In this episode of Quality Talks with Peggy O’Kane, Peggy welcomes Anna Taylor, Associate Vice President for Population Health and Value-Based Care at MultiCare Connected Care in Tacoma, Washington. 

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

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

Listen to learn about:

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

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

Key Quote:

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

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

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

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

-- Anna Taylor

Time Stamps:

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

Links:

Connect with Anna Taylor

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

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, NCQA President Peggy O’Kane speaks with primary care and health IT veteran Dr. Marc Overhage.

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

Topics Marc and Peggy explore include:

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

Key Quote:

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

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

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

-- Marc Overhage, MD

Time Stamps:

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

Links:

Connect with Marc

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 Reflections

Links:
Connect with Farzad Mostashari

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

In this episode of Quality Matters, host Andy Reynolds welcomes Bryn Rhodes and Rob Reynolds of Smile Digital Health to unravel two foundational, yet widely misunderstood, technologies in health care: Clinical Quality Language (CQL) and Fast Healthcare Interoperability Resources (FHIR). With decades of leadership in health care standards, Bryn and Rob share hard-earned insights, persistent misconceptions and what the future holds for digital transformation in such areas as clinical reasoning and quality measurement.

Listen to this episode to discover:

• Why CQL and FHIR Are Often Misunderstood and Why That Matters: CQL enables knowledge and logic sharing, while FHIR facilitates data exchange. Together, they empower precise and scalable healthcare interventions.
• CQL’s Human Readability is More Than a Feature; It’s a Gateway:  Learn how CQL’s intuitive language design bridges clinical and technical teams, reduces errors in translation and is already proving to be a strong match for AI-based tools and systems.
• Why FHIR Alone Doesn’t Guarantee Interoperability: Hear why true interoperability requires coordinated expectations between parties, including common terminology and agreed use cases.
• Business Strategy Meets Standards Adoption: Learn why treating interoperability as a strategic imperative (not just compliance) can unlock innovation, lower costs and drive better population health outcomes.
• CQL Engine News: NCQA Chief Technology Officer Ed Yurcisin updates the quality community on the role of CQL engines, why no engine covers all use cases and how NCQA’s open-source engine is moving the industry forward.

This conversation is a must-listen for health care leaders, B2B strategists and informatics professionals navigating digital transformation. It’s packed with actionable ideas, tech-forward insights and a human-centered approach to quality’s future. 

Key Quote:

“I’m delighted you’re hearing FHIR and CQL used together because that wasn’t always the case. People in the past used them separately and thought these things are completely distinct. 

Both of them have their power and bring the value separately, but you need both of them to achieve greater value. If you have FHIR, you have the ability to share the data. We can express questions. ‘What about this, about the data?’ We can do that in a shared, interoperable way with CQL.

But if the data isn’t interoperable, the ability to share questions doesn’t do much because you can’t get the data that those questions are about. So hearing people talk about those things in the same sentence, that’s fantastic. That’s exactly where we need to be.“

 -Rob Reynolds
 

Time Stamps:

(02:00) The Relationship Between FHIR and CQL

(08:20) Common Misconceptions About CQL and FHIR

(12:57) NCQA's Commitment to CQL

(17:40) Advice for Adopting CQL and FHIR

Dive Deeper:

Episode 18 of Quality Matters with Ed Yurcisin

Episode 19 of Quality Matters with Ed Yurcisin

Connect with Rob Reynolds

Connect with Bryn Rhodes

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, NCQA President Peggy O’Kane speaks with Susan Dentzer, President and CEO of America's Physician Groups. Susan brings her extensive experience in health policy to a rich discussion on the evolution, strengths and future of value-based care, particularly within Medicare Advantage.

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

Peggy and Susan explore:

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

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

Key Quote:

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

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

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

-- Susan Dentzer

Time Stamps:

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

Links:

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

Medicare Risk Arrangement and Use and Outcomes Among Physician Groups

Connect with Susan Dentzer

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, 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

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, 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

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, 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

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