Advertise on podcast: Quality Matters: A Podcast by NCQA

In the premiere of Data Quality Perspectives, host Burke Burnett explores a fundamental question: Why doesn’t healthcare trust its own data? He is joined by NCQA Chief Product and Transformation Officer Vik Wadhwani and physician, engineer and clinical informaticist Dr. David Kendrick. Together, they examine how health care’s dependence on data has outgrown trust models built for a simpler era. Data now moves across organizations, vendors, platforms and use cases, while decisions tied to prior authorization, care coordination, treatment, payment and organizational performance carry higher stakes. The conversation also explores why data quality is no longer only a reporting or compliance concern. Wadhwani explains how incomplete or poorly governed data can limit AI performance and automated decision-making. Kendrick examines completeness as a persistent blind spot when a patient’s information is distributed across many care settings. Listeners will learn why data quality must become a continuous, enterprise-wide capability. The discussion offers practical questions leaders can ask about data sources, gaps, fitness for purpose, authorization and lineage before relying on information for strategic, operational or clinical decisions. Timestamps (00:00) Introducing Data Quality Perspectives (00:46) Why Doesn’t Health Care Trust Its Own Data? (01:20) A More Complex Data Ecosystem (03:12) Why Higher Stakes Require Greater Trust (04:14) AI Raises the Urgency of Data Quality (06:18) From Compliance Issue to Strategic Business Issue (07:11) Completeness as Health Care’s Biggest Blind Spot (09:14) The Operational, Clinical and Financial Costs of Untrusted Data (10:12) Why Continuous Data Quality Monitoring Matters (10:59) Questions Health Care Leaders Should Ask (11:53) Building Enterprise-Wide Ownership (12:51) Key Takeaways and What Comes Next Hosted by Simplecast, an AdsWizz company. See https://pcm.adswizz.com for information about our collection and use of personal data for advertising.

Aging Together: Why Age-Friendly Care Is Everyone's FutureAs the U.S. population ages, healthcare organizations and health plans are facing an increasingly important question: How do we make sure care is designed around what older adults actually need—and what matters most to them? In this episode of Quality Matters, host Daniela Lawton explores the Age-Friendly Health Systems movement and its 4Ms framework: What Matters, Medication, Mentation and Mobility. She is joined by Rani Snyder and Eric Cahow for a conversation about how age-friendly care has evolved, what it looks like in practice and how Medicare Advantage plans can help make it a standard part of care. Rani Snyder discusses the origins of the Age-Friendly Health Systems movement, launched in 2016 through The John A. Hartford Foundation and the Institute for Healthcare Improvement, and its growth to more than 6,900 recognized sites. As the movement enters a new phase, the focus is increasingly on reliable implementation, measurable outcomes and demonstrating the impact of age-friendly practices. Eric Cahow explores what age-friendly care means for Medicare Advantage, including the need to prepare for different generations of older adults, align quality measures and financial incentives and build partnerships across the healthcare system. The panel discusses evidence showing improvements such as reduced readmissions, fewer falls and reductions in inappropriate medication use, while also considering the challenges of scaling these approaches and demonstrating return on investment. The conversation also addresses Reframing Aging, an effort to challenge ageism and change the way society talks about aging. Then, in The Patient Voice, Dave White shares his personal journey with kidney disease and the importance of being heard by his care team. His experience reinforces a central message of age-friendly care: understanding what matters to the person receiving care is essential to making care better. Because when it comes to age-friendly care, every touch matters. Key Quote“Every touch matters. Every member of the medical team is equally important when it comes to patient care. One bad interaction at any point can ruin the experience for people living with serious illnesses.” — Dave White What You'll HearHow the Age-Friendly Health Systems movement began and evolvedThe 4Ms framework: What Matters, Medication, Mentation and MobilityWhy age-friendly care is increasingly important as the U.S. population agesHow Medicare Advantage can help scale age-friendly practicesWhy aligned quality measures and financial incentives matterEvidence connecting age-friendly care with outcomes such as fewer readmissions, falls and inappropriate medicationsThe challenges of demonstrating ROI and creating reliable implementation at scaleHow Reframing Aging can help address ageism in healthcare and societyDave White's experience navigating kidney disease and the importance of being heardWhy shared planning and understanding the patient's goals are essential to quality careTime Stamps00:00 — Why Aging Matters01:47 — Meet Rani Snyder and Eric Cahow05:44 — How Age-Friendly Health Systems Began09:51 — Medicare Advantage Readiness11:49 — What Age-Friendly Care Looks Like in Practice14:37 — The Role of Health Plans and Incentives17:24 — Proof Points and Payment Reform20:55 — Scaling Challenges and ROI25:36 — Measuring What Matters28:27 — Reframing Aging and Key Takeaways31:08 — The Patient Voice: Dave White41:30 — Closing Summary and Next Steps Links & ResourcesThe John A. Hartford Foundation | Improving Care for Older AdultsIndependence Blue CrossNCQA’s Person-Centered Outcome Measures National Center to Reframe AgingAge-Friendly Health Systems | Institute for Healthcare ImprovementThe Age-Friendly Health System ImperativeDeveloping an NCQA Age-Friendly Medicare Advantage Health Plan Program to Distinguish High PerformersThe 4Ms of Age-Friendly CarePatient Outcomes Associated With a Composite Measure of 4Ms Care Adherence in the Inpatient Setting - Rosner - Journal of the American Geriatrics Society - Wiley Online LibraryStrengthening the National Research Infrastructure for Age-Friendly Health Systems EvidenceAge-Friendly Health Systems Join the Movement | Institute for Healthcare ImprovementAge-Friendly Health Systems | Center | AHAAHA Age-Friendly Healthcare Impact Award | AHAStay Connected | Subscribe to JAHF E-NewsAbout the GuestsRani Snyder, President of The John A. Hartford Foundation, is part of the leadership behind the Age-Friendly Health Systems movement and its efforts to make evidence-based, age-friendly care more reliable across healthcare organizations. In this conversation, she discusses the movement's origins, its expansion across the country and the next phase of focusing on measurable outcomes. Eric Cahow, Vice President of Government Markets Performance at Independence Blue Cross, brings a Medicare Advantage perspective to the conversation, exploring how health plans can prepare for an aging and increasingly diverse population, align incentives and measures and work with partners across the healthcare system to advance age-friendly care. Dave White is featured in The Patient Voice, sharing his experience navigating kidney disease and the healthcare system. His story highlights the importance of listening to patients, incorporating their priorities into care planning and recognizing that every interaction can shape a patient's experience. Key TakeawaysAge-friendly care starts with What Matters.The 4Ms framework puts the patient's goals and priorities alongside medication, mentation and mobility as core elements of quality care. The movement is shifting from adoption to reliability.With thousands of recognized sites, the focus is increasingly on making age-friendly practices consistent, measurable and sustainable. Health plans have an important role to play.Medicare Advantage plans can help drive adoption through quality measurement, incentives, partnerships and alignment with broader healthcare goals. Outcomes matter.The conversation points to improvements associated with age-friendly approaches, including reductions in readmissions, falls and potentially inappropriate medications. Changing how we talk about aging matters, too.Reframing Aging challenges assumptions and stereotypes about older adults and encourages a more accurate, respectful understanding of aging. The patient's voice belongs at the center.Dave White's story demonstrates why patients need to be heard and involved in decisions about their care. Understanding the person behind the condition can change the care experience–and potentially the care itself. The Patient VoiceAt 31:08, Daniela Lawton speaks with Dave White about his experience living with kidney disease. Dave's story brings the themes of the episode down to the individual level: quality isn't only about measures, programs or systems. It is also about whether a person feels heard, whether their priorities are understood and whether their care team works with them to plan what comes next. His experience offers a powerful reminder that every touch matters.   Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Credentialing rarely makes headlines, but it plays a critical role in determining how quickly patients can access care, how providers join health plan networks, and how healthcare organizations maintain quality at scale. In this episode of Quality Matters, host Tsveta Polhemus examines why credentialing has become one of the most important foundations for modern healthcare delivery—especially as virtual care continues expanding across states and specialties. Joining the conversation are Sharon Meers, President and Co-Founder of Midi Health, and Greg Smith, Director of Operations at Evernorth Health Services. Together, they explore how credentialing impacts providers, payers, and patients alike, and why standardized, trusted processes are essential for improving access while maintaining confidence in care. Sharon shares Midi Health's remarkable growth from approximately 20 clinicians to nearly 800 providers serving patients nationwide. As the organization rapidly expanded across all 50 states, credentialing and payer enrollment became one of its greatest operational challenges. She explains how achieving NCQA Credentialing Accreditation enabled delegated credentialing with major national payers, reducing enrollment timelines from months to just days and allowing patients to access care sooner. Greg offers the payer perspective, discussing how credentialing supports network adequacy, strengthens audit readiness, and creates greater consistency across provider networks. He explains why recognized standards help reduce administrative friction while giving health plans greater confidence in the organizations they partner with. The episode concludes with a Patient Voice segment featuring Carroll Schreibman, who shares her experience navigating perimenopause symptoms after years of searching for answers. She reflects on how quickly accessing virtual care through Midi Health transformed her health, work, and quality of life—and why listening to patients remains central to delivering meaningful care. As healthcare delivery continues evolving, one message becomes clear: credentialing isn't simply a compliance exercise. It's the infrastructure that enables trusted, timely, and equitable access to quality care. Highlights Credentialing Enables Access Credentialing determines how quickly providers can begin seeing patients, making it one of the most important drivers of timely access to care. Scaling Virtual Care Responsibly Midi Health shares how standardized credentialing supported rapid national expansion while maintaining consistency and quality. Trusted Standards Build Confidence NCQA Credentialing Accreditation creates a common framework that strengthens relationships between providers, payers, and patients. The Payer Perspective Credentialing helps health plans improve network adequacy, streamline oversight, and reduce administrative burden while supporting quality care. A Patient's Experience Carroll Schreibman shares how timely virtual access to menopause care helped restore her quality of life after years of unanswered questions.     Key Quote "Credentialing isn't just a compliance requirement—it's the infrastructure that makes timely, trusted, high-quality care possible." — Sharon Meers     Time Stamps - Waiting on Final File (00:00) Why Credentialing Matters More Than Ever (01:52) Meet Sharon Meers & Greg Smith (05:43) A Patient's Journey to Virtual Care (09:25) Credentialing 101: Why It Matters (12:12) How Delegated Credentialing Improves Access (14:36) Scaling Midi Health from 20 to 800 Clinicians (18:00) Balancing Speed, Quality, and Trust (24:44) Measuring Patient Access and Outcomes (28:47) The Future of Credentialing and Virtual Care (33:25) Patient Voice: Carroll Schreibman's Story (42:47) Key Takeaways and Closing Thoughts     Links & Resources NCQA Credentialing Accreditation Learn more about Midi Health Learn more about Evernorth Health Services Connect with Sharon Meers Connect with Greg Smith Connect with Carroll Schreibman Connect with Tsveta Polhemus Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

This episode of Quality Matters examines the growing role of digital wellness and chronic condition management programs and the challenge of measuring what truly matters. Host Rachel Harrington is joined by Peter Robertson of the Purchasing Business Group on Health and California Quality Collaborative and Kevin Masci of Omada Health to discuss how digital health solutions can help address rising healthcare costs, workforce shortages and fragmented care experiences. Peter and Kevin explain why meaningful engagement goes far beyond app downloads and login counts. Instead, successful programs focus on sustained participation, patient-centered goal setting, integration with primary care and measurable improvements in health outcomes. The conversation explores how employers, health plans and providers are evaluating digital solutions through clinical outcomes, patient-reported outcomes, utilization measures and value-based contracting arrangements. The guests also discuss one of the most important challenges facing digital health: trust. Privacy, transparency, data security and clear communication about how patient data is collected and used all play critical roles in long-term adoption. The episode concludes with a Patient Voice segment featuring Brandee Hicks, who shares her firsthand experiences using digital health tools, highlighting both the convenience they offer and the ongoing challenges around interoperability, digital literacy and maintaining support after programs end.     Highlights Beyond Logins and Clicks Meaningful engagement isn't about how often patients open an app. It’s about helping people achieve their health goals through sustained participation and measurable outcomes. Measuring What Matters Guests discuss the growing use of clinical outcomes, patient-reported outcomes, utilization data and value-based contracting to assess digital health program performance. Trust Is Essential Digital health solutions must address concerns around privacy, transparency, data security and how patient information is stored and shared. The Patient Perspective Brandee Hicks shares how digital tools can improve organization, access and self-management while also revealing gaps in continuity, support and interoperability. Looking Ahead The future of digital health depends on better integration with primary care, more personalized engagement strategies and stronger measurement frameworks that prioritize patient outcomes.     Key Quote: "If we're really serious about improving health outcomes, we have to move beyond measuring clicks and logins. The real question is whether people are achieving meaningful progress toward their health goals—and whether these programs are creating lasting value for patients, providers and purchasers alike." — Kevin Masci     Time Stamps: (02:20) Meet Peter Robertson (03:45) Meet Kevin Masci (05:53) Why Digital Solutions Matter (10:01) Care Coordination, Not Care Fragmentation (11:52) Defining Meaningful Patient Engagement (15:07) Why Consistent Measurement Matters (18:32) Measuring Outcomes in Value-Based Contracts (21:12) Data Stratification, Risk Adjustment and Performance Guarantees (27:22) Privacy, Trust and Transparency in Digital Health (30:44) The Future of Digital Wellness and Chronic Care Management (35:08) Patient Voice: Brandee Hicks (40:25) Patient Challenges, Access and Continuity of Care (45:23) Key Takeaways and Closing Thoughts     Dive Deeper: Connect with Peter Robertson Connect with Kevin Masci Connect with Brandee Hicks Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

This episode of Quality Matters examines primary care’s evolving role and features Karen Johnson of the American Academy of Family Physicians and Jeff Sitko of NCQA.  Karen and Jeff outline primary care’s distinguishing focus on patient relationships, the strain on the primary care workforce, and technology’s promise to ease burdens. The discussion connects the dots between workforce sustainability, AI-driven efficiency, payment reform, and NCQA’s vision for next-generation primary care. Karen highlights the underappreciated fact that only 5% of health care spending goes to primary care, despite public perception that the figure is—and should be—higher. Jeff describes a dawning era of proactive, data-driven care delivery. He also previews NCQA’s plans to build upon the successful Patient-Centered Medical Home model of primary care. HighlightsThe Human Core of Primary Care: Continuity and trust are what make primary care special, even as practice settings change.Workforce Challenges and Opportunities: Clinicians report high stress and burnout, yet relationships with patients keep them engaged. Building systems that protect these relationships—and make primary care careers attractive—is critical to sustainability.Economics and Incentives: Guests discuss new payment models, state-level initiatives and federal efforts to rebalance incentives and support primary care in new ways.Looking Ahead: The foundational Patient-Centered Medical Home model gets an update in 2026. Plus, Karen calls for a seismic shift to resource primary care as a common good.This episode is essential listening for healthcare executives, policymakers, and clinicians committed to strengthening primary care as the cornerstone of quality improvement. Key Quote: If you want to boil it down to the simplest terms, it's taking primary care from a reactive model—Call me when you're sick; I'll put you on my schedule; Come in and see me—to a proactive model. I am paying attention to a population of patients. They're mine. They're on my panel. And now maybe they're also tied to some accountability arrangement in value-based care, where performance comes into play. And so I'm going to be proactive for a lot of reasons. One, it's the right thing to do for patients. But I also want to make sure my patients are getting preventive services they need, they are taking the medications I prescribe, they are going to the referral I recommended. And I'm getting the information back from that physician, and my team is acting on that. It's all of those things that should be ubiquitous in primary care. -Karen Johnson, PhD Time Stamps: (01:07) The Changing Landscape of Primary Care (06:42) Challenges in the Primary Care Workforce (08:49) How Technology is Impacting Primary Care (15:59) Future Directions and Innovations (18:11) NCQA's Plans for 2026 Dive Deeper: State of the Primary Care Workforce 2024 (HRSA) The Pulse of Primary Care (JGIM) Connect with Karen Johnson Connect with Jeff Sitko Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this year-end episode of Quality Talks, Peggy O’Kane, NCQA’s founding President, sits down with Dr. Vivek Garg, incoming President and CEO. Together, they reflect on Peggy’s 35-year legacy of building the nation’s first quality measurement and accreditation programs, and discuss the future of NCQA under Vivek’s leadership. From embedding quality measurement into medical practice to tackling fragmentation and misaligned payment incentives, this episode captures both the persistence required to drive change and the optimism for what lies ahead. Peggy shares candid reflections on the quality movement’s achievements, including the creation of national standards and her push to make quality measurement more clinically relevant. Vivek offers personal insights shaped by his family’s health care journey, his career in value-based care, and his vision for advancing interoperability, chronic condition management and specialty care integration. This conversation, Passing the Quality Torch, is a must-listen for health care executives, policymakers and clinicians committed to building on quality’s decades of success to create a more data-driven and sustainable health care system.  Highlights:  Origins and Transformation of Quality Measurement: Peggy recounts the shift from outdated peer review models to building the first national measurement and accreditation systems, setting the foundation for modern health care standards.Leadership, Persistence and Collaboration: The conversation highlights the need for resilience and adaptability in driving change, plus the need for teamwork within and across disciplines.Technology’s Role in Reducing Burden: Both leaders emphasize how tech-driven solutions can streamline medical practice, remove inefficiencies and reduce clinicians’ burden.Chronic Condition Management and Specialty Care Integration: Vivek underscores the need for longitudinal care strategies and better coordination between primary and specialty care.Key Quote: “We have an opportunity to work together with the community to say, 'Let's plant our flag. What is that next aspirational vision?’ Because the standards are part guidepost and part instruction manual. But they reflect this commitment across the community that we can be better, and we can define what that looks like. And some of us are gonna go for it. So I'm excited about all of those areas.” -- Vivek Garg, MD Time Stamps: (02:42) Reflections on 35 Years of Quality(6:59) Peggy’s Prescription(10:50) Vivek’s Path to NCQA(15:52) Vivek’s Vision for the Future(18:27) We All Have a Role in the Transformation to ComeLinks: Connect with Vivek Garg Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

This episode of Quality Matters features Rupa Valdez, Professor at the University of Virginia; Polina Lissin, NCQA Senior Healthcare Analyst; and Elizabeth Ryder, NCQA Assistant Director of Product Management. Together, they unpack the meaning of disability in health care, the importance of self‑identification and how NCQA is working to improve outcomes for people with disabilities. The conversation bridges academic, policy and real-life perspectives, making a compelling case for why disability is central to quality improvement. Listen to learn about: Disability and Destiny: One in four Americans has a disability. That prevalence understates everyone who will have a disability.  Defining and Measuring Disability: Policymakers and disability advocates agree that people with disabilities should define their own disability status. Measures of population health and quality must adjust accordingly.  NCQA’s Contributions and Innovations: New standards for Health Outcomes Accreditation and the Disability Description of Membership measure in HEDIS 2026 show disability can be a valuable lens for assessing quality.  Designing for Inclusion: From curb cuts in sidewalks to adjustable exam tables, accessibility is a design principle that improves life for everyone—not just those who identify as disabled.This episode is an essential resource for quality advocates, policymakers, accreditation professionals and others committed to improving care for all. It underscores that disability is not a niche issue but something that affects nearly all of us, eventually. By accounting for disability, health care can be better and more accessible for everyone. Key Quote: “The reason to use words like illness and impairment is someone may have a functional limitation but not identify with the term disability. That's common in some groups, like older adults, where having some physical limitation may lead to experiences similar to someone who would identify as being disabled. But that person might not identify with the term disability. Different people identify with different terms that underlie that same need for accommodation and access. Someone may consider themselves disabled but not have that same limitation—because of technology, the way the physical space has been built or laid out—may not actually experience that functional limitation. So wording needs to be broad and encompassing to capture the range of experiences within the disability community.”  -Rupa Valdez, PhD Time Stamps: (01:46) Understanding Disability in Health Care (03:40) Challenges in Measuring Disability Care (07:30) Addressing Ableist Bias (12:29) Building Better Standards and Measures for Disability Care (18:52) Tips on Improving Care for People with Disabilities Dive Deeper: NCQA Health Outcomes Accreditation HEDIS Disability Description of Membership (DDM) Connect with Rupa Valdez Connect with Polina Lissin Connect with Elizabeth Ryder Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

This episode of Quality Matters features Misty Milby, VP of Clinical Business Development at Everlywell, and Claire Mendelson, Product Manager at NCQA. To illuminate what makes virtual care safe, effective and sustainable, Misty and Claire unpack NCQA’s new Virtual Care Accreditation program. They explore five essential standards that define excellence in virtual primary and urgent care—and share insights from Everlywell’s experience piloting the standards. Misty and Claire make a compelling case for treating virtual care as a permanent, integrated part of the health care continuum. Listen to learn about: Quality and Patient Safety in Virtual Care: Virtual care must meet the same clinical and ethical standards as in-person care. Misty and Claire explain how high standards ensure rigorous quality improvement and patient safety across remote modalities.Fixing Fragmentation Through Care Coordination: Virtual care can either bridge or widen gaps in the system. Effective care helps prevent “referral loops” and ensure seamless handoffs between virtual care and in-person providers.Equity Beyond Access: Equitable virtual care means more than logging in; it’s about language, culture and more. Misty shares ideas on how to tailor care to patients’ preferences, regardless of zip code or income.Clinician Experience Matters: Virtual care can reduce burnout, but only if it’s intuitive and sustainable. Hear how effective standards for virtual care support clinicians with better workflows, realistic panel sizes and time to recharge. Key Quote: “ As a clinician, I can tell you that handoff is everything. A great virtual encounter means nothing if the patient falls through the cracks afterwards or gets on this continuous referral highway, and is never able to get off of it. So NCQA really ensured for us that virtual providers have defined workflows for referrals. We had to make sure that this was really buttoned up, as we didn't want anybody to get stuck on that referral loop or fall through the cracks. We wanted to make sure that the patients experience continuous care versus fragmented care. And it's really about making sure virtual care doesn't create silos, but that it strengthens that bridge between virtual care and in-person care.”  -Misty Milby -- Time Stamps: (04:26) Misty’s Dream for Virtual Care (08:35) Quality and Patient Safety (10:03) Expectations for Care Coordination (11:32) Assessing Equitable Access (13:34) Goals for Patient and Clinician Experience (16:29) Standards for Sharing and Exchanging Data -- Dive Deeper: NCQA Virtual Care Accreditation Connect with Misty Milby  Connect with Claire Mendelson Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of Quality Talks with Peggy O’Kane, Peggy welcomes Dr. Troyen Brennan, adjunct professor at the Harvard School of Public Health, former Chief Medical Officer at CVS Health and Aetna, and author of Wonderful and Broken. With decades of experience spanning academic medicine, hospital administration and retail health care, Troy brings candor and clarity to the challenges facing American health care and the promise of primary care reform. Troy’s insights are both sobering and hopeful, pointing to a future where coordinated, data-driven primary care can finally fulfill its promise. Highlights: ·Diagnosing a System Under Pressure: The limits of fee-for-service payment and why employer-sponsored insurance is reaching a breaking point.Building the Foundation for Better Care: The critical role of primary care in medicine’s value-based future.Spotlighting Innovation Across the Map: Real-world examples of successful primary care transformation, including Catalyst Health in Texas and Southcentral Foundation in Alaska.Reimagining Accreditation for Modern Needs: Reflections on NCQA’s Patient-Centered Medical Home and future redesigns.Clearing the Policy Bottleneck: Observations on policy inertia and how policymakers can accelerate change.This episode is a timely and thought-provoking update for healthcare executives, policymakers and clinicians committed to building a more sustainable, efficient health care system. Key Quote: The only way you can see a health care system that works in the future is if it's value based—that it’s prospective payment and risk on the providers for the elaboration of care provided. If we believe what most people write about these things, we've got 25 to 30% waste as a result of the fee-for-service system. If we move to a value-based approach, that's money that's going to fund the system, that extra third that we can put back into real health care. So you need a value-based approach. -- Troy Brennan, MD Time Stamps: (3:12) Employment-Based Health Care is Unsustainable (7:29) The Value-Based Future and Primary Care(10:00) Payment Disparities and Policy Inertia(22:00) Technology and Data Analytics in Advanced Primary Care(28:18) Peggy’s ReflectionLinks: Connect with Troyen Brennan Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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

In this episode of 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 ReflectionsLinks: Connect with Anna Taylor Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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

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

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

In this episode of 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 ReflectionsLinks: Connect with Farzad Mostashari Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.