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.

• The 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

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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 Come

Links:

Connect with Vivek Garg

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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

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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

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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 Reflection

Links:

Connect with Troyen Brennan

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This episode of Quality Matters features Kate Hobbs, CEO of the behavioral healthcare services company, Author Health.

Aiming to help listeners navigate behavioral healthcare’s complexities, Kate outlines four essential dimensions of the field. She also explores how validated clinical tools and emerging technologies, such as wearables, can help measure what matters in behavioral health. She makes a powerful case for moving beyond fee-for-service toward value-based payment models that incentivize coordinated care and reach vulnerable patients.

Listen to learn about:

• Understanding Gaps in Access: Fragmented systems and funding silos make care hard to reach, especially for people who need care the most.
• What’s Exciting—and Worrisome—About Digital Technology: Digital innovation expands the reach of the behavioral health workforce and enables smarter, scalable care. But ongoing attention to accuracy and privacy is essential.
• The Need for Value-Based Payment: Fee-for-service “breaks” behavioral healthcare and fails vulnerable people most of all. Value-based care offers the path to quality, equity and sustainability.

Key Quote:

“We cannot exist with fee-for-service. We have to move to a value-based approach.

You've seen progression in behavioral health with payers and states moving towards value-based payments that are holding providers accountable for quality.

That gets me excited because that's going to help us move the needle and fund the level of resources we need to help people get better.”

 -Katherine Hobbs, MD, MPH


Time Stamps:

• (03:16) Assessing In-Person vs. Virtual Behavioral Healthcare
• (05:07) Wearables and Other Tech-Based Innovation
• (06:08) Understanding and Measuring Access to Behavioral Healthcare
• (10:56) Why Fee-For-Service Must Go
• (15:20) Excitement for the Future

Dive Deeper:

Connect with Katherine Hobbs

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

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

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

Listen to learn about:

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

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

Key Quote:

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

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

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

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

-- Anna Taylor

Time Stamps:

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

Links:

Connect with Anna Taylor

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In this episode of Quality Matters, host Andy Reynolds is joined by Josh Wymer, Chief Health Information and Data Strategy Officer for the State of Missouri Health Data Consortium. Together, they explore how Missouri is building a smarter health care system that uses AI not just to automate care, but to elevate it.

Drawing on Josh’s experience in clinical care and informatics, the conversation reveals how states and standards bodies can work together to ensure innovation serves people—not just systems.

Listen to this episode to discover:

• AI with a Human Touch: Josh shares how Missouri is designing AI systems that center citizen experience, protect privacy and preserve empathy in care delivery.
• Cross-Agency Collaboration as a Catalyst: Learn how Missouri’s unified health data strategy breaks silos and builds trust across public health, social services and mental health care systems. 
• Workforce Readiness in the Age of AI: Explore how upskilling and retention strategies are helping Missouri address staffing shortfalls and prepare its workforce for a future of data-driven care.
• The Sunny Side of AI: Hear why optimism, not fear, is driving Missouri’s approach to innovation, and how thoughtful, ethical design can unlock better outcomes at scale.

This episode is essential listening for health IT leaders, policymakers and quality professionals who want to understand how proactive states are turning AI into a force for good, through a commitment to protecting the human element in health care.

Key Quote:

“ What I really like to challenge the listener to think about is, what's the sunny side of this story? What's the optimistic and positive ways we can use these solutions? What's the positive version of the future around quality and safety? Because these tools are enabling that.  

Never have we had the ability to extrapolate against data like we do now. Never have we had the chance to do deep, meaningful research against large data sets. Never have we had a chance to spread and educate populations and accelerate innovation and learning like we do now. With the right focus and the right priorities, we can narrow that to areas that will drive meaningful change and better the lives of everyone we engage with.”

 -Josh Wymer, DNP

Time Stamps:

• (02:06) Missouri's Health Data Consortium
• (04:58) AI's Growing Role in Health Care
• (10:06) Workforce Readiness for AI
• (12:22) NCQA's AI Initiatives
• (18:19) Preserving the Human Element in Health Care

Dive Deeper:

“The ‘Show Me State’ Shows How AI Can Succeed

Josh Wymer at the Health Innovation Summit

Connect with Josh Wymer

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In this episode of Quality Talks With Peggy O’Kane, NCQA President Peggy O’Kane speaks with primary care and health IT veteran Dr. Marc Overhage.

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

Topics Marc and Peggy explore include:

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

Key Quote:

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

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

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

-- Marc Overhage, MD

Time Stamps:

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

Links:

Connect with Marc

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In this episode of Quality Matters, health IT veteran and standards-editor John D’Amore joins host Andy Reynolds to unpack the deeper purpose behind the push to improve data quality. Drawing on decades of experience, from startups and academic research to national standards and consulting, John explains why the real goal isn’t just clean data or seamless interoperability. It’s better care, delivered more efficiently.

Listen to this episode to discover:

• Interoperability is a Tool, Not the Goal: John compares interoperability to a power drill—valuable only when it helps achieve better care outcomes.
   
• Economic Incentives and Bipartisan Momentum: Learn why following the money reveals the true levers of change. From value-based purchasing to performance bonuses, John shows how economic feedback loops accelerate improvements in data quality.
   
• Good Pipes, Bad Water: Explore the disconnect between robust data pipelines and poor data flowing through them. John breaks down why measuring the quality of data is essential for progress.
   
• Why Quality Measurement is the Real Catalyst: John argues that quality measurement, not interoperability, is what drives meaningful change. Discover how improving data quality can yield long-term benefits across the health care ecosystem, far beyond quality improvement.

This episode is essential listening for health IT leaders, quality professionals and policy makers who want to understand the deeper purpose behind the quest for data quality and how it’s shaping the future of care.

Key Quote:

We don't really want interoperability for its own sake. Free flow of information if it's never used by the destinations isn't useful. It doesn't improve care. It doesn't bring down costs.

When you go to Home Depot or Lowe's and buy a power drill, what are you really trying to buy? You want holes in the wall. Interoperability is the tool or the power drill that delivers the holes that we want, and the holes are better, more efficient care that reduces costs.

I mean, can we envision a future where health care costs go down year over year? It sounds almost impossible. It sounds like a fantasy land. I think that's going to be within reach within the next 20 years.

 -John D’Amore

Time Stamps:

• (03:21) Interoperability's Incentives, Means and Ends
• (06:42) Good Pipes, Bad Water
• (09:38) Next-Generation Data Validation
• (12:06) Correcting Myths and Misconceptions
• (14:17)  Quality Drives Interoperability, Not Vice Versa

Dive Deeper:

NCQA’s Improving HEDIS Data Quality in a Digital World

NCQA’s Data Aggregator Validation

HEDIS Compliance Audit

Connect with John D’Amore

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