Quality Matters: A Podcast by NCQA: Recent Episodes
NCQA
Welcome to "Quality Matters," the podcast where we unpack the complexities of modern healthcare to shape a brighter future. Join us as we delve into the dynamic world of healthcare quality and innovation, exploring topics such as digital transformation, health equity, and quality standards. Each episode brings together thought leaders, industry experts, and innovators to discuss the latest trends, best practices, and challenges shaping the future of healthcare. With a focus on convening voices from across the industry, "Quality Matters" provides a platform for meaningful conversations and collaboration.
Whether you're a health plan leader, a health IT professional, or simply someone passionate about improving healthcare outcomes, tune in to gain valuable insights and actionable strategies for driving positive change in healthcare delivery.
Because when it comes to healthcare, quality truly matters. Join us on "Quality Matters" as we shape tomorrow's healthcare today.
This episode of Quality Matters features Kate Hobbs, CEO of the behavioral healthcare services company, Author Health.
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
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In this episode of Quality Talks with Peggy O’Kane, Peggy welcomes Anna Taylor, Associate Vice President for Population Health and Value-Based Care at MultiCare Connected Care in Tacoma, Washington.
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
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In this episode of Quality Matters, host Andy Reynolds is joined by Josh Wymer, Chief Health Information and Data Strategy Officer for the State of Missouri Health Data Consortium. Together, they explore how Missouri is building a smarter health care system that uses AI not just to automate care, but to elevate it.
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
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In this episode of Quality Talks With Peggy O’Kane, NCQA President Peggy O’Kane speaks with primary care and health IT veteran Dr. Marc Overhage.
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
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In this episode of Quality Matters, health IT veteran and standards-editor John D’Amore joins host Andy Reynolds to unpack the deeper purpose behind the push to improve data quality. Drawing on decades of experience, from startups and academic research to national standards and consulting, John explains why the real goal isn’t just clean data or seamless interoperability. It’s better care, delivered more efficiently.
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
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In this episode of Quality Talks, NCQA President Peggy O’Kane speaks with Dr. Farzad Mostashari, Co-founder and CEO of Aledade. Farzad brings decades of experience in health IT, policy and primary care transformation to a candid and energizing conversation about what’s holding back US health care and how we can move it forward.
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
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In this episode of Quality Matters, host Andy Reynolds welcomes Bryn Rhodes and Rob Reynolds of Smile Digital Health to unravel two foundational, yet widely misunderstood, technologies in health care: Clinical Quality Language (CQL) and Fast Healthcare Interoperability Resources (FHIR). With decades of leadership in health care standards, Bryn and Rob share hard-earned insights, persistent misconceptions and what the future holds for digital transformation in such areas as clinical reasoning and quality measurement.
Listen to this episode to discover:
- Why CQL and FHIR Are Often Misunderstood and Why That Matters: CQL enables knowledge and logic sharing, while FHIR facilitates data exchange. Together, they empower precise and scalable healthcare interventions.
- CQL’s Human Readability is More Than a Feature; It’s a Gateway: Learn how CQL’s intuitive language design bridges clinical and technical teams, reduces errors in translation and is already proving to be a strong match for AI-based tools and systems.
- Why FHIR Alone Doesn’t Guarantee Interoperability: Hear why true interoperability requires coordinated expectations between parties, including common terminology and agreed use cases.
- Business Strategy Meets Standards Adoption: Learn why treating interoperability as a strategic imperative (not just compliance) can unlock innovation, lower costs and drive better population health outcomes.
- CQL Engine News: NCQA Chief Technology Officer Ed Yurcisin updates the quality community on the role of CQL engines, why no engine covers all use cases and how NCQA’s open-source engine is moving the industry forward.
This conversation is a must-listen for health care leaders, B2B strategists and informatics professionals navigating digital transformation. It’s packed with actionable ideas, tech-forward insights and a human-centered approach to quality’s future.
Key Quote:
“I’m delighted you’re hearing FHIR and CQL used together because that wasn’t always the case. People in the past used them separately and thought these things are completely distinct.
Both of them have their power and bring the value separately, but you need both of them to achieve greater value. If you have FHIR, you have the ability to share the data. We can express questions. ‘What about this, about the data?’ We can do that in a shared, interoperable way with CQL.
But if the data isn’t interoperable, the ability to share questions doesn’t do much because you can’t get the data that those questions are about. So hearing people talk about those things in the same sentence, that’s fantastic. That’s exactly where we need to be.“
-Rob Reynolds
Time Stamps:
(02:00) The Relationship Between FHIR and CQL
(08:20) Common Misconceptions About CQL and FHIR
(12:57) NCQA's Commitment to CQL
(17:40) Advice for Adopting CQL and 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
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In this episode of Quality Talks With Peggy O’Kane, NCQA President Peggy O’Kane speaks with Susan Dentzer, President and CEO of America's Physician Groups. Susan brings her extensive experience in health policy to a rich discussion on the evolution, strengths and future of value-based care, particularly within Medicare Advantage.
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
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In this episode of Quality Matters, Dr. Richard Bergenstal, Executive Director of the International Diabetes Center, joins host Andy Reynolds to explore the evolving landscape of diabetes care—from the legacy of A1C to the promise of continuous glucose monitoring (CGM).
Rich shares lessons from decades of clinical leadership, research and quality improvement, including his advisory role in NCQA’s updated Diabetes Recognition Program. He explains how CGM, new metrics like the Glucose Management Indicator and a focus on patient experience are reshaping how we define and deliver high-quality diabetes care.
Listen to this episode to discover:
- Why the A1C Era Was Just the Beginning. Learn how A1C transformed diabetes care—and why it’s no longer enough. Richl explains why A1C is a measurement tool, not a management tool, and how CGM fills that gap.
- The Rise of CGM and What It Means for Quality. Understand why CGM use has surged sixfold in two years, and how it empowers patients with real-time data, alerts and confidence. Discover how CGM metrics like Time in Range and GMI are becoming the new standard.
- The Power of Visualizing Glucose Data. Explore how tools like the Ambulatory Glucose Profile (AGP) help clinicians and patients detect patterns, personalize care and move from data to action.
- Why Quality Measures Must Evolve. Learn how NCQA’s updated Diabetes Recognition Program adds HEDIS measures to reflect contemporary care standards and whole-person health.
- What’s Next in Diabetes Care. Hear Dr. Rich’s optimistic, collaborative vision for the next decade of helping people who have diabetes live better lives.
This conversation is essential for quality leaders, clinicians and health plan professionals who want to stay ahead of the curve in diabetes care, digital health and patient-centered quality improvement.
Key Quote:
The A1C set up the need for the next technology. Why did finger stick glucose come about? Because the average A1C said, “You need to do better.”
But nobody wants to poke their finger multiple times a day. So A1C led to finger sticks. Finger sticks led to CGM and now CGM has changed the dialogue. The A1C era had its role, but you look for the next thing to get to the next level. That's what I see CGM as.
-Rich Bergenstal, 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
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In this episode of Quality Talks With Peggy O’Kane, NCQA President Peggy O’Kane has an energizing, constructive conversation with Dr. Will Shrank, a Venture Partner at Andreessen Horowitz.
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
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In this episode of Quality Matters, Jules Reich, NCQA Senior Health Care Analyst in Population Health, and Grace Glennon, NCQA Director of Digital Quality Informatics, join host Andy Reynolds to discuss the latest tool in the long crusade against tobacco use: NCQA’s new HEDIS measure, Tobacco Use Screening and Cessation Intervention (TSC-E).
This measure replaces an outdated survey-based approach. It also facilitates the transition to digital measurement by using the Electronic Clinical Data Systems (ECDS) reporting method to capture, track and help health plans act on data better and faster.
Listen to this episode to discover:
· Why It’s Time to Modernize Tobacco Measures. Learn why NCQA replaced its legacy tobacco survey measure, and how TSC-E aligns with updated clinical guidelines and evidence-based interventions.
· The Full Scope of Tobacco Use. Understand how the new measure covers a wide range of nicotine delivery systems—from cigarettes and vapes, to hookahs and dissolvable gels. Also learn why NCQA counts vaping in the measure of tobacco use, but not in the measure of tobacco cessation.
· The Power of Structured Data in Quality Improvement. Discover how the ECDS reporting method promotes standardized, sharable data across health systems, and why that shift supports more actionable insights, better patient care and data interoperability.
This conversation is key for quality leaders, digital health pioneers and public health champions who are interested in the modernization of quality measurement, advancing data standards and helping providers reduce tobacco use in the populations they serve.
Key Quote:
“ Most people would recognize cigarettes, pipes, cigars, maybe chewing tobacco. A lot of people have seen e-cigarettes and vaping devices out and about.
But there's also hookers and water pipes. There’s cigarillos, small cigars. There’s snuff, there's dissolvable gels, orbs. There’s a lot of products to list.
This measure was developed with all of that in mind. We hope to institute a measure that recognizes the complexity of that, and that providers in different cultural contexts, different regions are able to use the same way.”
Jules Reich
Time Stamps:
(03:08) The Relationship Between Tobacco Screening and Cessation
(06:32) Who's Included: Ages 12 to 98 and Beyond
(09:10) What’s Included: Vapes? It Depends.
(11:30) The Difference ECDS Reporting Makes
(15:24) The Future: From ECDS to Digital Quality Measures
Dive Deeper:
NCQA’s Tobacco Cessation HEDIS Measure
Connect with Jules Reich
Connect with Grace Glennon
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In this episode of Quality Matters, Julie Seibert, Assistant Vice President of Behavioral Health at NCQA, joins host Andy Reynolds to explore the rise of—and the relationship between—two trends in behavioral health: measurement-informed care and peer support. Julie breaks down how these strategies improve outcomes, engage patients and close gaps in access and accountability.
Listen to this episode to discover:
- How Measurement-Informed Care Engages Patients: Learn how measurement-informed care supports patient engagement and treatment adjustments in behavioral health. We explore the importance of ongoing assessment, tracking symptoms and outcomes and empowering patients to understand their journey.
- Friction and Fuel for New Approaches: We unpack historical challenges to measurement-informed care. These include the omission of behavioral health from key legislation and the costs of EHR integration. We also discuss how NCQA depression measures and person-centered outcome measures relate to measurement-informed care.
- Benefitting From Peers’ Lived Experience: We discuss how people who have been through mental health or substance use treatment can provide non-clinical support to help others navigate the system, subvert stigma and fill care gaps.
This discussion is a valuable resource for providers, policy leaders and others who care about improving access, engagement and outcomes in behavioral health.
Key Quote:
"Measurement-based care has been around for a long time and only 20% of behavioral health providers adopted it.
Traditionally, these are trained clinicians. And in the course of a session with a patient, probably in the back of their mind, they’re evaluating whether an individual is improving or has worsening function.
Payers would like some numerical or standardized way of seeing the clinician’s clinical judgment. Measurement-informed care offers that."
Julie 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
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In this episode of Quality Talks With Peggy O’Kane, NCQA President Peggy O'Kane sits down with Dr. Rita Redberg, a cardiology pioneer and fierce advocate for evidence-based care. Dr. Redberg, who famously served as Editor-in-Chief of JAMA Internal Medicine for 14 years, shares her "Less is More" philosophy — a perspective that challenges the view that "more" care is always better.
Join Peggy and Rita as they explore:
- The Problem with "More": Why a health care culture focused on technology and volume over patient needs leads to runaway costs and poor results.
- The Stent Story: How a widely adopted procedure in cardiology gained traction without initial evidence of patient benefit, and the uphill battle to integrate rigorous clinical trials.
- Mary Caldwell's Odyssey: A cautionary tale illustrating the dangerous cascade of unnecessary testing and interventions, based on a desire for reassurance rather than clinical need.
- Re-evaluating Statins: Rita’s unconventional view on the use of statins in asymptomatic people. She advocates lifestyle changes over medication when the evidence of benefit is thin.
- Rebuilding Trust: How the fee-for-service payment model erodes the patient-doctor relationship and how regulatory reforms can shift incentives towards patient wellbeing.
Rita reminds us that health care quality isn't about more tests or interventions. It’s about thoughtful, patient-centered decisions and a commitment to "first, do no harm." This episode is a must-listen for anyone curious about improving health outcomes and reducing waste in health care.
Key Quote:
Most statins are prescribed for people that have not already had a heart attack or have established coronary disease. In that higher risk group, there is some benefit to taking statins. It's not huge but there is some benefit.
But most people I see, and most people taking statins, are not in that category. They're healthy people that want to prevent a heart attack and want to live longer. They definitely are not going to feel better.
Rita Redberg, 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
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In this episode of Quality Matters, Tonya Winders, President and CEO of the Global Allergy and Airways Patient Platform (GAAPP), joins host Andy Reynolds to unpack the diagnosis and care gaps that plague asthma treatment—from delayed access to spirometry, to underuse of biologics. Tonya explains what high-quality, patient-centered asthma care requires, and what health care leaders can do to close that gap.
Tonya also discusses:
- Why a definitive diagnosis of asthma isn’t necessarily the norm.
- What the “three-legged stool” of asthma care looks like.
- Why patient-centricity is essential for chronic disease management.
- How new treatments like biologics are changing what’s possible in asthma treatment.
This podcast is a must-listen for anyone working to redesign care delivery and improve outcomes for patients with chronic respiratory illness.
Key Quote:
“We are finding in that moderate to severe category, when they are diagnosed accurately and get appropriate access to targeted treatments, about one in three go into a clinical remission, where they have no exacerbations, no symptoms, no hospital, no ER, no oral corticosteroids, no use of short acting bronchodilator.
This is something that, I have to tell you, I never dreamt would come in my career. So, it's very exciting, especially for those that have had the opportunity to access these miracle drugs—that’s the term they use, miracle drugs—that have changed their lives and given them the freedom to breathe.”
Tonya Winders
Time Stamps:
- (04:00) Diagnostic Delays: Spirometry and Systemic Barriers
- (05:44) How Age and Comorbidities Obscure Asthma
- (08:00) Challenges of Misdiagnosis and Access to Specialists
- (10:28) The Three Legs of Effective Asthma Care
- (18:20) NCQA’s Measurement Strategy for Asthma
Links:
NCQA White Paper: Improving Outcomes for People with Asthma
Connect with Tonya Winders
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In this debut episode of Quality Talks With Peggy O’Kane, Founder and President of NCQA, Peggy is joined by Dr. Sachin Jain, CEO of SCAN Group and SCAN Health Plan, to explore a provocative question: Why isn’t health care better at getting better?
- Measuring—Not Missing—What Matters: Anxieties about access and affordability plague everyday people. But quality measurement’s focus is elsewhere. Is health care chasing the wrong metrics and missing the big picture?
- The Complacency Crisis: Sachin says the core issue is a reluctance to embrace real reform, noting the industry’s tendency to want improvement without being willing to change fundamental practices. He calls for a bolder approach.
- Rethinking Medicare & Medicare Advantage: Sachin challenges rosy view of traditional Medicare, and describes how a legal battle over a flawed Medicare Advantage star rating raised questions about how measuring quality affects care.
- Simplifying for Impact: Sachin proposes focusing on three or four areas, emphasizing patient experience, ease of access and basic care for common conditions. He urges cost transparency, simpler administrative processes and renewed competition.
Key Quote:
“ If we all just took care of our own part of the ecosystem, we'd get 20, 30% better. But instead, the most industry talking points are about, ‘Hey, we don't get paid enough for what we do.’ Everyone who's making money claims that they're losing money on X, Y, or Z lines of business. Everyone complains about regulatory capture, so there's just a bit of having normalized the abnormal. And I think that that's the thing we have to undo if we're going to actually make the kinds of forward progress that we're hoping to make as an industry.”
-Sachin Jain, 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
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Why isn't health care better at getting better? Join Peggy O'Kane, founder and outgoing president of NCQA, as Quality Talks tackles this critical question. This engaging, limited-series podcast brings together health care's most innovative thinkers and doers to explore powerful ideas and real solutions needed to transform care. If you're ready to reimagine costs, quality and care delivery, tune in to discover the future.
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In the second episode of our special series on recommendations to the Trump administration, Quality Matters host Andy Reynolds welcomes Ryan Howells, Principal at Leavitt Partners, for an illuminating discussion on transforming digital quality and data exchange..
Ryan shares fresh ideas from the Leavitt Partners roadmap to reshape digital health infrastructure by embracing scalable, internet-based standards and dismantling policy barriers. At the core of this conversation is that effective data exchange must be powered not only by modern standards, but by trust among people and institutions.
Ryan’s suggestions include:
· Implementing APIs at scale to reduce manual processes and administrative waste. The same APIs that power everyday apps can streamline data exchange between payers and providers, replacing faxes, phone calls and redundant forms.
· Certifying data exchange—not just software functionality. Instead of dictating how systems are built, federal policy should focus on certifying APIs, allowing EHR vendors the flexibility to innovate while helping ensure that data flows freely.
· Establishing “tables of trust.” Regional collaboration among payers, providers and government agencies can test new digital infrastructure in real-world settings and be the model for national expansion.
Digital quality transformation will require more than just tech upgrades—we must rethink relationships, trust and policy levers. Listen to this episode to learn how the Trump administration could support a data-driven revolution in health care quality.
Key Quote:
“I’ve been doing this for a long time, almost 30 years. But when I go into my doctor’s office and I still have to fill out a clipboard with a piece of paper on it with information I know they already have, it is painful.
The best representation of whether we are making progress is, I don’t want to ever go into a doctor’s office and fill out a clipboard. If I could just not fill out my health history, my demographic information, whether information should be sent to my doctor—if all that is just in the doctor’s system—I would say we have made progress. Because at that point it will be real to the individual.
Think about it in terms of digitizing all of the health care data and making sure it is with the right person, at the right time, in the right place to make the right decisions. When that happens, we’ll know we’ve made significant progress.”
Ryan Howells
Time Stamps:
(02:27) Why Implementing Health Care APIs is Hard
(05:32) Tables of Trust: A Case Study from Utah
(07:03) Scaling Trust and Interoperability
(13:12) Eliminating Manual Processes
(18:23) Solving Diverse Use Cases
(19:36) Encouraging Early Adoption of APIs
Links:
NCQA Recommendations to the Trump Administration
Leavitt Partners Recommendations: “Kill the Clipboard!”
Connect with Ryan Howells
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One-hundred days into the second Trump administration, Quality Matters host Andy Reynolds welcomes Eric Musser, Vice President of Federal Affairs at NCQA, for an insightful discussion about NCQA’s recommendations to the Trump administration for improving health care quality.
Eric shares ideas to shape a strong quality future for value-based care, digital health infrastructure and behavioral health.
The conversation focuses on value-based care models that prioritize care integration to prevent or alleviate chronic illness. Eric identifies fragmentation’s threats to care delivery and data management—problems NCQA’s recommendations aim to address.
Specific suggestions include:
- Expanding the commitment the first Trump administration made to getting all Medicare beneficiaries in value-based care arrangements by 2030. This ambitious goal requires big changes in policy and practice, but could lead to better outcomes and more efficient care delivery.
- Creating innovative care models that leverage technology and dynamic care plans. These models would use advanced technologies like AI to integrate patient data more quickly and effectively. Dynamic care plans would allow for real-time updates based on patient data from various sources, including remote monitoring.
- Prioritizing patient-generated data and patient-reported outcomes. This approach focuses on incorporating patients' experiences and goals into their care plans. The aim is to improve patient engagement and ensure care matches what matters to patients, particularly those with chronic conditions.
- Promoting standardized data exchange in Medicare Advantage programs. This recommendation addresses the need for better data sharing between plans, providers and patients. This would mean dismantling data silos and creating more comprehensive, real-time views of patient populations.
There is tremendous potential for the Trump administration to improve health care quality. Listen to this episode to find out how.
Key Quote:
“ We know the Trump administration has a patients first agenda. They put the consumer first in the way they think about quality and payment. There is a desire in the measurement space to have more measures centered around patients’ goals. That's a person-reported outcome or a patient-centered outcome, as we call it here at NCQA.
You want to make sure that the patient gets that strong clinical care. But the experience to ensure that they want to come back for that clinical care is also extremely important.
So person-reported outcomes are about enhancing the experience of patients as they work with their care team. This is important for folks with chronic conditions, behavioral health. Having those goals that are patient-centric–like walking down the stairs, getting to church–are all ways which improve health and then get that buy-in to the care plan that we're seeking to support.”
-Eric 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
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In this special edition of Quality Matters, we explore what three powerful conversations have taught us about one of health care’s most pressing and perplexing questions: What do we know about the economics of care in America, and how can we make substantial, sustainable improvements? We look back at previous episodes of Quality Matters to reflect.
We begin with health economist Sanjula Jain, who challenges conventional thinking around value-based care and urges a shift toward a more intuitive concept: “value for money.” With real-world examples (think hotels and Costco), she explains why the US health economy needs stability, and what it would take to rebuild trust and deliver real value to patients.
Next, Brittany Cunningham, of Vanderbilt University Medical Center, shares how My Health Bundles help employers rein in costs while improving patient experience and provider satisfaction. Her team’s approach flips the traditional payment model on its head—designing care first and payment second.
And obstetrician Tiffany Inglis, of Elevance Health, takes us inside a groundbreaking program that pairs OB/GYNs with dedicated practice consultants. The result? Dramatic improvement in maternal health outcomes that could affect a staggering 12% of the nation’s births.
Each voice in this episode offers fresh, actionable insight. Together, they offer a roadmap toward a more sustainable—and humane—health care economy.
Key Quote:
“ Value for money is the ultimate consumer of the service is going to determine that value based off what they are paying. Value-based payment, it's different because value-based payment is ultimately a reimbursement scheme that doesn’t change the total cost of care. Value-based payment is really a policy scheme focused on the provider level, which doesn't even affect the patient or consumer. It's one pool of dollars that is being reallocated. Providers are just reallocating those dollars and actually reducing the total cost of care. Who is benefiting doesn’t actually translate down to the patient or the consumer.”
Sanjula 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
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In this episode, we sit down with NCQA leaders Stacy Grundy, Rachel Harrington and Kristine Toppe for a behind-the-scenes look at the upcoming Health Quality Forum 2025, and a discussion about the complexities and possibilities of modern health care, with a focus on data sharing and strategies to address health inequities.
Learn about data-driven collaborations in states like Maryland, Pennsylvania and North Carolina, where public agencies, health systems and community groups are uniting to improve outcomes.
And get an inside look at our hands-on workshops on NCQA Health Equity Accreditation and Virtual Care Accreditation, designed to give professionals at the leading edge of virtual services the tools they need to help reduce disparities.
The conversation and conference highlight stories of how virtual care is dissolving data silos and transforming maternal health in states like Arkansas. The emphasis of this episode—and the forum—is on curating diverse voices not often featured at national meetings. The common thread: Moving beyond identifying problems to showcase solutions that work.
Key Quote:
“ Data for the sake of data doesn’t help anybody. If it just sits there and you pat yourself on the back, ‘I’ve got this sitting in my database’; that doesn’t help. What you do with it, matters.
We have a couple of sessions digging into innovating to address health disparities, talking about analytics to understand populations and how to address interventions. Also, we have sessions focused on creating equitable systems of care for populations with disabilities.
Understanding where unmet needs are, how to make things accessible, make things usable—data is part of that. It’s understanding who, what, when, where and how to take what you’re sitting on in your organization and understand it so you can improve care.”
Rachel 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
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Why does a potentially deadly condition that affects 1 in 7 adults fly under the radar, undetected and undiscussed? Join us on this episode of Quality Matters as we explore Chronic Kidney Disease (CKD), a silent killer that’s finally coming into the limelight of quality improvement.
Our conversation begins with Dr. Ben Oldfield, a primary care physician, who sheds light on the startling prevalence and hidden complexities of CKD. Why is it so hard to detect, even with simple blood and urine tests? And why does this condition, despite its extensive impact, often get lost in the shuffle of busy health care visits?
We’ll unpack the challenges of diagnosing and managing CKD, exploring the emotional weight the diagnosis carries for patients and the hurdles clinicians face in communicating about it. Discover why CKD is a “loaded term” and how we can shift the narrative from fear to empowerment.
But that’s not all. We’ll also tackle the big picture: How CKD fits into the broader landscape of cardiovascular, kidney, and metabolic (CKM) disorders. Could a holistic approach to these interconnected conditions revolutionize patient care?
The conversation ends with Ben’s thoughtful observations on how classic literature, particularly epic poetry, helps doctors make sense of health care’s emotional complexities, connect with patients and find empowerment in the face of life and death.
Join us as we explore how we can move CKD from the sidelines to the front lines of quality improvement, and how collaborative, longitudinal care can make a real difference.
Key Quote:
“Thinking about chronic kidney disease is a longitudinal process. It's only half the story to make the diagnosis in a snapshot in time.
What's the follow up like? How are we doing with the patient over time? Because oftentimes quality measures can look at things in a snapshot in time.
Chronic kidney disease really begs us to think more longitudinally.”“
- Benjamin Oldfield, 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
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Continuing the last Quality Matters episode, host Andy Reynolds and NCQA Chief Technology Officer, Ed Yurcisin, break down the complexities of the digital transformation in health care quality and explore the importance of high-quality data exchange, particularly in the context of HEDIS reporting and the FHIR interoperability standard. Ed explains how NCQA’s work in digital HEDIS measurement not only improves health care quality reporting, but also lays the groundwork for broader industry advancements. By ensuring consistent, standardized data for digital HEDIS, NCQA is setting the stage for better measurement of public health, smoother prior authorization and general data accessibility.
The conversation also explores the technical side of digital quality measurement, focusing on Clinical Quality Language (CQL) and the role of HEDIS “engines” in the health care data ecosystem. Ed clarifies the difference between SQL and CQL, and underscores that NCQA’s focus is on measures’ content, not on building the end-to-end software systems that run measures.
Through collaborations like the Digital Quality Implementers Community, NCQA is working to ensure alignment across CQL platforms so everyone is “doing the same math.” Amol Vyas, NCQA Vice President for Interoperability, joins the conversation to explain how a public-private partnership is bringing choice and confidence to the market for CQL engines.
Ed reflects on how his international perspective and personal experiences shape his passion for health care data interoperability. He shares how challenges accessing medical records for his family members underscore the need for a seamless, patient-centered health care system. His real-world perspective highlights why creating standardized, high-quality data isn’t just a technical challenge, but a crucial factor in helping to ensure better, safer care for all.
As the episode wraps, listeners are encouraged to explore NCQA’s resources and upcoming events to stay informed on the future of digital quality.
Key Quote:
“ HEDIS measures are incorporated into government payment programs—for example, Medicare Star Ratings.
There’s incentive to enable digital HEDIS because it is tied to your CMS Star Ratings and the money a Medicare advantage plan might receive from the government. That’s not the case for other important use cases, whether it be public health or prior authorization.
So our infrastructure is tied to financial returns incenting organizations to make higher quality data accessible for digital HEDIS.
And that means if it’s good enough for digital HEDIS, it’s been cleansed and analyzed in a way that could be used for public health, could be used for prior authorization—all of these different use cases.”
Ed Yurcisin
Time Stamps:
(02:10) Clearing a Path for Data Quality
(05:30) HEDIS “Engines” vs. HEDIS “Calculators”
(07:17) Measures’ Content vs. Software that Runs Measures
(11:18) Digital Quality Implementers Community
(19:35) The Need for Data Quality Cuts Close to Home
Links:
Bulk FHIR Quality Coalition
Digital Quality Implementers Community
NCQA Digital Hub
Connect with Ed Yurcisin
Connect with Amol Vyas
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In this episode of Quality Matters, host Andy Reynolds is joined by Ed Yurcisin, Chief Technology Officer at NCQA, to break down the complexities of digital transformation in health care quality. Ed explains how NCQA’s push for digital measurement cuts through inefficiencies and inconsistencies in assessing quality. Traditionally, HEDIS® quality measures have existed as large, text-heavy PDFs, leaving room for misinterpretation. By digitalizing these measures into computer code—Clinical Quality Language (CQL)—NCQA removes ambiguity and standardizes interpretation. That makes it easier for health care organizations to implement and use quality measures. This shift reduces administrative burden and helps ensure that quality assessments are more accurate and actionable.
The conversation then shifts to FHIR® (Fast Healthcare Interoperability Resources), a standard designed to streamline health care data exchange. Ed explains that while FHIR might sound intimidating, it’s built on the basic web technologies that power everyday internet browsing. FHIR brings five essential components to the table—JSON files, Rest APIs, standardized value sets, a common data model and government-mandated data exchange. While the government requires organizations to “pitch” data (make data available), there’s no mandate to “catch” data (actually use the data). That means organizations that choose to use the data gain a competitive advantage.
The discussion ends by focusing on data quality, an issue that looms large over digital transformation efforts. Ed introduces the Bulk FHIR Quality Coalition, a collaborative initiative aimed at improving the reliability of data exchanged between health care providers and insurers. Using the analogy of water through pipes, Ed explains that current data-sharing efforts help ensure flow, but don’t always guarantee that data are “clean” enough to be useful. The coalition enhances existing provider–insurer relationships to test and improve large-scale data exchange methods.
Ultimately, Ed underscores that digital transformation in health care is only as strong as the quality of the data being exchanged. Standardization, accessibility and interoperability are the foundations of progress, ensuring that technology-driven solutions improve enhance outcomes. Digital HEDIS, FHIR and the Bulk FHIR Quality Coalition are examples of how NCQA is reducing measurement burden to streamline measurement and improve quality.
Key Quote:
“ The digital transformation of health care is necessary to deliver higher quality care. But that is dependent on high-quality data and the ability to exchange this data. It starts with high-quality data–making it accessible, interoperable, exchangeable. That is the foundation for being able to deliver digital health care transformation. Nothing in digital transformation in health care makes sense without high-quality data exchange.”
-Ed 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
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On this episode of Quality Matters, host Andy Reynolds is joined by Brittany Cunningham, Vice President of Episodes of Care and Population Health at Vanderbilt University Medical Center, to discuss how value-based care is reshaping health care through MyHealth Bundles. By packaging treatments into predictable, all-inclusive bundles, employers save money, patients avoid surprise bills and providers can focus on delivering high-quality care instead of navigating insurance complexities.
But does bundling mean cutting corners? Brittany sets the record straight: The model eliminates waste, not necessary care. With lower C-section rates, near-zero infection rates for joint replacements and faster recovery times for spinal surgeries, bundle results are strong. Employers love the savings, patients love the simplicity and providers appreciate the shift from restrictive insurance rules to evidence-based care.
So why isn’t this standard everywhere? Andy and Brittany explore the hurdles, from outdated billing systems to awareness among employers. NCQA’s Meghan Malone-Moses joins the conversation to share insights on why value-based care is the future—and how more health care systems to catch up. Tune in for a conversation that could change how you see health care.
Key Quote:
“ Value-based care, while the employers want to deliver higher value and higher outcomes to their employees and their members, it's hard to understand what that level of risk is.
A lot of employers don't understand what it means to take value-based care on. The biggest thing is that education of what value-based care is and that the provider is taking on the risk. They are paying less than what they would pay in fee-for-service and they are getting the same or even higher outcomes for their members.”
-Brittany 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
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In this engaging episode of Quality Matters, host Andy Reynolds is joined by Aaron Neinstein, Chief Medical Officer at Notable, to explore how AI is reshaping health care. It’s not all robotic efficiency and cold algorithms. Aaron shares how AI takes over repetitive and data-heavy tasks so doctors can focus on their patients. Imagine spending less time sorting through charts and more time asking, “How does your illness affect your life?” That’s the transformative hope of AI.
The conversation takes a deep dive into the pressures on the health care workforce—from burnout to unstaffed job positions—and how AI could be the labor multiplier health care has been waiting for. But it’s not just about solving staffing shortages or making systems faster. Aaron foresees an optimistic future where AI helps personalize care, tailoring interactions to each patient—including by health literacy and language. It’s a future that feels surprisingly human, thanks to tech doing what it does best: Crunching the numbers and leaving empathy to the people.
No responsible discussion of AI can omit cautionary tales. Bias in training data, transparency and ethical partnerships all come into focus as Aaron reminds us to move thoughtfully in this brave new world. Whether you’re excited about AI, or skeptical, or just curious how it might impact your next doctor visit, this episode offers a balanced and insightful take.
Key Quote:
“Nothing in health care AI makes sense, except in light of seamless integration with clinical workflow.
The mistake I’ve made, that I’ve seen others make, is, ‘Hey, we’ve got this great new tool. Use it on the side of what you’re doing today. It’s going to be so good, it’s going to be worth it for you to move out of your EHR and come use our tool.’ And it never works.
People have their home that they work in, that they do all their work in every day. And the new tool, the new automation, the AI has to be tightly integrated into workflow, has to be integrated into the core system. Or it's just not going to work.”
Aaron Neinstein, 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
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This week on Quality Matters, we dive into a complex discussion on the often perplexing landscape of the health care economy with guest Sanjula Jain, Chief Research Officer at Trilliant Health. This isn’t your standard health policy chat; it’s a bold exploration of how costs, value, and quality intersect—and often misalign—in America’s health care system. Sanjula challenges us to rethink buzzwords like "value-based care" and "value for money," peeling back the layers to reveal stark realities behind these terms. Is our system delivering what we pay for, or are we caught in an unsustainable loop of rising costs and stagnant outcomes? The answers may surprise you.
Sanjula combines sharp analysis with relatable analogies. Her insights into the difference between maximizing and optimizing value—and why the latter could save the health economy—offer a framework for health care enterprises seeking competitive advantage in a negative-sum game.
The episode also spotlights the human element of health care economics, from patients delaying care due to unaffordable costs, to the flawed assumption that higher prices mean better outcomes. Sanjula doesn’t mince words: The current system is failing and incremental policy tweaks aren’t cutting it. But her optimism shines through as she calls on employers, voters and innovative thinkers to drive change.
Key Quote:
“Think about the airline industry and retailing, large consumer brands. They're constantly having to think about value and there ends up being fewer players.
It's going to be interesting to see who is up for competing. Those who don't figure out a way to change their approach are going to be at a disadvantage. Nobody wants to say, “You are going to fail.” No one likes to talk about the bad things coming our way. But I view it as a warning.
Hopefully some players are starting to think differently and understand nuances of their markets and how they can optimize. Because the optimization equation is going to look different for everybody.”
-Sanjula 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
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On this episode of Quality Matters, we highlight a thought-provoking panel from the NCQA Health Innovation Summit, featuring experts Dr. Bryan Buckley, Tosan Boyo, Dr. LaShawn McIver, Camille Burnet and Daniel Dawes.
The conversation cuts through labels and buzzwords to remind listeners that equity is about giving everyone an opportunity to be as healthy as they can be. The wide-ranging discussion references rural health, maternal care and veterans health as areas where an equity lens can help improve outcomes.
Panelists offer practical solutions grounded in data and accountability. Camille Burnett emphasizes the importance of collecting and using the right data to close care gaps, while Tosan Boyo challenges health systems to move from talk to tangible results. Daniel Dawes provides hopeful perspective, framing today’s challenges as part of a historical cycle that calls for persistence, innovation and a focus on structural solutions.
This episode is both a source of inspiration and a call to action. Health equity, as Bryan Buckley reminds us, is an enduring pillar of high-quality care. The work is hard, essential and ongoing.
Key Quote:
“Everyone talks about health equity. People believe they understand it. People are constantly hearing about it. We've talked about health equity quite a bit in the past five years. But then I don't want health systems to start losing the thread as to, 'Oh, we talk about it, therefore it's happening.'
What we're doing is fundamentally about morbidity and mortality. Our work is to ensure that no population is dying or getting sicker than the other. We want to make sure no one is dying or getting sicker at a higher rate than anywhere else.”
Tosan Boyo
Time Stamps:
(01:01) Defining Health Equity
(04:09) The Distinction Between DEI and Health Equity
(06:10) The Connection to Digital Measurement
(07:38) Historical Perspective
(09:30) From Activity to Productivity
(10:54) Equity’s Enduring Connection to Quality
Links:
Quality Matters Ep. 11: Hospital President: Health Equity Verifies 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
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In this episode of Quality Matters, we dive into the complexities of behavioral health care with Julie Seibert, Assistant Vice President of Behavioral Health at NCQA, and Tom Tsang, founding CEO and Chief Strategy Officer at Valera Health. Together, they explore the interconnected challenges of access, quality and payment in behavioral health, emphasizing the need to treat the whole person by addressing both mental and physical health. Julie highlights NCQA’s three-part framework for behavioral health—access, quality, and payment—emphasizing that linking these elements is critical in improving care.
Tom shares how conversations around mental health have changed since the pandemic, making the connection between behavioral health and physical health more clear. He discusses the ripple effects of mental health conditions on chronic disease management and diverse societal problems, such as rising rates of adolescent substance abuse and suicide. Both Julie and Tom reflect on the potential of innovations like measurement-based care, telehealth and value-based payment models to expand access and improve outcomes. They also discuss ongoing systemic barriers, including a shortage of providers who accept insurance.
Julie and Tom shine a light on emerging solutions, from CMS payment reforms to NCQA’s development of quality measures tailored for behavioral health. This discussion offers invaluable insights into addressing the urgent need for accessible, high-quality behavioral health care that meets the needs of an increasingly diverse America.
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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
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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
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Links:
NCQA White Paper: Developing a Behavioral Health Quality Framework
Connect with Julie Seibert
Connect with Tom Tsang
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This episode of Quality Matters features highlights from the NCQA Health Innovation Summit panel discussion on data interoperability, held on November 1st in Nashville. Moderated by Arcadia’s Aneesh Chopra, the panel explored how to make health data accessible and usable for improving patient care. Panelists (Laura McCrary of KONZA, Dr. Marc Overhage of Elevance Health and Abdul Shaikh of AWS) emphasize interoperability is critical for quality reporting, care coordination and closing care gaps. Emphasizing trust as the cornerstone of data exchange frameworks such as TEFCA, panelists outline the need for alignment between payers, providers and technology organizations to ensure better health outcomes.
The panel unpacks technical and operational challenges surrounding interoperability, such as integrating fragmented data sources and transforming raw reports into insight practitioners can use at the point of care. Panelists compare HIEs and QHINs to highways, illustrating how these systems enable cross-border data sharing. But delivering actionable information, rather than overwhelming clinicians with reports, remains a challenge. Solutions such as Bulk FHIR and cloud-based technologies are highlighted as promising ways to help data reach its best, highest use.
The discussion closes with an appeal for greater collaboration and participation in initiatives like the NCQA Bulk FHIR Quality Coalition to test modern quality measures. As Laura McCrary points out, the interoperability challenge isn’t just technological—it’s cultural and contractual. By aligning incentives and fostering trust between stakeholders, health care can evolve from fragmentation to seamless, person-centered care.
Key Quote:
"Bringing data together for a particular patient so we have a comprehensive view for clinical care, quality assessment, predictive modeling, whatever it might be–it’s still the golden ring that I'm trying to get to.
We have standards and that's great, and those continue to improve.
It's pretty amazing the volume of data and the number of people that we're able to access and share data between payers, providers, other participants in the healthcare ecosystem."
Marc Overhage, MD
Time Stamps:
(2:55) Data exchange is all about trust.
(4:38) QHINs are the superhighways of health data exchange. HIEs are the on- and off-ramp.
(5:25) QHINs were created to work around geographic limitations of HIEs.
(6:12) QHINs’ challenge is providing information in a way that practitioners can use.
(7:21 ) To understand where data exchange can go wrong, focus on the interfaces between steps.
(9:12) Data exchange agreements often require legal expertise as much as technical expertise.
(11:13) The industry faces a big binary choice about how to organize quality information.
(12:46) Bulk fire and cloud computing are a powerful combination.
(14:31) Join the Bulk FHIR Quality Coalition.
Links:
Bulk FHIR Quality 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
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n this episode of Quality Matters, host Andy Reynolds sits down with Tosan Boyo, President of Sutter Health East Bay Market, to discuss his inspiring journey from Nigerian immigrant to leading a major health care institution. Boyo shares how his early experiences as a patient in a safety-net hospital shaped his commitment to health equity and continue to shape his leadership. He reflects on key moments that drove his passion for providing equitable care and the responsibility health care leaders have in ensuring access for all.
Boyo highlights the importance of community engagement in health care workforce development, emphasizing the need for institutions to reflect the communities they serve.
He also highlights the crucial role of transparent data reporting in driving improvement and building trust. Boyo discusses the impact of partnerships and how collaboration sets a precedent for addressing inequities.
Tosan will participate in a panel discussion at NCQA's Health Innovation Summit, where he will discuss ongoing efforts and challenges in advancing equitable care. His insights offer a roadmap for ensuring that health care systems evolve to meet the needs of diverse communities.
Key Quote:
“Health equity gives us tools and to validate we are living up to the thesis that motivates us to come to work every morning. Fundamentally, delivering high quality outcomes is always the number one priority with that thesis being a foundation, how are we ensuring every patient is achieving the high quality outcome? We verify that by Saying let's stratify your outcome metrics by race and ensure that race is not a factor that one population is not getting the same high quality outcome Let's do it by language and ensure that language is not a barrier to access and not a barrier to following the instructions that you get from a physician. Let's verify by zip code, to understand socioeconomic status. How are we ensuring that regardless of zip code, you are getting the best care? These are different ways we can verify we are living up to the priority to deliver high quality outcomes.”
-Tosan 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
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In this episode of Quality Matters, host Andy Reynolds previews the upcoming Women in Quality panel at NCQA’s Health Innovation Summit. He speaks with Vanessa Guzman, CEO of SmartRise Health and Ella Es Health, who will moderate the panel. Vanessa shares her insights on empowering women in quality by cultivating self-awareness, fostering connections and building a culture of quality. She also introduces two thoughtful panelists, Khanh Nguyen, CEO of Cozeva, and Lynn Todman, Vice President of Health Equity at Corewell Health, who bring unique perspectives on resilience, community impact and health equity.
The discussion emphasizes the importance of trust, community and personal reflection in leadership, with personal stories from each guest about navigating challenges and creating meaningful change. The episode concludes with practical advice for attendees of the Women in Quality event on November 1, encouraging self-reflection and a focus on personal growth.
Key Quote:
“The Women in Quality reception will focus on three segments.
The first one will focus on cultivating oneself, understanding your purpose, walking your journey. What does that look like? The second segment will be focused on connection and collaboration. How to build meaningful relationships; how to build a trusted network. And then the third will be focused on creating and expanding that culture of quality. What areas of your life and workforce meet your goals and objectives? How are you tracking and measuring those processes?
When you combine those, you're manifesting the goals that you have set.”
- Vanessa 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
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In this episode of Quality Matters, host Andy Reynolds is joined by Dr. Tiffany Inglis, National Medical Director for Women’s and Children’s Health at Carelon Health, to explore the Elevance Health Obstetrics Practice Consultants program. A winner of an NCQA Health Innovation Award, the Elevance Health program breaks new ground by bringing value-based care to obstetrics, a field where value-based strategies remain rare. Dr. Inglis discusses the program’s focus on improving maternal health outcomes by addressing racial disparities and providing practitioners with insight and know-how. By emphasizing collaboration and data-driven support, the program improves the care of mothers and babies.
The conversation further examines the growth and impact of the program since its inception in 2015. Dr. Inglis highlights measurable indicators of success, including double-digit reductions in low birth weight and preterm births. The discussion addresses implications of integrating value-based care into obstetrics, showcasing how this model not only improves outcomes for mothers and babies but also fosters an effective, sustainable health care system.
Key Quote:
“For me, the surprise has been the impact you can have by taking this approach of value-based care, tied to quality, and then aligning it to provider supports. The member gets better care, the provider gets their value-based care contract stuff taken care of, and the plan gets a better outcome for mom and baby. It's the triple win, a good outcome for everyone. And I think the thing that caught me most off guard was just the scale at which we can improve outcomes and see better care.”
- Dr. Tiffany Inglis
Time Stamps:
00:43 Elevance Health OB Practice Consultants Program’s Impact on Maternity 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
On this episode of Quality Matters, we explore the growing importance of Health Information Exchanges (HIEs) and Qualified Health Information Networks (QHINs) with Laura McCrary, President and CEO of KONZA National Network. Laura discusses the pivotal role these systems play in quality care, enabling the secure and efficient sharing of medical records across diverse networks. By advancing the digitalization and interoperability of health data, these networks enhance patient safety and care coordination.
We explore how integrating claims data with clinical data enhances quality, underscoring the critical importance of trusted networks for data exchange. Laura dispels common myths surrounding HIEs and QHINs, while offering practical tips for health care organizations curious about connecting to these essential systems.
Additionally, we examine national efforts to expand connectivity and ensure that all health care organizations are part of a growing, robust data infrastructure. This episode serves as a handy guide for how to leverage HIEs and QHINs to participate in more capable and coordinated health care ecosystem.
Key Quote:
“There is a lot more information available. It really is both a blessing and a curse. In the past, there was no information available for the doctor. Now there's so much. The first problem was how did we actually move the data from Florida, say, to New York? It's been solved through QHINs. As we solve one problem, we've created a new one, which is there's too much information available. We've got to address this new problem.”
-Laura McCrary, Ed.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
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Links:
NCQA resources on digital quality
Learn about KONZA
Connect with Laura
In this episode of Quality Matters, host Andy Reynolds delves into the transformative impact of the Trusted Exchange Framework and Common Agreement (TEFCA) on health care data interoperability. Joined by Amol Vyas, NCQA Vice President of Interoperability, and Eric Musser, Vice President of Federal Affairs, the discussion uncovers how TEFCA is reshaping the landscape of health information exchange.
Amol explains TEFCA’s function as a voluntary, national network (analogous to the postal service in its role as a connector) and highlighting implications for the free flow of HEDIS data. Eric provides insight into TEFCA’s bipartisan roots in the Cures Act of 2016, emphasizing TEFCA as a model of public-private partnership and standards-based improvement.
Key Quote:
“I think TEFCA has kind of been the underdog in health policy for a while now. Value-based care, patient safety, whole-person care, all those things are really salient topics that are brought up a lot. I think TEFCA is about to have its moment and I'm excited to see it come to greater fruition. I'm really happy to see all the progress we've made. It's going to take a full government, full industry approach to make this work for people. I think we're well on our way,”
-Eric 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
In this episode of Quality Matters, host Andy Reynolds sits down with Rebecca Jacobson, CEO of Astrata, to explore the challenges and opportunities in transitioning to digital quality measurement in health care.
Rebecca offers an in-depth look at the sociotechnical shifts required for this evolution, sharing practical strategies to help organizations navigate this complex process. Discover how to overcome common obstacles, and learn about the real financial benefits that can convince even the most skeptical CFOs to invest in this transition.
Rebecca also provides a candid assessment of the industry's current state of readiness, emphasizing the importance of starting early for long-term success. She discusses why progress has been slower than expected and shares her updated timeline for widespread adoption.
Key Quote:
“I'd want my billboard to say: “Digital quality, you can do it.” Big things like this, big transformations that impact so much of the organization, they can be daunting, but we've seen plans make substantial progress that are clearly going to do very well. It can be done. Every quality team has it in them to guide this transformation and derive benefit. Just start now and have the confidence that you're able to do it, that there are a lot of resources that help you.”
-Dr. Rebecca 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
In this episode of Quality Matters, host Andy Reynolds discusses the U.S. Playbook to Address Social Determinants of Health with its lead author, Dr. Sandra Elizabeth Ford. Dr. Ford, a pediatrician and public health advocate with extensive experience at both local and federal levels, highlights the necessity of looking beyond clinical care to factors like housing, nutrition, and transportation. She emphasizes the importance of expanding data gathering and sharing, supporting flexible funding, and investing in backbone organizations to improve healthcare outcomes.
Dr. Ford also tackles the disconnect between local and national levels, advocating for leveraging local expertise and strengthening local programs before seeking federal support. The episode concludes with practical insights on integrating social needs into healthcare delivery and the importance of addressing these determinants to foster a sustainable healthcare system. Dr. Ford dives into what makes a successful organization in public health, focusing on the critical role of data. From the challenges of data standardization and sharing to the importance of good governance and leadership, this episode offers invaluable insights. This conversation is a must-listen for anyone passionate about creating a comprehensive healthcare system that truly considers the full spectrum of social determinants of health.
Key Quote:
“We are not going to doctor ourselves out of the healthcare crisis. If we really want to address healthcare crises in this nation, we need to understand how are people living, what they're missing. We need to ask questions around how people live their lives. It’s cheaper to give somebody a food prescription than it is to treat an amputee from diabetes. So if we ask the questions on the front end of what people need, we’re better able to serve them from a clinical perspective.”
-Dr. Sandra Elizabeth 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
On this episode of “Quality Matters” with host Andy Reynolds, we explore the vital role of Sexual Orientation and Gender Identity (SOGI) data in healthcare. Our expert guests, Kellan Baker, Executive Director of the Whitman-Walker Institute, and Dr. Carl Streed, a primary care physician at Boston University, share why SOGI data are essential for delivering personalized health care interventions and improving overall health outcomes. Understanding sexual orientation and gender identity alongside other demographic variables like race and ethnicity is crucial for providing comprehensive and inclusive care. Emphasizing the importance of building trust within healthcare settings, our guests discuss how fostering a trustworthy environment encourages the sharing of sensitive SOGI information, which is vital for patient care quality.
The conversation addresses the challenges the current political climate poses and its potential negative impacts on LGBTQ health. We highlight the necessity of robust privacy protections to prevent the misuse of SOGI data and the role of the entire healthcare team in safeguarding this information. Additionally, we share insights into new resources from the US Department of Health and Human Services to enhance demographic data quality. Calvin emphasizes recognizing LGBTQ individuals as people with unique stories and the importance of methodological data collection. For further guidance, recommendations include resources from the Office of the Assistant Secretary for Planning and Evaluation at the US Department of Health and Human Services.
Key Quote:
“These are intimate areas of people's lives that we're dealing with in health care, and HIPAA was enacted to protect that information from exploitation and misuse. so it's incredibly sad to see state actors intentionally misusing the law. To take personal health information from patients, from families, from healthcare institutions, not just that incredible intrusion into the provider patient relationship, but then also to Press charges against healthcare providers, for providing medical care in accordance with their training and expertise. It's an incredible violation of HIPAA and something that should concern all of us, regardless of whether we're transgender or we provide care to transgender people.”
-Kellan Baker, Executive Director of the Whitman-Walker 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
In the first episode of a two-part series titled, 'In Data We Trust,' host Andy Reynolds and Tam Ward, Senior Vice President of Business Strategy and Operations at Oscar Health, discuss the intersection of technology and health care to improve care equity, especially in underserved communities.
Focusing on initiatives by Oscar Health, Tam highlights efforts to build culturally competent care networks and improve data-driven solutions for marginalized groups, including African Americans and the LGBTQ community.
The episode emphasizes the importance of trust, transparent data sharing, and personalization in healthcare to address disparities and enhance patient experiences.
Key Quote:
“If there was one ask I could have of those in a place of influence to help create standardization around provider data, it's share the attributes of the physician that are important to the patient and hold us accountable for doing what's right with that information.”
-Tam 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
Join us for an insightful conversation with North Carolina Secretary of Health and Human Services, Kody Kinsley, as he shares how growing up without health insurance influences his drive to improve health care access and affordability in his home state. Discover the transformative impact of the state’s recent Medicaid expansion and substantial investments in behavioral health.
Secretary Kinsley emphasizes North Carolina’s novel, bipartisan approach to improving care. The discussion covers innovative strategies for staffing the 988 crisis hotline and the unusual integration of the health care system and the prison system. Secretary Kinsley ends with reflections on leadership in an era of identity politics and his advice for quality advocates everywhere.
Key Quote:
“We are very excited to have, after 10 years been able to finally expand Medicaid. And not only have we gotten it done, we've gotten it done well. The other thing that's particularly exciting was a near billion-dollar investment in behavioral health. That is just so consequential to overall health and well-being, something that had also been forgotten and neglected for too long,”
-Secretary of the North Carolina Department of Health and Human Services Kody 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
University of Chicago professor and Doctor, Marshall Chin, joins us on Quality Matters to revolutionize medical training with his unique blend of improv and stand-up comedy. Discover how these innovative techniques equip medical students with the skills to care for diverse patients and engage in vital discussions about systemic racism and social privilege. By prioritizing active listening and real-time interaction, Dr. Chin's approach helps shift the perspective from merely addressing health disparities to fostering genuine health equity.
The episode culminates with actionable strategies to propel health equity forward, highlighting the importance of culturally tailored solutions and comprehensive interventions. We explore the power of honest dialogues about racism, power, and privilege, and discuss how lifelong learning and diverse experiences, akin to team sports, can drive systemic change.
Join us for this enlightening conversation that underscores the critical need for continuous improvement and authentic community partnerships to pursue health equity.
Key Quote:
“The thing about health equity is that it’s the right thing. Everyone wants to do the right thing. And it requires all this expertise and all these stakeholders. It has the community expertise. It requires the clinicians on the staff who have the frontline experience. It requires people who do quality improvement. It includes the data people. I mean, everyone has a role.” - Dr. Marshall 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
Welcome to "Quality Matters," the podcast where we unpack the complexities of modern healthcare to shape a brighter future. Join us as we delve into the dynamic world of healthcare quality and innovation, exploring topics such as digital transformation, health equity, and quality standards.
Each episode brings together thought leaders, industry experts, and innovators to discuss the latest trends, best practices, and challenges shaping the future of healthcare. With a focus on convening voices from across the industry, "Quality Matters" provides a platform for meaningful conversations and collaboration.
Whether you're a health plan leader, a health IT professional, or simply someone passionate about improving healthcare outcomes, tune in to gain valuable insights and actionable strategies for driving positive change in healthcare delivery.
Because when it comes to healthcare, quality truly matters. Join us on "Quality Matters" as we shape tomorrow's healthcare today.
In this episode, we highlight two companies that leverage data from many different sources to create a more complete picture of a person’s health. The ultimate goal? Shifting away from the current model of “sick care” - where patients primarily see their doctors when they aren’t feeling well – to care models that prioritize long-term health and self-management with guidance from providers. These companies are helping lead the way to value-based care, from using AI to sift through patient-reported data and provide actionable insights, to integrating NCQA's HEDIS measurements into their data platform, thereby putting quality at the center of everything they do. Here, you’ll get a glimpse into the challenges and opportunities in our current data-rich health care ecosystem.
The episode begins with a conversation with leaders from Welldoc. Welldoc is a health tech company developing patient-facing apps to support self-management of chronic conditions. Using an omnichannel approach, their apps gather as much data as possible from sources including remote monitoring devices, like wearables, and clinical data.
Chief Analytics Officer, Dr. Anand Iyer, and Chief Medical Officer, Dr. Mansur Shomali, explain how Welldoc uses AI to parse the patient information, ultimately helping doctors and patients work together to construct an effective path to wellness.
Jessica Robinson is Chief Platform Officer for health care digital developer The Garage. Jessica manages all aspects of the product life cycle, from the spark of innovation through design, development, testing, and roll-out. Founded in 2012, The Garage aims to utilize digital tools to help providers shift from fee for service models to value-based models of care.
In this interview, recorded live at NCQA’s 2023 Health Innovation Summit, Jessica explains how The Garage works with Management Service and Accountable Care organizations, among other provider groups, to develop digital applications that help clinically integrated networks across 34 states harness the full extent of the population data available to them. The Garage also utilize NCQA’s HEDIS measures into their platform, allowing networks to visualize the full patient care team across the entire care continuum and deliver optimized quality care to their patients.
For information on NCQA’s Health Equity Forum, click here: https://events.ncqa.org/healthequityforum
The course of the Digitalization of Health doesn’t always run smooth. But for every set of pain points a provider might experience, there are companies developing technological solutions – platforms and tools – that not only guide us through digital transformation but identify crucial patient and population data along the way.
In this episode, we talk with two health tech leaders, interviewed during NCQA’s 2023 Health Innovation Summit in Orlando, Florida, about their strategies and successes in using digital tools that can ultimately reveal and resolve gaps in health care delivery.
Sebastian Seiguer, is co-founder and CEO of Scene Health. Scene Health is a company focused on medication “engagement”, a comprehensive approach that means more than just getting patients to take their medicine. They provide personalized medication support by combining video technology, clinical coaching, and validated interventions to improve medication adherence rates. Within the tapestry of their mission is the clear goal of reaching and engaging with diverse, vulnerable, and hard-to-reach populations.
Upendra Patel, CEO of AaNeel Infotech, is finding ways to support clinicians through EHR, or Electronic Health Record, interoperability. AaNeel Infotech worked with Medstar Health to transform an isolated risk calculator into a FHIR-based app. Upendra’s company helped them use the SMART on FHIR methodology. That’s FHIR as in “Fast Health Interoperability Resources” and SMART as in “Substitutable Medical Applications and Reusable Technologies”. Using the SMART on FHIR approach, AaNeel Infotech helped create an app called “Mobilizing a Million Hearts”, which integrates the Million Hearts Longitudinal Atherosclerotic Cardiovascular Disease risk calculator into the MedStar Health EHR system and allows Medstar providers to get an even more comprehensive view of their patients at risk for cardiovascular disease.
This episode of “Inside Health Care: a Podcast by NCQA” features three interviews recorded live at our Health Innovation Summit in October 2023. Among many panels and presentations was an incredible session titled “Health Equity Trailblazers: Where Vision Meets Commitment.” Health equity leaders discussed their organizations’ health equity strategies, vision and lessons learned, delving into how leaders can commit to and advance health equity priorities. Each of this episode’s guests sat on that panel then sat with me for a deeper dive. These leaders, each in their own way, want to inspire us to action.
Dr. Joneigh Khaldun is Vice President and Chief Health Equity Officer for CVS Health. In this role, she advances the company’s data-driven strategy to improve access to services, address social determinants of health and decrease health disparities. She is a sought-after speaker and thought leader who has appeared on Meet the Press, MSNBC and CNN, among others, and she has testified before Congress.
In her past work, as the top doctor leading Michigan’s COVID response, she is credited with the state’s early identification of and actions to decrease disparities, and in 2021 was appointed by President Biden to the national COVID-19 Health Equity Task Force. She is a practicing emergency physician who earned her MD from the Perelman School of Medicine at the University of Pennsylvania.
Dr. Ronald M. Wyatt is a renowned global health care quality and safety expert with a passion for advancing health equity worldwide. Dr. Wyatt is Founder and CEO of Achieving Health Equity, LLC. As a distinguished Senior Fellow with the Institute for Healthcare Improvement, he holds pivotal roles as Chief Science Officer and Chief Medical Officer at the Society to Improve Diagnosis in Medicine, an organization dedicated to enhancing diagnostic accuracy in health care. As an expert in hospital safety oversight, Dr. Wyatt holds a significant role in shaping the National Patient Safety Goal on Health Equity. His contributions to the National Patient Safety Plan, authored by AHRQ and IHI, underscore his commitment to advancing health care on a global scale.
Dr. Bryan O. Buckley moderated the Health Care Trailblazers panel at NCQA’s 2nd annual Health Innovation Summit. Dr. Buckley is NCQA’s Director for Health Equity Initiatives. In this position, he plays a key role in developing partnerships with funding and research organizations, care delivery systems, the managed care industry and communities to translate research knowledge and real-world evidence into development of equity-oriented products and programs. These include NCQA’s Health Equity Accreditation programs.
In this Inside Health Care interview, we explore GME — graduate medical education — and explore a few fundamental questions. How can we make sure today’s medical residents are paying attention to their patients? How do we teach residents to ask the right questions? And even more fundamentally, how do we make sure that the next generation of clinicians knows how to implement value-based models of care in order to focus on person-centered outcomes?
A value-based model helps patients envision what their lives could be a few months, or even years, down the line. And that’s the point at which clinicians can help patients develop a treatment plan to get them from point A to point B. That may be the best way to keep a patient healthy, boost their interest in their self-care and prevent repeat visits for the same problem.
So the questions stand regarding graduate medical education. How do you teach med school students the value of quality? How do you train them to follow a model of value-based care? And if your hospital’s HEDIS scores are low, how much of that is because of the residents? What's the correlation between medical residencies and health care quality?
Michael Kanter, MD, is a professor and chair of Clinical Science at the Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, California. In his work within Kaiser Permanente’s health care system, he’s overseen the quality of care provided by 22,000 physicians to 12.2 million patients. He also was responsible for development of Kaiser’s national quality strategy. An expert in patient safety and clinical quality, he developed policy-based and software-based programs that decreased the number of missed or delayed diagnoses and increased patient engagement.
Jung Kim, PhD, MPH, is Assistant Professor for Health Systems Science at the Kaiser Permanente Tyson School of Medicine, and a protégé of Dr. Kanter. Dr. Kim explores approaches to health care and healing, including studies on the roles of acupuncture and other East Asian practices as complementary or alternative medical treatments for cancer, H-I-V and other conditions. As we’ll hear in our interview, Dr. Kim also investigates innovations in medical education residency programs, including analysis of email communication among medical students and new learning strategies for medical education.
We close 2023 with our annual year-end State of Health Care interview with NCQA President Peggy O’Kane. In this interview, Peggy talks with Vice President for Public Policy and External Relations, Frank Micciche, about NCQA’s progress in 2023—both in improving equitable access to health care and implementing digital transformation across the ecosystem. As you’ll hear, we’re hitting the ground running in 2024. With new digital products, digital quality implementers and digital solutions to reveal—and reverse—health care disparities, NCQA stands ready to take the lead on advancing quality for everyone.
Don't forget to sign up for NCQA’s next big event: the Health Equity Forum, coming up March 4th and 5th, 2024, at the Westin Los Angeles Airport. The Health Equity Forum convenes state officials, advocates and health care providers, showcasing the blueprint for creating and implementing statewide health equity strategies. Our next Quality Talks event is planned for Spring 2024. And as mentioned in this episode's interview, go to www.ncqasummit.com to learn more about our Health Innovation Summit, and click here to register for our next event, October 31-November 2, 2024, in Nashville.
In this episode of our “Inside Health Care” podcast, we hear two interviews that each demonstrate how close we are to solving the challenges of health disparities and digital transformation. Our first interview finds a real-life, “Last Mile” solution that will bring historically under-served populations to the health care services they need and deserve. Our second interview reveals how improved efficiencies in digitalization actually make it easier to add even more data – and more data crunching – into the mix.
PHIT4DC stands for the Public Health Informatics and Technology for the District of Columbia Workforce Diversification Program. PHIT4DC brings together public health programs at two HBCUs—historically Black Colleges and Universities—namely, the University of the District of Columbia and Howard University. Together, these esteemed institutions train professionals from historically under-served neighborhoods in 21st-century IT knowledge and skills so they can return to their neighborhoods and give back to their communities.
PHIT4DC trains PCMH professionals in order to send them to work in and support their hometown communities and neighborhoods. It’s a powerful solution for bridging the gap in health equity provision. And it’s probably possible to set up this model in any U.S. city. But, as you can imagine, it’s no small feat.
Dr. Mary Awuonda currently serves as an Associate Professor and Director of the Center of Excellence at the Howard University College of Pharmacy. In her directorship role, she helps the College advance its health care workforce diversification mission and student academic success initiatives. She is published in the areas of minority health, health disparities, health outcomes research and workforce diversification.
Hannah George is a health care consultant with years of service across the health care industry. She’s been a college professor/mentor for nursing students and director of nursing for multiple home health agencies in the District of Columbia. She’s worked on multiple health care research protocols and served as senior clinical lead on multiple projects and initiatives. Hannah is certified in Project Management, is a Certified Professional in Healthcare Quality (CPHQ) and a Certified Professional in Patient Safety (CPPS).
Digitalization ensures the safe and efficient transfer and parsing of health care data between providers. Patients benefit, clinics benefit, clinicians can spend more time with patients. And improvements in data transfer and parsing reveal more population data than ever before, which uncovers gaps in health equity. And with that population data, researchers can start to reverse deficiencies and ensure better health care for all.
Josh Hetler is Chief Operations Officer at DataLink and an expert in the potential revelations of supplemental data. Josh has over a decade of experience developing software products for advancing value-based health care. At DataLink, he’s held management, director and vice president positions, successfully building strategies that impact customer adoption and engagement.
Josh was interviewed live and in person at NCQA’s 2nd annual Health Innovation Summit, in October 2023 in Orlando, Florida.
In this episode of Inside Health Care, we present two interviews that each ask really basic, yet complex, questions about health care.
The first question: Why 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.
In this episode, we explore a much-discussed Inside Health Care topic: interoperability. Within the process of health care digitalization, interoperability deals with the multi-lane, multi-directional transfer of electronic health records, or EHRs. But more and more, in that transfer process, companies discover data they hadn’t considered using, data needing refinement, and data that tells stories of patients being overlooked and left behind.
In the first interview, my guest and I discuss the best way to smoothe the road to health equity: form a patchwork of different types of health care companies that can safely and efficiently shepherd data along the patient journey. Later, I co-interview a team that discovered a disparity gap and closed it—permanently. Their secret? Ask the community how to reach those patients.
Mo Weitnauer is MRO’s Chief Product Officer. She drives its product strategy and roadmap. Throughout her high-level career, Mo has helped develop tech-based strategies for managing medical costs and patient bills, trying to even things out for both sides while still striving to advance care quality.
Mo graduated with a bachelor’s degree in Biochemistry and Economics from Smith College, and she got her master’s degree in Health Policy and Management from Harvard’s T.H. Chan School of Public Health.
Next, we hear a success story from a team from WellSpan Health, a health care that found a gap in health care equity and nailed down a solid and sustainable solution.
Jenna Jansen is Senior Director of Quality at WellSpan Health. She earned her BS and MPH degrees from West Virginia University. She is a Fellow of the American College of Healthcare Executives and also a CPHQ.
Jodi Cichetti is Vice President of Quality, Patient Safety and Infection Control and Prevention at WellSpan Health. She’s an RN with a background of working in the ICU. She holds an MS in Health Systems Management from the University of Baltimore, and her certifications include, among others, a CPHQ, a.k.a. she’s a Certified Professional in Healthcare Quality.
Jenna and Jodi presented a session at the Health Innovation Summit titled “STOP, Collaborate, & LISTEN! Improving Equitable Access to Care”. In the interview, they told the story of how their research revealed a gap in care delivery. Using various analytical tools including NCQA’s breast cancer screening measure, part of our HEDIS set of measures, they discovered a disparity among Spanish-speaking patients.
In this episode, we hear clips from four interviews recorded live at NCQA’s 2nd annual Health Innovation Summit.
Parker Holcomb is Chief AI Engineer at Elevance Health. At NCQA’s 2023 Health Innovation Summit, he participated in a session titled “Building Trust in Clinical Data for Value-Based Care”. Parker stands at the forefront of data quality, constantly seeking to perfect data quality standards, all towards closing gaps in health equity. So how do professionals and technologists align the movement toward digital health transformation in the direction of value-based care?
Dr. Joseph Betancourt is president of the Commonwealth Fund. One of the nation’s preeminent leaders in health care quality, Dr. Betancourt formerly served as senior vice president for Equity and Community Health at Massachusetts General Hospital (MGH), overseeing a number of entities including the Center for Diversity and Inclusion.
A prolific author, lecturer, and board-certified internist who focuses on Spanish-speaking and minority populations, Dr. Betancourt is also an associate professor of medicine at Harvard Medical School. This is notable for this interview, as he earned his MPH from Harvard with one of the first classes in the Commonwealth Fund–Harvard University Fellowship in Minority Health Policy.
At the 2023 NCQA Health Innovation Summit, he led a session titled “Pursuing the North Star: A high performing, equitable health care system”. And as you’ll hear, increasing diversity among health care professionals and rebuilding the trust of historically under-served patients are just two of a myriad of ingredients necessary to right the ship on the journey to Health Equity.
Next, we hear a success story from a team from WellSpan Health, a health care that found a gap in health care equity and nailed down a solid and sustainable solution.
Jenna Jansen is the Senior Director of Quality at WellSpan Health.
Jodi Cichetti is Vice President, Quality and Patient Safety, at Wellspan Health.
Jenna and Jodi presented a session at the Health Innovation Summit titled “STOP, Collaborate, & LISTEN! Improving equitable access to care”. In the interview, they told the story of how their research revealed a gap in care delivery. Using various analytical tools including NCQA’s breast cancer screening measure, part of our HEDIS set of measures, they discovered a disparity among Spanish-speaking patients.
Christopher J. King is the inaugural Dean of the School of Health and former Chair of the Department of Health Systems Administration at Georgetown University in Washington, DC. An academic administrator, associate professor, and strategist, who is board certified in healthcare, Dr. King’s writing and teaching focus on the intersection of institutional racism, social determinants of health, and healthcare administration. And he envisions a world in which health status cannot be predicted by race, social class or place of residence.
At this year’s NCQA Health Innovation Summit, Dr. King joined the dais in a session titled “No Quality without Equity”. In this clip from our interview, Dr. King talks about race-based clinical data in health care. And in his view, the use of this data is doing more harm than good.
Stay tuned for more information about NCQA’s next Health Innovation Summit, set for Nashville, October 31-November 2, 2024. For more, go to https://www.ncqasummit.com.
In this episode of “Inside Health Care,” we meet two guests, in two interviews. Our first guest advocates for birth, racial and gender equity, driven by her own distressing experiences as a patient. Our second guest developed effective ways to implement virtual care on a large scale to improve equity and representation for rural communities.
Sinsi Hernández-Cancio, JD, is a vice president at the National Partnership for Women & Families, where she leads the Health Justice team. Born in Puerto Rico, Sinsi is a national health and health care equity policy and advocacy thought leader dedicated to advancing equal opportunities for women and families of color. The Partnership worked with health care experts and partner organizations to develop a report that includes recommendations for improvement in resolving gaps in health equity that executive leaders can tailor to their organizations.
Debbie Welle-Powell, MPA, is CEO of DWP Advisors and an Adjunct Professor at the University of Colorado Executive MBA. But Debbie is best and widely known in the health care world as the former Chief Population Health Officer at Essentia Health. Headquartered in Duluth, Essentia is an integrated delivery system of 14 hospitals and 1,500 providers spanning the states of Minnesota, North Dakota and Wisconsin. Debbie designed, built and operationalized Essentia’s $2.5 billion transition from a primarily fee-for-service model of care to one that focuses on value.
Later in our “Fast Facts” segment, we observe Breast Cancer Awareness month for October 2023. We discuss the CDC’s guidance on how to help people with cancer "Stay Mentally and Emotionally Healthy.” We also discuss NCQA’s Breast Cancer Screening HEDIS measure, which assesses women 50–74 years of age who had at least one mammogram to screen for breast cancer in the past 2 years.
In this episode of “Inside Health Care,” we take a look back at what we’ve learned since the pandemic hit over two years ago. We first chat with an upcoming star speaker at NCQA’s 2023 Health Innovation Summit on what we’ve garnered from the growth of telehealth in remote medicine. Then in our second interview in this episode, we discuss the public’s conflict with immunization and new strategies on encouraging vaccination.
Dr. Leslie Eiland is an Associate Professor of Medicine in the Department of Internal Medicine, Division of Diabetes, Endocrinology & Metabolism at the University of Nebraska Medical Center. She is Medical Director of Patient Experience and Digital Health at Nebraska Medicine, and has been Medical Director of the endocrine telehealth program there since 2014. The program provides care via telehealth to eight rural community hospitals in Nebraska and Iowa. Dr. Eiland’s clinical areas of interest and expertise are remote delivery of endocrine care and providing endocrine support for primary care providers in rural communities.
For our second interview, we wonder: what have we learned from the pandemic? With backs up against the wall and clinical care pushed to capacity, 2023 was a time of reflection...and re-invigoration. In this interview, hosted by Dr. Sepheen Byron, Assistant Vice President, Performance Measurement at NCQA, you’ll hear about one such effort to see what we’ve learned about, and gain new insights into approaches to care, from review of pandemic care. In this case, we focus on Adult Immunization and improving adult immunization rates.
A panel of experts, including partners from NCQA, convened in June of 2023 for a roundtable discussion on adult immunization. They not only discussed clinical guidelines and approaches to better health. They considered simple human behavior: how to rebuild trust with patients and ultimately find new ways to encourage them to vaccinate. In September 2023, NCQA released a white paper summarizing the roundtable’s discussions and their conclusions.
Megan Lindley, MPH, is the adult vaccination Team Lead of the Applied Research, Implementation Science, and Evaluation Branch in the Immunization Services Division of the CDC. Her areas of research interest include immunization law and policy, adult immunization quality measurement, vaccination in pregnancy and healthcare personnel vaccination. She was an active member from 2012-2019 and a co-chair from 2018-2019 of the National Adult and Influenza Immunization Summit’s Quality Measures Workgroup, which developed two immunization quality measures that were added to HEDIS in 2019: a measure of routine adult vaccination and a composite measure of vaccination of pregnant women. Ms. Lindley has authored or co-authored over 100 peer-reviewed publications.
In our Fast Facts segment, we observe September’s Prostate Cancer Awareness Month with important information from the CDC on symptoms and screening. We also discuss one of a number of NCQA’s cancer-related HEDIS screening measures. Colorectal Cancer Screening, which we call C-O-L or C-O-L-E, assesses adults 50–75 who had appropriate screening for colorectal cancer with any of a number of tests, including a colonoscopy every 10 years, computed tomography colonography every 5 years and a stool DNA test every 3 years.
In this episode of “Inside Health Care,” we talk interoperability with a cardiologist who helped develop a new standard for data records exchange. Fast Healthcare Interoperability Resources, a.k.a. FHIR, can improve efficiencies in use and transfer of electronic health records. It can ease pressure on medical staff while also improving health equity measurement.
In our discussion with Dr. James Tcheng, we focus on the CardX Hypertension Project. CardX, or cardiovascular data exchange, was launched in 2022 by the University of Nebraska Medical Center’s Center for Intelligent Heath Care. The project stems from the greater CodeX FHIR Accelerator project. The project seeks to use FHIR as a standard for data transfer and parsing. The project’s stated objective is to “facilitate the communication of hypertension management data between clinicians and patients to increase the proportion of individuals with hypertension who are treated to goal.”
Our guest is Dr. James Tcheng, cardiologist and professor of Family Medicine and Community Health at Duke University’s School of Medicine. In addition to his work with patients, his research ranges from developing therapies for cardiovascular disease to use of A.I., I.T., and clinical informatics to improve efficiencies in the delivery of care. I’m pleased to say that Dr. Tcheng will be presenting a session on the CardX FHIR Accelerator at NCQA’s annual Health Innovation Summit, coming October 2023.
Later on in our “Fast Facts” segment, we observe September’s Healthy Aging Month in the U.S. with information about osteoarthritis. We also give a rundown of NCQA’s HEDIS OMW measure, namely Osteoporosis Management in Women Who Had a Fracture. This measure assesses women 67–85 years of age who suffered a fracture and who had either a bone mineral density test or a prescription for a drug to treat osteoporosis in the 6 months after the fracture.
In this episode of “Inside Health Care,” we chat with a prominent NCQA board member about flipping fee-for-service models to value-based models, all in order to ease digital transformation. Then, we talk about the challenges and true rewards of pursuing Credentialing Accreditation.
Dr. Craig Samitt is the CEO and Founder of ITO Advisors, an advisory and investment firm committed to value transformation of the health care industry. Dr. Samitt sits on many boards in addition to NCQA’s Board of Directors. He also serves as a strategic advisor to federal agencies, public and non-profit health plans and numerous digital health and care delivery organizations.
At the Health Innovation Summit, Dr. Samitt will panel alongside NCQA President Peggy O’Kane and other experts. In a session called “Payment Models and Digital Transformation,” they’ll discuss the opportunities and challenges associated with digital transformation in a fee-for-service landscape.
Bill Vargo is Program Manager in the Northwestern Medicine Physician Network of Northwestern Medicine. He helped lead Northwestern Medicine through NCQA’s Credentialing Accreditation process, and he wanted to share with us the need for this program, the rewards of simply going through the evaluation and how Northwestern did it.
NCQA Credentialing Accreditation helps improve credentialing and protects consumers by ensuring a consistent, effective and diligent credentialing process. It provides a framework for organizations to implement industry best practices that help them efficiently credential and re-credential health care professionals.
Later in our Fast Facts segment, we observe August as National Breastfeeding Month with some data on federal legislation regarding breastfeeding in the workplace. This information is provided by an independent nonprofit organization, the United States Breastfeeding Committee. We then describe NCQA’s Prenatal and Postpartum Care HEDIS quality measure, also known as PPC.
In this episode of “Inside Health Care,” we talk digital transformation with a prominent medical informaticist. Then, we hear a conversation on NCQA’s long-term services and supports programs, a.k.a. LTSS, from a long-time accredited managed care supporter.
Dr. John Glaser is Executive in Residence at Harvard Medical School Executive Education. Previously he was Chief Executive Officer of Siemens Health Services. He is former Chair of the Global Agenda Council on Digital Health in the World Economic Forum, and former Senior Advisor to the Office of the National Coordinator for Health Information Technology. He’s also a member of NCQA’s Board of Directors.
Dr. Glaser will also be at NCQA’s second annual Health Innovation Summit in October 2023. In addition to helping open the Summit, he’ll sit on a C-suite panel alongside NCQA President Peggy O’Kane and other industry leaders, discussing, among other things, the transition to a digital health ecosystem.
Centene is the largest Medicaid Managed Care Organization in the U.S., as well as the largest carrier on the Health Insurance Marketplace.
Nicole McLean is an accreditation manager for Centene, and she spends much of her time working with NCQA on our LTSS programs. But which services are included in LTSS? What could they be? Well, as Nicole will tell you, in order to evaluate which services and supports people need, you first have to learn about...the patient.
Later in our Fast Facts segment, we observe August as National Immunization Awareness Month. First, we present some tips from the CDC for providers' offices on how to talk about vaccinations to young patients and their families. We also mention NCQA's HEDIS "Childhood Immunization Status" measure.
In this episode, we talk with two leaders of an amazing NCQA partner company, Cozeva, while revisiting one of NCQA’s cutting edge digital products, our Data Aggregator Validation program [DAV]. Cozeva, a member of the original program cohort, is an integrated, comprehensive population health platform.
Our Data Aggregator Validation program now forms the backbone of Cozeva’s services. Cozeva currently provides health care data solutions to nearly 37,000 providers across 16 states. For more details on NCQA's data analysis work, check out our Data Measures Roadmap.
Dr. Khanh Nguyen is Chief Executive Officer of Cozeva. Khanh has a doctorate from the University of California San Francisco School of Pharmacy, focusing on health policy and management. She has over 15 years of experience in creative payer-provider collaborations. Khanh is an expert in data crunching, discussing how improving and easing the flow of health care data will then improve efficiency for both payers and providers.
Dr. Rosh Singh is Cozeva’s Chief Technology Officer. In his over eight years with Cozeva, Rosh was previously VP of Product Management, and before that, Director of Analytics. He has a PhD in Biomedical Engineering from Cornell and over 15 years experience combining product management with A.I. and machine learning. He creates what he calls “decision science,” finding hard- and soft-tech solutions that support multi-billion-dollar transactions.
Later on in our Fast Facts segment, we observe Gastroparesis Awareness Month with important information that could save a life. The episode also discusses NCQA's Colorectal Cancer Screening measure [COL], featured as part of our HEDIS package of quality health care measures.
In this episode, we’re focusing on NCQA’s PCSP—Patient-Centered Specialty Practice Recognition program. As noted on our website, the PCSP Recognition program focuses on coordinating and sharing information among primary care clinicians and specialists. It requires clinicians to organize care around patients—across all clinicians seen by a patient. Patients and their families or other caregivers are included in planning care and considered partners in managing conditions.
Specialty practices that earn NCQA’s PCSP Recognition communicate more effectively with primary care, integrate services better with primary care and improve the quality of their care. Patients see the difference through reduced costs, better data and records management, improved identification and oversight of chronic conditions, and more face time with a more satisfied medical staff.
For this interview, we found one of our greatest advocates of the PCSP Recognition program, an extremely busy and dedicated medical team from Providence Heart Institute in Portland, Oregon. A number of years ago, they saw the need for PCSP, found solutions that worked conclusively and spread the word throughout their company about the effectiveness of the patient-centered specialty practice model of care.
Xiaoyan Huang, MD, Chief of Clinical Cardiology, leads clinical operations and care transformation for advanced heart failure, electrophysiology, general cardiology and interventional cardiology subspecialties. Danielle Christensen is Clinical Program Manager at the Providence Heart Institute in Oregon. With experience in both ambulatory and acute care settings, Danielle’s expertise spans business development and strategy, change management and development, and the optimized exchange of electronic health records.
Dr. Huang and Danielle led a session at NCQA’s first Health Innovation Summit in the fall of 2022. And they ran a fascinating and informative training webinar which is still available for download on our education website. The title of their course: “CCE Quarterly: Building with a Blueprint: Taking a Patient-Centered Specialty Practice from Medical Neighborhood to High Performing Network.”
The interview is hosted by NCQA’s Senior Vice President for Product and Customer Operations, Lori Ferguson.
Later on, in our Fast Facts segment, we observe National Minority Mental Health Awareness Month with important stats to share with colleagues and community. Among many of our products and measures addressing behavioral health needs, we mention is NCQA’s “Managed Behavioral Health Organization Accreditation” or MBHO, an important accreditation for employers.
On this episode of Inside Health Care, we talk Medicaid with a large, equity-focused provider about the end of the Fed’s pandemic-related emergency Medicaid provisions. Following that, a chat with one of our 2022-2023 PCMH Certified Content Expert Quality Award winners. Later on, some fast facts for you in observance of World Hepatitis Day.
Elevance Health, a large multi-state health insurance provider, is the largest managed care company in the Blue Cross Blue Shield Association. In September of 2022, an Elevance Health subsidiary, Simply Healthcare Plans of Florida, became one of the first health care organizations in the U.S. to earn accreditation in NCQA’s Health Equity Accreditation Plus program.
We interview Elevance Health Medicaid President Aimée Dailey alongside Staff Vice President for Medicaid Whole Health Kalunde Wambua to find out more about the company’s continued commitment to Equity improvement.
We also talk with one of NCQA’s 2022-2023 PCMH Certified Content Expert Quality Award winner, Susanne Campbell, Senior Program Administrator for the Care Transformation Collaborative of Rhode Island. We talked about the challenges of getting people on board with quality measurement. And we learned that, as measurement improves, customer focus improves, and health delivery becomes more efficient, all leading to solutions for resolving historic gaps in health equity.
Finally, in our Fast Facts segment, we observe the World Health Organization’s World Hepatitis Day, scheduled annually every July 28th. We include resources from the U.S. Department of Health and Human Services alongside an article from the NIH. Hepatitis awareness includes further reminders for childhood immunization, something NCQA measures in our HEDIS Measures package called Childhood Immunization Status, or C-I-S. The measure calculates the rates for a number of childhood vaccines and vaccine combinations. Among the vaccines in the list, alongside DTaP, MMR, and the flu, are vaccines for both Hep A and Hep B.
We're also proud to announce that Inside Health Care won two media industry awards, both announced in June 2023. We won a Merit award from the Digital Health Awards. We've also been named a Gold Winner 2023 by the Hermes Awards. Thanks to all our interviewees and leadership staff at NCQA for their support along the way.
On this episode of Inside Health Care, we celebrate Pride Month with discussions on gender health equity, sexual orientation and gender identity health care quality issues, and health care access and representation for the LGBTQIA+ community. Later, some tips on improving the provider experience for transgender patients.
Dr. Alex Keuroghlian is an expert in Sex- and Gender-Informed Medicine and Sexual and Gender Minority Health Care. As a psychiatrist, Dr. Keuroghlian’s work often centers on patients suffering from post-traumatic stress disorder, or PTSD, especially within the LGBTQIA+ community. They hold numerous leadership and teaching positions at Massachusetts General Hospital and Harvard Medical School. They also support and educate health care centers and clinicians in gender equity with their leadership as Director of the Division of Education and Training at The Fenway Institute, and Principal Investigator of the National LGBTQIA+ Health Education Center, a HRSA-funded cooperative agreement to improve health care for LGBTQIA+ people at health centers around the country.
NCQA Senior Research Scientist for Health Equity Dr. Rachel Harrington discusses gender-equity needs and perspectives in health care. Her team develops improvements to NCQA's HEDIS measures updates. We discuss why it's been so difficult to gather health data on LGBTQIA+ populations.
Later in our Fast Facts segment, we include tips via the CDC from the GLMA on improving the provider experience for transgender patients.
On this episode of Inside Health Care, we feature two interviews celebrating winners of two different NCQA awards: a NCQA 2022 Health Innovation Award and a 2022-2023 PCMH CCE Quality Award Winner. Later in the show in our Fast Facts segment, we discuss gender equity-related health care terminology.
In our first interview, we talk with Dr. Ava Jones, PhD and RN, the Director for Health Equity and Accreditation at United Health Care Community and State’s Florida Plan. Dr. Jones workplace won an NCQA 2022 Health Innovation Award, for the “UnitedHealthcare Community Plan of Florida Housing Navigation Program.” A healthcare navigator assists plan members with advice or suggestions on how to pursue a medical issue affecting them or their family. Dr. Jones explains the nature and importance of a housing navigator.
NCQA PCMH Recognition is like a seal of approval for quality assurance. A health care practice that earns that seal can be trusted for their dedication to delivering quality care—which means they’re dedicated to their patients. And having a Certified Content Expert, or CCE, almost guarantees a practice will continue its dedication to excellence for years to come.
NCQA’s 2022–2023 PCMH Certified Content Expert Quality Award Winner Deneane Anderson works for the Capital Area Health Network, also known as CAHN, in Richmond, VA. She’s been in the medical field for the past 15 years and has been a patient advocate for the past 14 years at CAHN and operates as the Transformation Manager of the PCMH Team at CAHN. Click the link for more information about becoming a PCMH CCE.
Our Fast Facts segment in this episode celebrates Pride month with background on federal protections for those people identifying as LGBTQ+, info on gender-affirming care and gaining health insurance. We then focus on NCQA’s efforts to update HEDIS measures to include language for Sexual Orientation and Gender Identity.
On this episode of Inside Health Care, we talk about acupuncture, yoga and a host of other “alternative” therapies with a health leader in the U.S. government. After that, we explore a newly announced breakthrough in digitalization exploration with NCQA’s Chief Technology Officer.
Our first guest is one the foremost experts in the U.S. on integrative medicine. He answers some difficult questions. How have some alternative therapies become legitimized? And what are the risks of unregulated therapies?
Benjamin Kligler, MD, MPH, is Executive Director of the Office of Patient Centered Care and Cultural Transformation (OPCC&CT) at the Veterans Health Administration. He is a board-certified family physician, working as a clinician, educator, researcher and administrative leader in the field of complementary and integrative medicine.
At NCQA’s 2023 Quality Talks, Dr. Kligler talked about “whole health” and how it relates to his work.
In our next interview, NCQA Chief Technology Officer Ed Yurcisin breaks down our newest development in digital health, our newly-announced requirements and open source software for interpreting and executing clinical quality language (CQL) so any organization or software developer can use HEDIS Digital Content Services.
Later in Fast Facts, we observe Osteoporosis Awareness and Prevention Month. We also discuss the NCQA has HEDIS measure, Osteoporosis Screening in Older Women, that assesses the percentage of women 65–75 years of age who receive osteoporosis screening.
On this episode of Inside Health Care, we interview a pioneering speaker and a featured presenter at NCQA’s 2023 Quality Talks event.
We first interviewed Dr. Pippa Shulman back in episode 76, which dropped in April 2022. Since then, Dr. Shulman's seen the growth and expansion of her business, Medically Home, the world’s first virtual hospital. Medically Home is a tech-enabled services company, providing all the necessary capabilities to safely shift medical care from hospitals to patients’ homes. Dr. Shulman is board certified in family medicine, preventive medicine, and hospice and palliative medicine. Dr. Shulman and her company were described in a January 2023 New York Times article titled “Your Next Hospital Bed Might Be at Home.”
Later in the show, we'll hear some fast facts regarding Stroke Awareness Month, including warning signs from the CDC and info about NCQA's Heart/Stroke Recognition Program (HSRP).
On this episode of Inside Health Care, we interview two upcoming speakers at NCQA’s 2023 Quality Talks event. First, we meet a global leader with a deep understanding of the need for health equity. Following that, we have an in-depth discussion with an amazing tech expert on digital transformation in the health care ecosystem.
Dr. Garth Graham is Managing Director and Global Head of Healthcare and Public Health at Google/YouTube and Google Health. Among other significant positions, he’s the former HHS US Deputy Assistant Secretary for Minority Health. He also headed up CVS Health from 2018-2020, making sure to provide testing and vaccinations to as many under-served communities as possible.
Dr. Aaron Neinstein is an Endocrinologist and Technologist headquartered at the University of California, San Francisco. In his many roles, he’s also Senior Director at the UCSF Center for Digital Health Innovation. He’s a foremost expert in digitalization and moving IT and AI into the health care realm.
In our Fast Facts segment, we discuss Alcohol Awareness Month with some stats from the NIAAA’s free booklet, “Rethinking Drinking: Alcohol and Your Health.” And if you’re in crisis, you can contact SAMHSA via their National Helpline, by texting 9-8-8, calling 1-800-662-HELP or going to their national “helpline” website. We also mention NCQA’s “Unhealthy Alcohol Use Screening and Follow-Up” measure, part of our HEDIS measure package.
On this episode of Inside Health Care, we’ll hear from two health care innovators. One developed a unique yet powerful approach towards resolving historic gaps in health equity. The other champions artificial intelligence as a key solution in the drive towards streamlined patient-centered care.
And...both of them will be featured speakers at NCQA’s annual Quality Talks event, set for May 3, 2023, in Washington, DC.
Nzinga Harrison, MD, is Co-Founder and Chief Medical Officer of Eleanor Health, a tech-enabled, population-based provider of comprehensive, whole-person, substance use disorder care and mental health care. She is a vocal advocate and activist who emphasizes the need for U.S. health care to address systemic and ingrained harms of racism and marginalization faced by many communities in this country.
This interview begins with Dr. Harrison to explaining one of her most profound concepts: that Racism can be considered – and treated – as an addiction.
Suchi Saria, PhD, stands firmly at the crossroads of Artificial Intelligence and Modern Medicine. She is the Founder and CEO of Bayesian Health, and works at Johns Hopkins University, serving both as the John C. Malone associate professor and the Director of the Machine Learning, A.I. and Healthcare Lab.
In this interview, you'll learn how A-I, Machine Learning, and even ChatGPT can soon propel us into a world of resolved Equity disparities and improved patient-centered outcomes.
In our Fast Facts segment, we observe National Minority Health Month by exploring disparate asthma diagnoses in African-American populations. We also explore NCQA's asthma-based HEDIS measure, Asthma Medication Ratio [AMR].
On this episode of Inside Health Care, we hear from a digital entrepreneur who’s dedicated to getting the most out of health tech.
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.
On this episode of Inside Health Care, we hear from a digital scientist and researcher eagerly finding tech solutions to promote immediate change in health care.
Jennifer C. Goldsack is founder and CEO of the Digital Medicine Society (DiMe), a 501(c)(3) non-profit organization dedicated to advancing digital medicine to optimize human health. Jen earned her master’s degree in chemistry from the University of Oxford, England, her masters in the history and sociology of medicine from the University of Pennsylvania, and her MBA from the George Washington University. And she’s the first Olympian to appear on the podcast, a rower for the U.S. at the 2008 Beijing Olympics. Jen will also be a speaker at NCQA’s 2023 Quality Talks event.
Later, in our Fast Facts segment, we observe Endometriosis Awareness Month, with important information from Endometriosis.org. We also discuss NCQA’s Cervical Cancer Screening measure, or CCS, part of our HEDIS measures. CCS contains a number of assessments for women who had cervical cytology and/or high-risk HPV testing within the last few years.
In celebration of the 100th episode of the Inside Health Care podcast, we take a moment to tell stories of health equity and health digitalization. Through clips from six interviews over the past few years, we explore the evolution of these two concepts—both now pillars of NCQA programming.
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.
On this episode of Inside Health Care, we offer two interviews. NYC Health + Hospitals leaders, Dr. Eric Wei and Dr. Ted Long, discuss hospital worker burnout, including suicide, and the need for awareness, mitigation and prevention.
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.
On this episode of “Inside Health Care,” we hear from Tracy Parris-Benjamin, Director for Community Health and Health Equity at Horizon Blue Cross Blue Shield of New Jersey, about its 2022 NCQA Innovation Award-winning program “Neighbors in Health.”
“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.
On this episode of “Inside Health Care,” we revisit our 2022 Health Innovation Summit interview with Dr. Don Rucker, a leader in health care digitalization. As you might have experienced, when you go from one doctor to the next, your health records don’t always go with you. Dr. Rucker’s provides insight into interoperability: getting health care software systems to send electronic health records, or EHR, more efficiently.
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.
In this episode of “Inside Health Care,” we discuss both Gender Health Equity as well as the state of pharmacists today and their roles and positions in the health care ecosystem. In this episode’s interview, recorded live at NCQA’s inaugural “Health Innovation Summit” in November 2022, both guests are board-certified geriatric pharmacists from Consana, a pharmaceutically-centered health care company that works to change the face of Medication Therapy Management.
Lisa Morris, FASCP, serves as Executive Director of Clinical Services for Consana. Lisa works to elevate pharmacists as key members of the interdisciplinary team, by focusing on medication optimization while creating a healthcare environment that fosters innovation and excellence.
Karmen Stephens is Vice President of Clinical for Consana, where she is responsible for the strategic direction and clinical development. Karmen’s primary clinical focus has been high-risk populations, with a particular interest in de-prescribing through comprehensive medication management in older adults, and 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 our interview, they discuss how important it is that care not be restricted from people suffering from gender dysphoria or going through any type of gender transition.
Later on, we observe Cervical Health Awareness Month in January with statistics on Cervical Cancer screenings in the U.S. We also discuss NCQA’s HEDIS Cervical Cancer Screening.
In this episode of “Inside Health Care” featuring NCQA’s President, Peggy O’Kane, we look back at the challenges and successes of 2022. In a chat with NCQA’s Vice President of Public Policy and External Relations, Frank Micciche, they discuss a wide range of issues, including NCQA’s Health Equity Accreditation programs, the launch of our annual Health Innovation Summit, and Digitalization of the health care world.
Do you have comments or feedback about this episode? Send us a note with ideas for topics for the show, or mention some innovative guests you think everyone should know. Even if you just want to tell us how much you like the show, send it along. We want to hear from you. You can always reach us by emailing at Communications@NCQA.org.
This episode of “Inside Health Care” features three interviews recorded live at NCQA’s inaugural Health Innovation Summit in November 2022. We first talk about the national "988 Suicide and Crisis Lifeline" with a broader look at behavioral health crisis management at the national, county and community levels. Later on, we get an inside look at NCQA’s Recognition programs.
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.
First on this episode of Inside Health Care, we discuss Health Equity in an interview with Darrell M. Gray II, MD, the first Chief Health Equity Officer for Elevance Health. The company, as announced in Fall 2022, was one of 9 companies to earn distinction in both of NCQA's Health Equity Accreditation programs. This interview is one of three podcast interviews conducted in coordination with Elevance Health and was recorded live at NCQA's first Health Innovation Summit in November 2022.
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.
On this episode of Inside Health Care, we help observe the Lung Cancer Awareness month of November with a talk on advances in lung cancer screening. This interview, recorded at our Inside Health Care podcast center at the 2022 Health Innovation Summit, is sponsored by AstraZeneca.
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.
In the health care world, we talk about “value-based care” in terms of putting patients first, listening to patients’ stories and giving thoughtful input. Sometimes we talk about “value-based payment models”—where providers and clinicians are encouraged to base their payment drivers on achieving positive patient outcomes rather than on a purely financial basis. But as we look to 2023, could it be time for a Reset…on the definition of “value”?
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.
At NCQA, we believe and solidly state the following principles:
• 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.
In this episode, we find a fascinating look at one state’s efforts to develop changes that will indelibly improve Health Equity for their citizens. There are so many ways in which Health Equity initiatives can be implemented on the state level. And it doesn’t have to start with some kind of legislation.
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.
In this BONUS episode of Inside Health Care, you'll find the full interview with Louisiana Medicaid leaders on a new framework for improving Health Equity at the state level.
In this interview, NCQA Assistant Vice President for State Affairs Kristine Toppe moderates a discussion with state Medicaid quality leaders from Louisiana. They discuss a new report, funded by the California Health Care Foundation. The paper follows an earlier one, as Kristine will explain, with both reports geared to provide new tools for states in improving Health Equity. Specifically, the discussion here focuses on improving Medicaid-based managed care.
Kristine’s guests in this interview are Kolynda Parker, Medicaid Deputy Director, Louisiana Department of Health, and Amanda Dumas, Chief Medicaid Officer, Louisiana Department of Health.
Don't forget about the upcoming NCQA Health Innovation Summit, live in DC, October 31-November 3, 2022.
We begin this episode with a special appearance from NCQA President Peggy O’Kane, giving us exciting news about NCQA’s first annual, live, in person, 4-day Health Innovation Summit! Join us October 31-November 3, 2022, in Washington, DC. Go to https://www.ncqasummit.com to register.
For our featured interviews this week, we discuss NCQA's Person-Centered Outcome Measures.
Imagine a clinician asking you what you feel, what you think might be wrong, and just…listening. And then the clinician says…what would you like to be able to do that you can’t do now? What are your goals? And what can I do to help you get there?
Person-Centered Outcome Measures have already begun to ask these questions and change the health care landscape.
On this episode of “Inside Health Care”, we take a deep dive into the Person-Centered Outcome measures and what may be a revolutionary reorientation of the traditional doctor-patient relationship.
For more on this, we speak with three people involved with this important NCQA project.
First up, we talk with NCQA Senior Research Scientist Dr. Caroline Blaum. Then we hear from Patient Partner Ireland Hawkins, a retired researcher and caregiver, now a patient herself with a patient’s perspective. After that, we hear from Sherry Nolen, a Patient Partner with a very clear caregiver perspective.
For more information contact Dr. Caroline Blaum at pcomeasures@ncqa.org.
Later in the show, we observe September’s National Prostate Cancer Awareness Month. NCQA has a number of HEDIS measures related to cancer and cancer screenings. Go to www.NCQA.org and search “cancer” for more information.
On this episode of “Inside Health Care”, we talk with Eric Gremminger, CEO and Co-Founder of ERPHealth. Eric is an Internationally Certified Alcohol and Drug Counselor and a nationally recognized leader in the behavioral health space. Since 2014, Eric has trained behavioral healthcare professionals around the country on how to use patient reported outcome measures to personalize clinical curriculums and inform policy and procedure.
Eric’s company, ERPHealth, develops tech tools and platforms for collecting and delivering patient-reported data from behavioral health treatment and therapy. The mission of his company, ERPHealth “is to save and transform lives through individualizing behavioral healthcare.” As you’ll hear, his own story drives him to smooth the journey for anyone seeking a way out of addiction.
As we mentioned in the interview, some NCQA HEDIS measures speak to alcohol or other drug dependencies. Please contact us for further information.
In our regular “Fast Facts” segment, we observe Childhood Obesity Awareness Month with CDC statistics that touch on the Health Equity gaps in childhood nutrition. Click here for one of NCQA’s HEDIS measures that help track childhood nutrition. For more about NCQA’s HEDIS measures on obesity in adults and kids, go to www.NCQA.org and search “HEDIS OBESITY.”
NCQA stands at the forefront of the effort to identify and firmly resolve the issues of health inequity. Our Health Equity Accreditation Programs help the health care industry re-evaluate how to advance health equity for all. As part of our dedication to closing Equity gaps, NCQA continues to expand our team as we welcome Dr. Bryan O. Buckley as NCQA’s Director for Health Equity Initiatives.
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.
This episode of Inside Health Care begins with a look at interoperability: the hopeful goal of getting health information systems - and providers - to share data efficiently and effectively. As patients journey from primary doctors to specialists, sometimes from one hospital system to another, all the caregivers have to keep track of what the other ones have already examined, diagnosed, prescribed, and ordered.
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.
On this episode, we discuss an all-too-often underdiagnosed disease: NASH, a.k.a. nonalcoholic steatohepatitis, a severe form of “fatty liver” disease. Though NASH can affect people who are obese or diabetic with high cholesterol, it can also hit someone who’s relatively healthy and who doesn’t even drink alcohol. It’s because of this and other factors that liver disease can be easily underdiagnosed, leading to dire consequences.
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.
With more than 80 broadcasts under our belt, our latest spotlights an incredibly important running theme in our show: Health Equity. You’ll hear segments from past episodes of Inside Health Care and three cutting-edge thought leaders, each dedicated to resolving Equity gaps for all.
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.
For this special episode of Inside Health Care, we continue our celebration of Pride month with Abner Mason, the Founder and C-E-O of SameSky Health. Abner, who is African-American and Gay, says he proudly represents all aspects of himself in his work. He say it was empathy that led him to create SameSky Health, his company that works with health plans to change their approach to patients. SameSky encourages health care that’s based in “cultural experience”, and avoids traditional, impersonal methodologies, choosing instead to pay more attention to the individual. It envisions plans and systems that encourage dignity, autonomy and companionship.
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.
Happy Pride Month! In this episode, we speak with a psychologist whose company develops software that help diagnose behavioral issues in adolescents on the spot. Later, we talk with one of NCQA’s newest executives. Finally, we offer another dose of “Matt’s Facts”, this time focusing on some historical dates and important statistics relating to the LGBTQ+ population.
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.
May is Mental Health Awareness Month. In talking about behavioral health, NCQA again is at the forefront of health measurement. The NCQA Distinction in Behavioral Health Integration program works with NCQA PCMHs to perform gap analyses and figure out how to bring better care to mental health and substance abuse patients.
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.
On this show, we often discuss health disparities, but they're usually focused on populations identified by either race or ethnicity. This episode focuses on strides being made towards policyand measurement that would better address health equity gaps in the lesbian, gay, bisexual, and transgender, or LGBT, community.
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.
This week, we answer the age-old question: how do you talk about Health Equity without talking about Health Equity? NCQA’s Health Equity Accreditation Programs provide a strong framework for health care entities to improve equity in their organizations. When it comes to solving gaps in Equity, our guests in this episode come from very different backgrounds and experiences. Yet each one proves how bridging the historic gaps in Health Equity could be the key to solving all of the flaws of modern health care in the United States.
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.
Our show today celebrates three outstanding health care workers: NCQA’s Patient-Centered Medical Home Certified Content Expert Award Winners.
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.
In this episode of "Inside Health Care", we discuss the "hospital at home" health care model with two experts in remote care.
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.
In this episode, we get a look ahead, both at the future of NCQA's Quality Measurement agenda and our Quality Talks 2022 event.
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.
In this episode of Inside Health Care, we give you the inside scoop on Quality Talks, coming on April 21, 2022.
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.
Imagine a world where all medical and patient information gets combined and processed efficiently. No matter how many doctors you’d see about a certain problem, each doctor would already have the test results and evaluations of the one before.
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.
Dr. Nichola Davis is Vice President and Chief Population Health Officer at New York City’s Health and Hospitals.
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.
Janani Rangaswami, MD, FACP, FCRS, FAHA Mary Barton, MD 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.
Vanessa Guzman of SmartRise Health 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.
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.
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.
Dr. Douglas Jacobs 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.
Vanessa Guzman of SmartRise Health 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.
Vanessa Guzman of SmartRise Health 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.
Danielle Brooks of AmeriHealth Caritas 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.
Ashlee Wisdom of Health In Her Hue 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!
Dr. Adrienne Mims Courtesy of JenCare Senior Medical Center 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!
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.
We return to the Policy Primer for this edition of Inside Health Care. The aim is 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.
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.
There’s something new for this edition of “Inside Health Care.”
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.
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.
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.
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/.
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.
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.
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.
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.
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.
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.
Dr. Michael Barr, Executive Vice President, Quality Measurement and Research Group 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/.
In this episode of “Inside Health Care,” Peggy O’Kane, NCQA President, and Frank Micciche, NCQA VP of Public Affairs and Communications, discuss the importance of public health during the COVID-19 crisis: how COVID-19 is affecting American society as well as quality measurement—and NCQA. Peggy also talks about building a telehealth infrastructure and how the virus is disproportionately impacting African Americans, Hispanics and the underprivileged.
Listen to the podcast below.
Learn more about enacted policies for NCQA staff, contractors, and events due to the Coronavirus here: https://www.ncqa.org/covid/.
Don’t forget: Quality Talks 2020 is April 28. Join us virtually! Register at www.qualitytalks.org.
In this episode of “Inside Health Care,” Delia Brand, Director of Alabama Tombigbee Regional Commission Area Agency on Aging (AAA), and Matt Brock, NCQA Communications Director, discuss how NCQA’s Accreditation of Case Management for Long-Term Services and Supports provides a framework for improving the quality of care.
Delia describes how NCQA’s LTSS Best Practices Academy helped Alabama’s 13 AAA’s prepare to apply for Accreditation and how the application process led to better coordination of care. Delia also talks about Alabama AAA’s diverse client population and the benefits of delaying institutional care.
Listen to the podcast below.
Don’t forget: Quality Talks 2020 is April 28. Register at www.qualitytalks.org.
Thomasene Barnes, of New York Health and Hospitals, Peggy O’Kane of NCQA and Kelsey Keller, of Hackensack Meridian Health. In this episode of “Inside Health Care,” Thomasene Barnes, of New York Health and Hospitals, and Kelsey Keller, of Hackensack Meridian Health, discuss their PCMH Certified Content Expert (CCE) Quality awardwinning efforts with Matt Brock, NCQA Director of Communications. Thomasene and Kelsey talk about their innovative strategies for improving patient-centered care. They also discuss their leadership techniques, motivations and impressions of the PCMH Conference.
On October 6, CCE Awardee Thomasene Barnes will present CCE Quarterly: Building an Organizational Culture of Quality: Sustaining PCMH. Join us for this webinar training!
CCEs play an integral role in helping a practice transform into a PCMH. NCQA is currently accepting nominations here from Recognized practices for the 2020–2021 PCMH CCE Quality Award. Winners will be announced in September at the PCMH Congress in Dallas, Texas.
Register for PCMH Congress and the upcoming CCE Quarterly webinar before spaces sell out!
In this episode of “Inside Health Care,” Dr. Christopher Grimsrud, of Kaiser Permanente Northern California; Dr. Pallavi Kamjula, of Arnot Ogden Medical Center; and Nick D’Ambra, of WellCare Health Plans, Inc., discuss their NCQA Innovation Award-winning projects with Matt Brock, NCQA Director of Communications. The awardees talk about the motivations, goals and future plans of their projects. Click here to learn more about the 2019 NCQA Innovation Award winners.
The NCQA Innovation Awards recognize NCQA-Accredited health plans and NCQA-Recognized practices for implementing leading-edge strategies that improve both quality and value. The awards also recognize organizations that support delivery system redesign and patient engagement initiatives (including digital engagement strategies) to help drive better integration across the delivery system and support person-centered care. Apply for the 2020 NCQA Innovation Awards here: www.ncqa.org/innovationawards.
Register for Health Care Quality Congress before spaces sell out!
In this episode of “Inside Health Care,” Katharine Iskrant, Practice Leader of Healthy People, Inc., joins Matt Brock, NCQA Director of Communications, for a conversation about the benefits of electronic clinical data system reporting for federal and state stakeholders, health plans, providers and patients. Katharine talks about her experiences as a certified compliance HEDIS auditor and how she works with health plans to improve the quality of care.
She also discusses the challenges health plans face when gathering data for the new ECDS measures and how they can prepare for the imminent mandatory requirement of ECDS reporting. Learn what Katharine and Matt have to say about the future of HEDIS and what initially spurred Katharine to tackle health care quality.
Don’t forget: Quality Talks 2020 is April 28. Register at www.qualitytalks.org.
A Note: The views, information, or opinions expressed by our guests on Inside Health care are solely their own. They do not necessarily represent the views and opinions of NCQA or its employees. These interviews are provided to encourage and promote health care quality improvement. They should not be regarded as an endorsement of any business, organization or individual.
In this episode of “Inside Health Care,” Catherine Macpherson, Vice President of Product Strategy and Development and Chief Nutrition Officer of Mom’s Meals, joins Matt Brock, NCQA Director of Communications, to discuss how Mom’s Meals is addressing social determinants of health. What began as acts of kindness for family members transitioned to a company that provides home-delivered meals for health plans, AAAs and state governments, case managers and caregivers.
Catherine tells us the role of nutrition in health, how having access to nourishing food improves our well-being and how social determinants of health affect health outcomes. We also discuss health plans’ increasing investment in preventive health and how federal and state policy affect the mission of Mom’s Meals.
Click the link below to learn more about Mom’s Meals story.
Don’t forget: Quality Talks 2020 is April 28. Register at www.qualitytalks.org.
On this episode of “Inside Health Care,” Peggy O’Kane, NCQA President, and Frank Micciche, NCQA VP of Public Affairs and Communications, discuss challenges and exciting developments in health care and at NCQA in 2020.
Peggy talks about the role technology companies will play in health care and voices her excitement (and concerns) about who will provide health insurance options in the future. Peggy also discusses NCQA’s recent reorganization and efforts to recruit a Chief Product Officer and Director of New Products, the future of the Affordable Care Act, NCQA’s recent sickle cell disease research… and her personal New Year’s resolutions.
Click the link to listen to the conversation. Don’t forget to rate us!
In this episode of “Inside Health Care,” Shari Davidson, Head of Benefits for the city of Alexandria, VA, and Matt Brock, NCQA Director of Communications, discuss delivering high-quality health care to more than 3,500 Alexandria city employees.
Shari talks about the top priorities she implemented that promote the physical, emotional, and financial wellbeing of employees. She discusses how Alexandria, VA changed its open enrollment process from a manual to an electronic system and provided enrollees access to an online benefits decision support tool to help them make more informed health plan choices. She also shares how the city’s expanded wellness program and focus on helping employees shop for top doctors led to their improved health.
Click the link below to learn more about Shari’s drive to improve health care for Alexandria city employees.
In this episode of “Inside Health Care,” Peggy O’Kane, NCQA President, and Frank Micciche, NCQA VP of Public Affairs and Communications, begin with a discussion about the concept of “quality-adjusted life year (QALY)” and Massachusetts Governor Charlie Baker’s bill proposing new health care legislation that would require providers and insurers to spend more on primary care and behavioral health in that state.
Peggy also discusses her health care heroes and her commitment to meditation, and touches on the beginnings of NCQA.
Click the link to listen to their conversation. Don’t forget to rate us!
On this episode of Inside Health Care, we speak with Philip Saynisch, PhD, NCQA’s 2019 Phyllis Torda Health Care Quality Fellowship recipient and recent Harvard University graduate. He discusses his background, the current focus of his research and how he learned about the Phyllis Torda Health Care Quality Fellowship. Dr. Saynisch’s work aims to identify performance drivers for health care organizations and providers, and how performance can change over time.
Philip Saynisch, PhD, NCQA Torda Fellow The Phyllis Torda Health Care Quality Fellowship Program enables NCQA to train a new generation of health care quality leaders from diverse backgrounds. The Fellow works on critical issues related to health care quality, research and policy; for example, how patient-reported outcomes can improve case management, patient engagement in care and providing better information for decision making.
Learn more about Dr. Saynisch’s research and the Phyllis Torda Health Care Quality Fellowship on this edition of Inside Health Care.
On this episode of “Inside Health Care,” Peggy O’Kane, NCQA President, and Frank Micciche, NCQA VP of Public Affairs and Communications, discuss the unintended consequences of crafting health care policy.
Topics in this episode range from President Trump changing kick-back rules for health care providers, to the systemization of health care delivery, to lessons from the passage of the Affordable Care Act, to EHRs and what it takes to build a better health care system.
Click the link to listen to their conversation. Don’t forget to rate us!
With over 120 sites, CityMD is the leading urgent care provider in the New York metropolitan area and has earned NCQA Patient-Centered Connected Care Recognition for all of its eligible urgent care centers in New York, New Jersey and Seattle, Washington.
Dr. Frank Illuzzi, CityMD NCQA took a road trip to CityMD headquarters, to talk about how it coordinates care between patients, specialists and primary care physicians.
In this episode of Inside Health Care, guest host Paige Cook, NCQA’s Director of Business Development, talks with Dr. Frank Illuzzi, CityMD’s Chief Medical Officer, about growth, challenges and the Recognition journey.
Click the link to listen to their conversation. Don’t forget to rate us!
How do we help employers help their employees?
The employer market covers 180 million people in the United States—the largest payer of health care services.
On this episode of “Inside Health Care”, NCQA welcomes Ellen Kelsay, Chief Strategy Officer for the National Business Group on Health. Based in Washington, D.C, the Business Group is a nonprofit membership-based organization that works with large self-funded employers on a variety of health and well-being related issues.
In this episode, Ellen discusses how the Business Group is there to help companies improve health care quality among their employees—this impacts employee productivity, engagement, wellness and more.
Improvements are being made but there is still a gap—so, what is the employer’s role? What are the challenges?
Listen to the episode below to find out more. Be sure to rate us where you listen to podcasts!
NCQA President Peggy O’Kane discusses her appointment to the U.S. Department of Health and Human Services’ Quality Summit group. Peggy is serving among some of the nation’s top health care policy leaders to advise the government on the challenges ahead and the proposed solutions to address them. NCQA Public Policy Vice President Frank Micciche asks the questions. The two also discuss the on-again, off-again controversial proposals to assign each American with a number–a unique patient identifier.
We are facing a national crisis. According to the National Institute on Drug Abuse, each day more than 130 people in the United States die from an opioid overdose. How are health care professionals tackling this issue?
On this episode of “Inside Health Care,” we chat with Dr. Daniel Alford, Professor of Medicine and course director for Boston University School of Medicine’s “SCOPE of Pain” safer opioid-prescribing program. SCOPE of Pain is a series of continuing medical/nursing education activities designed to help safely and effectively manage patients with acute and/or chronic pain with opioid analgesics, when appropriate.
In this episode, Dr. Alford discusses how SCOPE of Pain addresses medical school and residency teaching gaps by training health care professionals—more than 160,000 thus far—how to prescribe and use opioids safely and effectively. Dr. Alford also discusses how to maximize the benefits and minimize the harms of opioids and proposes his solution to ending the opioid crisis.
Listen to the episode below to hear more—and don’t forget to rate us where you listen to podcasts!
On this edition of “Inside Health Care” we catch up with NCQA Founder and President, Peggy O’ Kane at the Digital Quality Summit in Boston, Massachusetts. O’Kane visits with NCQA Asst. Vice President Andy Reynolds, External Relations. They discuss the Summit, the future of Digital Quality and much more.
Please be sure to give us a rating on your podcast player to help us increase the reach of “Inside Health Care”. You’ll want to subscribe to the podcast, too. We feature experts from across the health care industry with short, timely and relevant interviews.
Peggy’s already planning her next visit. We hope you will stay tuned.
People get their health care from many different places, and information about their health sits in those many different places. Why does this matter? For providers caring for patients, a fuller picture of the care their patient has received means the provider has the tools to understand their needs and make better recommendations. The HEDIS ECDS measures promote that principle. ECDS stands for “electronic clinical data systems.” That includes everything from electronic health records and case management systems, to registries and claims data for measure reporting. ECDS measures encourage health plans to get and share health information electronically with health care providers so that all may better manage their members.
Pete Stoessel of AmeriHealth Caritas District of Columbia ECDS is a new data reporting method. We know learning something new always means bumps along the way. We learn from those bumps. Then, we improve.
That approach has already yielded significant progress for the ECDS domain. “ECDS Experience” is a new project that shares how health plans are developing solutions for collecting and reporting ECDS measures.
Inside Health Care introduces our first “ECDS Experience” story. NCQA’s Catherine Clair sits down with Pete Stoessel of AmeriHealth Caritas District of Columbia to talk about why ECDS is so important now and how his team is making progress with collecting data for ECDS measures.
The conversation about the quality of maternal health in the United States has suddenly become more urgent. In 2019 American women have more chance of dying in childbirth than women do in any other industrialized nation. The maternal mortality rate in 2007 was 55 percent higher than the rate reported in 1990, and it has only increased since then.
Why is this happening? How can we improve Maternal Health? We asked Dr. Joia Crear-Perry, of the National Birth Equity Collaborative, about that. She recently gave her “Mothers’ Voices Driving Birth Equity” presentation at the Roy Wood Foundation Grantee Conference.
Although our conversation focused on maternal care, it branched out to the broader topic of health equity. “We have to have an honest conversation in this country that we have not had about racism and classism, and gender oppression,” Dr. Crear-Perry noted. “We have structures that are built on valuing certain people because of their skin color.”
Black women are more than twice as likely to die during childbirth than White women. According to Dr. Crear-Perry, this is partly because of the structural racism within the health care system, and partly because hospitals and doctors don’t listen to women.
“A lot of times what [women are] saying is: ‘they’re not listening to us. When I go into the doctor they don’t hear what I say. They’re disrespectful. They don’t believe my complaints are valid.’” Dr. Crear-Perry emphasized, “So we know in the global context there is a language called respectful care. What we haven’t done in the U.S. is create that context here. It’s disrespectful to not listen to a woman about her care. That’s why we want women to drive this conversation.”
There’s a lot more to this enlightening discussion. Be sure to listen to the podcast—and check out our website for more information on maternal care.
In 2017 NCQA hosted its first Digital Quality Summit, a unique (and niche) conference that focused on issues of implementing digital quality measures. Participants at that first summit comprised a handful of interested health IT wonks and others deep in the weeds of the subject.
But to our surprise, the 2018 audience was a larger, more diverse gathering of tech gurus, health care professionals and policy experts—and tickets sold out.
On July 16–18, we’ll be in Boston, Massachusetts, for the 2019 Digital Quality Summit, which has become the premiere health IT conference of the year.
We spoke with Dr. Michael Barr, Executive Vice President with the Quality Measures and Research Group at NCQA, to get his thoughts and ideas about this year’s participants. “This is a community. A place for people interested in quality, digital measures, standards, new [coding] languages… anyone who wants to talk about and, more important, to work on these issues.”
Not Your Average Health Care Conference If you’ve ever been to any kind of convention or conference, you might be expecting a few speakers. Perhaps some breakout sessions to hear more speakers. That’s not the Digital Quality Summit! Participants can pursue the tracks that interest them. They’ll be presented with real-world issues that are relevant in the digital health space, and will engage in robust discussion and problem-solving to develop working measures and other solutions. In other words, this conference leaves “ordinary” in the dust.
Ben Hamlin, Lead Researcher for Digital Measures and Health IT at NCQA, describes the summit’s benefits to participants who aren’t (necessarily) data scientists or policy experts. “It’s important for anyone who wants to understand data quality from any angle and any aspect. I think is important, because [quality] is one of those things that’s holding back instant operation measures and how we access the quality data we want to use.”
Be part of this year’s experience. We expect tickets to sell out before this event. Check out our podcast and register today for the 2019 Digital Quality Summit!
It’s commonly assumed that people go into health care because they want to help others. They want everyone to get the care they need, when they need it most. In fact, don’t we all want that—especially when we are the patient? Unfortunately, this is not today’s reality, and discrepancies in care can depend largely on who you are.
As Minority Health Month draws to a close, we’re talking with Madhyatu Taylor, of NCQA’s Quality Solutions Group. She is principal project manager for the Health Equity Innovation Incubator Project, a contract with the CMS Office of Minority Health.
Because much of her work revolves around health equity and culturally and linguistically appropriate services—CLAS—we know Madhi is the person who can give us a deeper dive into this topic.
Listen to the full podcast below, or subscribe to the podcast on iTunes/Google Play to hear every episode of Inside Health Care!
On this edition of Inside Healthcare, catch up with our friend Tom Curtis, Senior Manager of Quality Improvement for the Michigan State Dept. of Health and Human Services. He sits on NCQA’s Public Sector Advisory Board.
We wanted to get an inside look at the state that has grown it’s Medicaid Managed Care program under the expansion of the Affordable Care Act. It’s been about 5 years since the expansion in Michigan, and Tom sees first-hand how changes impact Medicaid beneficiaries.
We also talk about population health and how states leverage HEDIS to address commonly noted disparities. Tim describes the disappointment of early results and describes the journey to improved performance.
Learn more about HEDIS measures and the programs it supports to address health equity and disparities. It’s particularly important during this Minority Health Month!
Listen now.
On this edition of “Inside Health Care” we catch up with NCQA Founder and President, Peggy O’ Kane.
There’s plenty to talk about. Most of this conversation concentrates on the technology revolution already underway in terms of health data collection and analysis. She points out quality improvement’s role in the revolution and what it means for the industry’s future.
Please be sure to come back here afterwards and tell us what you think about the interview and Peggy’s take on what lies ahead.
You’ll want to subscribe to the podcast, too. We feature experts from across the health care industry with short, timely and relevant interviews.
Peggy plans another visit soon too.
NCQA’s podcast Inside Health Care is back with a topic making a lot of news recently: ICD-10 diagnostic codes that capture social determinants of health.
In this episode, Matt Brock, NCQA’s Director of Communications, chats with Sheila Shapiro, UnitedHealthcare’s (UHC) Vice President for National Strategic Partnerships. Sheila talks about UHC’s efforts to promote these new codes.
Medicare providers can use them to target codes for social issues? Lack of healthy food choices? Limited transportation? You bet they can. Capturing these data will let providers address their patients’ needs and recommend community or government resources. And UHC has created a design model to recognize when a patient needs assistance related to social determinants of health.
Sheila says that since 2011, UHC has spent almost $400 million to help build affordable housing. In 2018 it delivered 1.7 million meals to local and national food banks. Looking ahead, it plans to schedule as many as 7 million rides for patients on its nonemergency medical transportation service.
Impressive contributions, to be sure. But expanding medical codes to include real issues that prevent or affect care is even more likely to meet patient needs. Don’t miss Sheila Shapiro’s take on UHC’s ambitious goal, on this episode of Inside Health Care.
It’s hard for me to remember a time when I wasn’t struggling with mental health issues. It’s even harder for me a remember a time when I wasn’t ashamed to talk about it. Even now, I still fear the reaction this kind of admission might invite from friends and professional peers. That’s why I am pleased and honored to interview Paul Gionfriddo for this edition of Inside Health Care.
Paul is President and CEO of Mental Health America (MHA), a nonprofit organization dedicated to addressing the needs of people living with mental illness and to promoting the overall mental health of all Americans. Paul has also worked in policy and medical fields related to behavioral health prevention and treatment.
NCQA and MHA have similar goals: Both want to improve the quality of behavioral healthcare; both want to see prevention become the norm instead of late-stage treatment (#b4stage4); both want to see behavioral healthcare integrated into the primary care setting.
When we asked Paul what he thought the next moonshot innovation in mental health care might be, he answered that it was complicated. “It may be, in a way, the next little thing that becomes a much bigger thing,” he explained. “NCQA has been working on the idea of certification of quality within health care delivery systems… we are doing the same thing here at Mental Health America with workplace behavioral health programs.”
This exchange is just a small part of our discussion. Hear the full interview below. And check out Mental Health America to learn more about their unique projects and programs. See the NCQA website for information on NCQA Distinction in Behavioral Healthcare.
In this episode of our podcast, Inside Health Care, NCQA Director of Communications, Matt Brock, spoke with Andrew Anderson, NCQA’s Phyllis Torda Health Care Quality Fellowship recipient. Anderson discusses his background and future plans, and how he learned about the Phyllis Torda Health Care Quality Fellowship.
Anderson, a PhD candidate at the University of Maryland, also discusses his new paper, ACO Affiliated Hospitals Increase Implementation of Care Coordination Strategies, which he recently co-authored and published in Medical Care. The Affordable Care Act provided incentives for hospitals, doctors and other providers to join ACOs and work together to deliver high-quality, coordinated care. Our findings suggest that ACO-affiliated hospitals increase the use of evidence-based care coordination strategies (e.g., predictive analytics, outreach after discharge, home visits). The paper informs the ongoing national conversation about ACO effectiveness.
Check out the podcast featuring Andrew Anderson below.
Dr. Ted Abernathy In this edition of our podcast, Inside Healthcare, NCQA traveled to Midlothian, Virginia, to speak to Dr. Ted Abernathy, founder of Pediatric and Adolescent Health Partners, a NCQA-Recognized Patient-Centered Medical Home.
In this podcast, Dr. Abernathy discusses how this care helps enhance clinicians’ responsiveness, significantly reduces patient stress, and improves cohesiveness among staff.
Dr. Abernathy also chats about his experience working with NCQA during the transformation process. He also offers advice to providers hesitant to make the leap toward becoming a NCQA-Recognized Patient-Centered Medical Home.
Listen to Dr. Abernathy’s story and learn how Pediatric and Adolescent Health Partners changes lives.
Quality Talks 2018 sneaked up on us quickly—it’s just a few weeks away! And here’s a “sneak” peek at one of our electrifying Quality Talks speakers, Liz Salmi. Unlike a lot of our speakers, who knew right away they wanted to be involved in medicine, Liz followed a different path. You could say that getting sick sparked her interest in health care: She has been living with brain cancer for 10 years.
Straight out of high school, Liz went on cross-country as a drummer in a punk rock band. And after the tour, she channeled her creativity into a career in graphic design. But at 29, Liz’s life was upended when she was diagnosed with a brain tumor.
As a coping mechanism, Liz drew on her creativity and began writing a blog—The Liz Army—that walked readers through her experiences as a cancer patient. When her health insurance required a change in health systems, her doctors said goodbye and handed her a DVD of her medical records. They totaled 4,800 pages.
Liz’s initial reaction? “Oh my gosh, what is this?” Then she began reading. That was the start of a new relationship with OpenNotes, and Liz’s mission to bridge what she calls a “knowledge gap” between physicians and patients.
Open Notes lets patients read the notes a doctor makes during a visit.
In the Open Notes trial, researchers followed 105 primary care doctors who agreed to share notes with about 13,000 patients. At the end of the trial, patients showed a better understanding of their condition and reported that they felt more comfortable talking to their doctors. The patients were asked if they wanted to opt out of Open Notes. None did.
Liz says the Open Notes approach provides transparency (one of NCQA’s favorite words!) in the health care system. If patients can read their doctors’ notes, they can notice errors and get them corrected. This benefits the patient, the doctor—and health care.
Thanks to Open Notes, 22 million patients have access to their doctors’ notes. Amazing, right? Yes, but there’s a way to go: 22 million people is only 6% of the American population. Traditionally, most doctors and health care systems don’t share notes—and many patients don’t even know they exist.
Watch More In-Depth Interviews With Our Speakers Want to learn more about Liz Salmi? Listen to NCQA’s Director of Communications, Matt Brock, interview her in our Inside Health Care podcast. You’ll find it in the Itunes app store and on Google Play. We think you’ll find her as fascinating as we do. Let us know what you think!
Want to Join Us at Quality Talks? Tickets to Quality Talks are going fast. Don’t miss out on your chance to hear unique and influential speakers like Liz Salmi. Register now.
In this week’s edition of our podcast, Inside Healthcare, NCQA traveled to Midlothian, Virginia, to speak to patients at Pediatric and Adolescent Health Partners, an NCQA-Recognized Patient-Centered Medical Home.
We sat down with Angela Ogden, a teacher and single mother of three.
Angela Ogden Angela has one biological child and two adopted children. Her two adopted children, Christine and Ariel, both 16, have special needs.
“With their level of need, I knew we needed someone who’d understand and be able to help with kids with special needs,” said Angela.
This led Angela to Pediatric and Adolescent Health Partners. She knew they were more than just an ordinary primary care pediatric center.
“[My kids’ pediatrician] has been wonderful in terms of support, above and beyond what a normal pediatrician typically offers,” said Angela.
Angela discussed a lot with her pediatrician, raising issues (sometimes nonmedical) she’s had as a parent of a special needs children. Her pediatrician referred Angela to practice staff who connected her to additional services.
“It makes a tremendous difference,” said Angela.
Listen to Angela’s story and learn how Pediatric and Adolescent Health Partners is not only a doctor’s office, it’s also an advocate for her children.
Excessive alcohol use is a leading cause of preventable death, but when it comes to screening for alcohol use and providing the right follow-up care, there is large gap in care.
The National Committee on Quality Assurance (NCQA) researched this issue and found a shortage of screening for misuse of alcohol. But when screenings do take place – like when doctors ask their patients about their drinking habits – we found many patients who need help are not identified or followed-up with appropriately. However there are strategies, such as the routine use of recommended screening tools to improve and ensure that health systems and providers are equipped to help.
Strengthening Alcohol Screening and Follow Up NCQA and FEi Systems, with funding from the Substance Abuse and Mental Health Services Administration (SAMHSA), developed a new measure for alcohol screening and follow-up. The Unhealthy Alcohol Use Screening and Follow-Up (ASF) measure is part of the Health Effectiveness Data Information Set 2018 (HEDIS®). It is the first measure to evaluate unhealthy alcohol use screening and follow-up care for adults in the health plan population. It is also one of the first HEDIS measures to be reported using electronic clinical data collected at the point of care.
We think this is important because measurement leads to improvement.
Listen to the Podcast! Want to learn more? Patricia B. Santora, PhD, Public Health Analyst at SAMHSA, Lela R. McKnight-Eily, PhD, Licensed Clinical Psychologist/Epidemiologist at the CDC and Junqing Liu, Research Scientist at NCQA joined us for a podcast to explain the problems of alcohol abuse, the consequences and how this ASF measure will make a difference. Take a listen and let us know what you think!
https://blog.ncqa.org/wp-content/uploads/2018-7.23-ASF-screening-measure-podcast-mix-mixdown-FINAL.mp3 The ASF Learning Collaborative One more thing…with funding from SAMHSA and the Centers for Disease Control and Prevention (CDC), through FEi Systems, NCQA is forming the ASF Learning Collaborative, a quality improvement learning collaborative of health plans to work on adding this measure to their quality performance matrix.
Following the model of the Institute for Healthcare Improvement’s quality improvement, the ASF Learning Collaborative will help collect and share data on screening and follow-up approaches plans use to improve the management of alcohol misuse.
Sign up Here This Learning Collaborative will include bimonthly sharing and coaching webinars with other participating health plans and in-person meetings where health plans will share experiences. More information can be found on the Collaborative’s web page. If you are interested in joining the Collaborative, contact our team at alcohollearningcollaborative@ncqa.org.
The Emory Transplant Center has been recognized as the first transplant center in the nation to receive the Patient-Centered Specialty Practice (PCSP) Recognition from the National Committee for Quality Assurance (NCQA). For this episode of Inside Health Care, Matt Brock, National Committee for Quality Assurance’s (NCQA) Communications Director spoke with Chris Diasio and Dr. James Spivey of the Emory Transplant Center. Both guests discuss how they became interested in NCQA’s PCSP Recognition Program and how it aligns with the Transplant Center’s mission. Dr. Spivey and Mr. Diasio also discuss how feedback has improved from patients and how they think the PCSP Recognition Program could improve employee engagement. The Emory Transplant Center employs over 25 full-time physicians, 100 program staff, and transplants over 300 kidneys a year.
Take a listen to this episode of Inside Health Care and let us know your thoughts.
How do we as a society think about mental illness? It’s a big question—and there’s more than one answer. But one thing is certain: There’s an urgent need for this issue to become part of a national discussion. Recently, we sat down with Mary Giliberti, CEO of the National Alliance on Mental Illness, who told us that the state of mental health treatment in the United States is in “crisis.”
“We feel like the urgency you see with HIV and cancer is the same urgency you should have with mental health care,” she argues. “We don’t just need a moon shot, we need a ‘Mars shot’ when it comes to innovations in behavioral health treatment.”
Our conversation takes place during a time of shifting opinions about behavioral health and greater emphasis on offering behavioral treatment in a primary care setting. We turned to NCQA’s behavioral health integration Distinction and how it can help practices improve patient outcomes by providing an incentive for them to incorporate behavioral health screening and services.
“It’s very important that behavioral health and primary care be integrated,” Giliberti explains. “My friend Patrick Kennedy always says we need a ‘check-up from the neck up.’ Which means, in primary care we should be looking at the brain. It’s on the top of your body for a reason!”
More Work To Do…
Naturally, the topic led us to Minority Mental Health Month and how primary care treatment can go a long way toward reducing care disparities—which can have dangerous, even fatal consequences, as Mary pointed out.
“[In our field, we] talk about ‘10-10-10.’ There are about 10 million people with mental illness, they’re dying 10 years earlier and they’re 10 times more likely to be in jail than [in] a psychiatric hospital.”
If there’s a silver lining, it’s this: People are starting to see how much repair our system really needs.
Listen to the full podcast here:
Look who stopped by to talk about the value of the Patient-Centered Medical Home model of care. Susanne Madden is founder and CEO of The Verden Group, a consulting firm founded to help practices navigate through the increasingly complex business of healthcare. Her career has spanned several sections of the healthcare industry. Prior to founding Verden, she was employed by UnitedHealthcare in the area of physician network management and spent several years as an independent healthcare consultant specializing in business development, revenue cycle remediation, vendor management and process improvement.
Formerly a pediatric practice administrator and surgical practice billing manager, she understands the many different challenges facing practices today. With an MBA in both Management Systems and Information & Communication Systems, she has applied her formal learning to understanding the principles of knowledge management and how information can be transformed into comprehension at all levels with the right facilitation.
Susanne writes frequently and speaks regularly on the business aspects of healthcare and is frequently quoted in industry and media publications.
For this episode of Inside Health Care, Susanne sits down with NCQA’s Matt Brock and demonstrates she is a true believer in the benefits of patient-centered care.
What does it mean to create a healthy population? It means not just treating patients for their specific illnesses but taking into account their whole health – the other factors that might contribute to their particular illness – then applying that kind of care to a group of people with similar health needs. It’s that whole-person delivery of care that NCQA has been advocating and working toward since its inception more than 25 years ago.
NCQA recently added Population Health Management (PHM) as a new category of standards in our 2018 Health Plan Accreditation (HPA) program.
Inside Health Care – Population Health In this episode of Inside Health Care, Tricia Barrett, NCQA’s VP, Product Design and Support talks about Population Health and Population Health Management. She explains population health focuses on aspects of people’s lives that impact their health. These include medical care, public health interventions, genetics, and individual behavior, along with components of the social (ex: income, education, employment, and culture) and physical (ex: urban design, clean air, and water) environments.
Providing the necessary whole-person care and population health management, is one thing. Creating a means for accountability to ensure that whole-person care is delivered, is another.
This is where health care is moving. Patient-centered care is whole-person care and whole person care leads to population health and to creating a healthy population.
Tricia explains it all so well in this podcast. Take a listen and let us know what you think!
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Dr. Mark H. Greenawald
Physician burnout has reached epidemic proportions in healthcare, presenting a serious challenge to achieving of the Triple Aim of better patient care and better population health at a lower cost.
In this episode of Inside Healthcare, Dr. Mark H. Greenawald, Vice Chair, Academic Affairs and Professional Development, Carilion Clinic talks about the ‘4th Aim’ of health care — the importance of caring for the caregivers. Dr. Greenawald describes the solutions they’ve put into place in the Carillon Clinic health system (as featured in US News and World Report) and how those solutions can also apply to health systems and individual practices. We caught up with Dr. Greenawald at the PCMH Congress in Orlando where he addressed the general session about this physician burnout epidemic. Highlights from the Podcast on Physician Burnout
• What is physician burnout and what does it mean for organizations and people?
• How can clinician burnout be addressed from an organizational perspective?
• How does the patient-centered medical home model take the burden off clinicians and ease burnout?
More on Dr. Greenawald Vice Chair, Academic Affairs and Professional Development, Carilion Clinic, Department of Family and Community Medicine, Professor and Vice Chair of Family and Community Medicine, Virginia Tech Carilion School of Medicine, Medical Director of Physician Leadership and Professional Development and Chair, Professional Well-Being Committee, Carilion Clinic.
Breast Cancer Awareness Month began in 1985 to promote mammography as the most effective weapon in the fight against breast cancer.
As a result of this awareness effort, more women are getting screened. But we still have a long way to go to ensure every woman gets a recommended mammogram at the right time.
How do we ensure screenings happen at the right time? As we like to say, NCQA has a measure for that. Our HEDIS measure for Breast Cancer Screening tracks women 50-74 who had at least one mammogram in the past two years.
In our latest Inside Health Care podcast, our own Dr. Mary Barton explains why measuring breast cancer screenings is the key to improvement.
Want to track screening rates? Take a look at the chart for the NCQA Breast Cancer Screening measure. After more than 30 years of breast cancer awareness, you’d think the results would be higher.
These facts from the National Breast Cancer Foundation are staggering:
- One in eight women in the United States will be diagnosed with breast cancer in her lifetime
- Breast cancer is the most commonly diagnosed cancer in women.
- Breast cancer is the second leading cause of cancer death among women.
- Each year it is estimated that over 252,710 women in the United States will be diagnosed with breast cancer and more than 40,500 will die.
- Although breast cancer in men is rare, an estimated 2,470 men will be diagnosed with breast cancer and approximately 460 will die each year.
- On average, every 2 minutes a woman is diagnosed with breast cancer and 1 woman will die of breast cancer every 13 minutes.
- Over 3.3 million breast cancer survivors are alive in the United States today.
These stats are no cause for celebrating Breast Cancer Awareness Month. They remind us how much farther we still have to go.
https://blog.ncqa.org/wp-content/uploads/Inside-Healthcare-002.mp3
In our first Inside Health Care episode, we preview the Quality Talk of Dr. Martin Makary. We encourage you to register now at www.qualitytalks.org. Hope you enjoy the preview.
Martin A. Makary, MD, MPH | Professor of Surgery, Johns Hopkins University School of Medicine; Professor of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health; Chief, Johns Hopkins Center for Islet Transplantation Surgery
Dr. Marty Makary is a surgical oncologist specializing in minimally-invasive pancreas surgery. At Johns Hopkins he has served as the endowed chair of gastrointestinal surgery, the director of surgical quality and safety and founding director of the Johns Hopkins Center For Surgical Outcomes Research and Clinical Trials. He currently serves as the chief of the Johns Hopkins Center for Islet Transplantation and Executive Director of Improving Wisely, a Robert Wood Johnson Foundation project to lower health care costs in the U.S. by creating measures of appropriateness in health care.
Dr. Makary is the creator of The Surgery Checklist, publishing its first description and subsequently served on the W.H.O. Safe Surgery Saves Lives committee and led the W.H.O. work group to create global measures of surgical quality. He has published over 200 scientific articles and is a leading voice for physicians, writing in The Wall Street Journal, Newsweek and TIME Magazine. Dr. Makary is The New York Times best-selling author of Unaccountable, a book about quality and price transparency in health care.