Inside Health Care: Presented 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-

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 po

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 aw

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

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, fro

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 equ

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 measur

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 d

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 ong

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

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, showcasin

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 guid

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 exc

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 s

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, focusin

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

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 WardTime Stamps:(02:32) Oscar's Approach to Culturally Compe

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.

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

 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.