The American healthcare system is one of the most innovative in the world. But it’s also riddled with complex challenges, such as access to affordable medications, inefficiency and administrative burdens, and communication barriers between providers. There’s clearly a better way—and at Surescripts, we have a unique sightline into what that may be. In this series, host Melanie Marcus, Chief Marketing Officer of Surescripts, sits down with today’s most inspiring and innovative leaders in healt ...
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Quality Matters: A Podcast by NCQA
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Andy Reynolds에서 제공하는 콘텐츠입니다. 에피소드, 그래픽, 팟캐스트 설명을 포함한 모든 팟캐스트 콘텐츠는 Andy Reynolds 또는 해당 팟캐스트 플랫폼 파트너가 직접 업로드하고 제공합니다. 누군가가 귀하의 허락 없이 귀하의 저작물을 사용하고 있다고 생각되는 경우 여기에 설명된 절차를 따르실 수 있습니다 https://ko.player.fm/legal.
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.
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167 에피소드
모두 재생(하지 않음)으로 표시
Manage series 2551918
Andy Reynolds에서 제공하는 콘텐츠입니다. 에피소드, 그래픽, 팟캐스트 설명을 포함한 모든 팟캐스트 콘텐츠는 Andy Reynolds 또는 해당 팟캐스트 플랫폼 파트너가 직접 업로드하고 제공합니다. 누군가가 귀하의 허락 없이 귀하의 저작물을 사용하고 있다고 생각되는 경우 여기에 설명된 절차를 따르실 수 있습니다 https://ko.player.fm/legal.
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.
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167 에피소드
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Quality Matters: A Podcast by NCQA

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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Quality Matters: A Podcast by NCQA

1 Quality Talks With Peggy' O'Kane: 'Systemness' is the Key to Better Quality 30:50
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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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Quality Matters: A Podcast by NCQA

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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Quality Matters: A Podcast by NCQA

1 Getting to the Root of Two Popular Behavioral Health Ideas 20:24
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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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Quality Matters: A Podcast by NCQA

1 Quality Talks With Peggy O'Kane: The Hidden Harms of 'Doing More': A Cardiologist's Perspective 29:21
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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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Quality Matters: A Podcast by NCQA

1 Reimagining Respiration: The Quest for Better Asthma Care 22:47
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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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Quality Matters: A Podcast by NCQA

1 Quality Talks with Peggy O'Kane: What Must Change for Care to Be Better 30:23
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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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Quality Matters: A Podcast by NCQA

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

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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Quality Matters: A Podcast by NCQA

1 The Next Four Years of Quality: What Trump’s Team Should Do Now 19:58
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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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Quality Matters: A Podcast by NCQA

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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Quality Matters: A Podcast by NCQA

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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Quality Matters: A Podcast by NCQA

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 Tim e 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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Quality Matters: A Podcast by NCQA

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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Quality Matters: A Podcast by NCQA

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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