and target audience of SCOPE of Pain. Dr. Alford chats about how SCOPE of Pain has evolved to train over 190,000 health care providers and how COVID-19 has affected training efforts. Dr. Alford also talks about managing patients who are currently on long-term opioids and/or high dose opioids and barriers to opioid prescribing today.

Don’t forget to check out NCQA’s upcoming Quality Innovation Series, which features talks and seminars from over 50 health care experts, live and on-demand September 17 – December 4.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of Inside Health Care, Peggy O’Kane, NCQA President, and Dr. Vivian Lee, President of Verily Life Sciences, discuss Lee’s book, The Long Fix: Solving America’s Health Care Crisis with Strategies That Work for Everyone. Dr. Lee lays out a concrete plan for paying doctors, hospitals and pharmaceutical companies to keep people healthy while improving care and decreasing patients’ health care costs.

Dr. Lee also talks about her childhood motivations for pursuing medicine, how delivery of care has changed in America and Verily Life Sciences’ cutting-edge, personalized health care products.

Don’t forget to check out NCQA’s upcoming Quality Innovation Series, which features talks and seminars from 47 health care experts, live and on-demand September 17 – December 4.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of Inside Health Care, Wendy Talbot, Assistant Vice President, Measure Collection & Audit and Lawrence Green, Communications Specialist, discuss the NCQA HEDIS Compliance Audit process and NCQA’s Data Aggregator Validation (DAV) pilot program.

The Compliance Audit helps ensure accurate, reliable data can be used by employers, consumers and government to compare health plans.. The DAVpilot program seeks to validate data aggregators that collect electronic clinical data from multiple sources to share with healthcare organizations as validated standard supplemental data for use in HEDIS and other quality measure reporting.

In this episode, Wendy discusses the Compliance Audit’s importance and challenges, and describes the DAV pilot program’s main goals, development process, target organizations and future plans.

Learn and collaborate with people who develop, use and support digital quality measures at www.ncqa.org/digital-measures/.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of Inside Health Care, Dr. Brad Ryan, NCQA’s new Chief Product Officer, and Matt Brock, NCQA Communications Director, discuss Brad’s experience and background in science, engineering and technology, and his mission to evolve NCQA’s existing product portfolio and launch new products in the digital space.

Dr. Ryan also talks about how collecting and using EHRs more readily could improve the quality of care and shares his vision of NCQA as a thought leader in determining the future of telehealth policies.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of “Inside Health Care,” Scott Meyer, Executive Director of Value Based Care Operations at Summit Medical Group (SMG) in Tennessee and Matt Brock, NCQA Communications Director, discuss how NCQA’s Recognized Patient-Centered Medical Home (PCMH) Program transformed SMG’s more than 70 practices.

Scott examines how NCQA’s PCMH Recognition program helped SMG quickly adapt to serve the needs of patients during the pandemic. He talks about how the Recognition program shares a “universal language”that aligns with CMS, and the financial benefits of delivering value-based care. Scott also divulges that he was not a big fan of NCQA at first, and tells us what led him to embrace PCMH Recognition.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of “Inside Health Care,” Peggy O’Kane, NCQA President, and Frank Micciche, NCQA VP of Public Policy and Communications, discuss how NCQA plans to help shape telehealth policy as it becomes the dominant form of care delivery during the COVID-19 pandemic.

Peggy and Frank discuss the Taskforce on Telehealth Policy—convened by NCQA, the Alliance for Connected Care and the American Telemedicine Association—which is leading the effort to develop recommendations for maximizing telehealth’s benefits while maintaining high standards for access, efficacy, quality, patient safety and program integrity. They also examine telehealth policy and the integration of remote care into the health care ecosystem.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

We want to make sure you don’t miss this. It’s an important edition of “Inside Health Care”.

Last week, NCQA issued a statement about the murders of Ahmaud Arbery, Breonna Taylor and George Floyd.

The full statement is posted on our website.

But here’s a small excerpt:

“These terrible losses in succession, followed by violence against peaceful protesters, are unfortunately part of a larger picture of law enforcement aggression and racial profiling of Black Americans dating back generations. Advances in technology, such as cell phones, have brought awareness of these practices to the public eye, and we witness the unfolding events in horror and shame. We say to our Black fellow Americans: We stand with you. We demand change with you.”

All this has spurred a lot of introspection for people across the country, even across the globe. We are among them.

Inside Health Care, What to Expect

In this episode,” Peggy O’Kane, NCQA President, discusses the murders, racism, and the role of race in health disparities. She touches on NCQA planned steps to improve ourselves and our communities, in and outside health care.

She, again, shares her perspective with Frank Micciche, NCQA Vice President for Public Policy and Communications.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of “Inside Health Care,” Peggy O’Kane, NCQA President, moderates an expert panel discussion to explore how health plans, systems and clinicians are using telehealth to respond to COVID-19 and how challenges and opportunities identified during the pandemic might inform the future.

Panelists are Dr. Yul Ejnes, Clinical Associate Professor of Medicine, Warren Alpert Medical School of Brown University; Kerry Palakanis, Executive Director of Connect Care Operations, Intermountain Healthcare; Dr. Hoangmai Pham, Vice President of Provider Alignment Solutions, Anthem; and Dr. Michelle Schreiber, Director of the Quality Measurement and Value Based Incentives Group at CMS.

In part 1* of this discussion, panelists share their thoughts about the adoption, capabilities and limitations of telehealth. In part 2, panelists answer a range of questions covering reimbursement, privacy concerns and resources for keeping up with telehealth developments.

Learn about newly enacted policies for NCQA staff, contractors and events due to the coronavirus here: https://www.ncqa.org/covid/.

*The Commonwealth Fund created the slides mentioned during part 1, documenting the growth of telemedicine during the pandemic.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of “Inside Health Care,” Peggy O’Kane, NCQA President, moderates an expert panel discussion to explore how health plans, systems and clinicians are using telehealth to respond to COVID-19 and how challenges and opportunities identified during the pandemic might inform the future.

Panelists are Dr. Yul Ejnes, Clinical Associate Professor of Medicine, Warren Alpert Medical School of Brown University; Kerry Palakanis, Executive Director of Connect Care Operations, Intermountain Healthcare; Dr. Hoangmai Pham, Vice President of Provider Alignment Solutions, Anthem; and Dr. Michelle Schreiber, Director of the Quality Measurement and Value Based Incentives Group at CMS.

In part 1* of this discussion, panelists share their thoughts about the adoption, capabilities and limitations of telehealth. In part 2, panelists answer a range of questions covering reimbursement, privacy concerns and resources for keeping up with telehealth developments.

Learn about newly enacted policies for NCQA staff, contractors and events due to the coronavirus here: https://www.ncqa.org/covid/.

*The Commonwealth Fund created the slides mentioned during part 1, documenting the growth of telemedicine during the pandemic.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of “Inside Health Care,” Dr. Michael Barr, NCQA Executive Vice President, Quality Measurement and Research Group, and Matt Brock, NCQA Communications Director, discuss how telehealth has transformed the delivery of care during the COVID-19 pandemic. Dr. Barr discusses his experiences with telemedicine and how primary care practices are adjusting to this new reality.

We also discuss the direction of NCQA during this time. Learn about newly enacted policies for NCQA staff, contractors and events due to the Coronavirus here: https://www.ncqa.org/covid/.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.