In this episode of Quality Matters, Tonya Winders, President and CEO of the Global Allergy and Airways Patient Platform (GAAPP), joins host Andy Reynolds to unpack the diagnosis and care gaps that plague asthma treatment—from delayed access to spirometry, to underuse of biologics. Tonya explains what high-quality, patient-centered asthma care requires, and what health care leaders can do to close that gap.

Tonya also discusses: 

• Why a definitive diagnosis of asthma isn’t necessarily the norm.
• What the “three-legged stool” of asthma care looks like.
• Why patient-centricity is essential for chronic disease management.
• How new treatments like biologics are changing what’s possible in asthma treatment.

This podcast is a must-listen for anyone working to redesign care delivery and improve outcomes for patients with chronic respiratory illness.

Key Quote:

“We are finding in that moderate to severe category, when they are diagnosed accurately and get appropriate access to targeted treatments, about one in three go into a clinical remission, where they have no exacerbations, no symptoms, no hospital, no ER, no oral corticosteroids, no use of short acting bronchodilator. 

This is something that, I have to tell you, I never dreamt would come in my career. So, it's very exciting, especially for those that have had the opportunity to access these miracle drugs—that’s the term they use, miracle drugs—that have changed their lives and given them the freedom to breathe.”

Tonya Winders

Time Stamps:

1. (04:00) Diagnostic Delays: Spirometry and Systemic Barriers
2. (05:44) How Age and Comorbidities Obscure Asthma
3. (08:00)  Challenges of Misdiagnosis and Access to Specialists
4. (10:28) The Three Legs of Effective Asthma Care
5. (18:20) NCQA’s Measurement Strategy for Asthma

Links:

NCQA White Paper: Improving Outcomes for People with Asthma

Connect with Tonya Winders

In this debut episode of Quality Talks With Peggy O’Kane, Founder and President of NCQA, Peggy is joined by Dr. Sachin Jain, CEO of SCAN Group and SCAN Health Plan, to explore a provocative question: Why isn’t health care better at getting better?

• Measuring—Not Missing—What Matters: Anxieties about access and affordability plague everyday people. But quality measurement’s focus is elsewhere. Is health care chasing the wrong metrics and missing the big picture?

• The Complacency Crisis: Sachin says the core issue is a reluctance to embrace real reform, noting the industry’s tendency to want improvement without being willing to change fundamental practices. He calls for a bolder approach.

• Rethinking Medicare & Medicare Advantage: Sachin challenges rosy view of traditional Medicare, and describes how a legal battle over a flawed Medicare Advantage star rating raised questions about how measuring quality affects care.

• Simplifying for Impact: Sachin proposes focusing on three or four areas, emphasizing patient experience, ease of access and basic care for common conditions. He urges cost transparency, simpler administrative processes and renewed competition.

Key Quote:

“ If we all just took care of our own part of the ecosystem, we'd get 20, 30% better. But instead, the most industry talking points are about, ‘Hey, we don't get paid enough for what we do.’ Everyone who's making money claims that they're losing money on X, Y, or Z lines of business. Everyone complains about regulatory capture, so there's just a bit of having normalized the abnormal. And I think that that's the thing we have to undo if we're going to actually make the kinds of forward progress that we're hoping to make as an industry.”

-Sachin Jain, MD

Time Stamps:

• (01:44) Inspired by Our Mentors in Health Care
• (04:27) How Does Health Care Get Better?
• (7:28) The Trap of Toxic Positivity 
• (11:34) Misplaced Nostalgia for Traditional Medicare
• (18:05) The Stars Program Controversy
• (22:13) Simplifying Health Care Measurement

Links:

Connect with Sachin 

Learn More About SCAN

Connect with Peggy

Learn More About NCQA

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

In the second episode of our special series on recommendations to the Trump administration, Quality Matters host Andy Reynolds welcomes Ryan Howells, Principal at Leavitt Partners, for an illuminating discussion on transforming digital quality and data exchange..

Ryan shares fresh ideas from the Leavitt Partners roadmap to reshape digital health infrastructure by embracing scalable, internet-based standards and dismantling policy barriers. At the core of this conversation is that effective data exchange must be powered not only by modern standards, but by trust among people and institutions. 

Ryan’s suggestions include:

·   Implementing APIs at scale to reduce manual processes and administrative waste. The same APIs that power everyday apps can streamline data exchange between payers and providers, replacing faxes, phone calls and redundant forms.

·   Certifying data exchange—not just software functionality. Instead of dictating how systems are built, federal policy should focus on certifying APIs, allowing EHR vendors the flexibility to innovate while helping ensure that data flows freely.

·   Establishing “tables of trust.” Regional collaboration among payers, providers and government agencies can test new digital infrastructure in real-world settings and be the model for national expansion.

Digital quality transformation will require more than just tech upgrades—we must rethink relationships, trust and policy levers. Listen to this episode to learn how the Trump administration could support a data-driven revolution in health care quality.

Key Quote:

“I’ve been doing this for a long time, almost 30 years. But when I go into my doctor’s office and I still have to fill out a clipboard with a piece of paper on it with information I know they already have, it is painful. 

The best representation of whether we are making progress is, I don’t want to ever go into a doctor’s office and fill out a clipboard. If I could just not fill out my health history, my demographic information, whether information should be sent to my doctor—if all that is just in the doctor’s system—I would say we have made progress. Because at that point it will be real to the individual. 

Think about it in terms of digitizing all of the health care data and making sure it is with the right person, at the right time, in the right place to make the right decisions. When that happens, we’ll know we’ve made significant progress.” 

Ryan Howells

Time Stamps:

(02:27) Why Implementing Health Care APIs is Hard

(05:32) Tables of Trust: A Case Study from Utah

(07:03) Scaling Trust and Interoperability

(13:12) Eliminating Manual Processes 

(18:23) Solving Diverse Use Cases 

(19:36) Encouraging Early Adoption of APIs

Links:

NCQA Recommendations to the Trump Administration 

Leavitt Partners Recommendations: “Kill the Clipboard!”

Connect with Ryan Howells

One-hundred days into the second Trump administration, Quality Matters host Andy Reynolds welcomes Eric Musser, Vice President of Federal Affairs at NCQA, for an insightful discussion about NCQA’s recommendations to the Trump administration for improving health care quality.

Eric shares ideas to shape a strong quality future for value-based care, digital health infrastructure and behavioral health.

The conversation focuses on value-based care models that prioritize care integration to prevent or alleviate chronic illness. Eric identifies fragmentation’s threats to care delivery and data management—problems NCQA’s recommendations aim to address.

Specific suggestions include:

• Expanding the commitment the first Trump administration made to getting all Medicare beneficiaries in value-based care arrangements by 2030. This ambitious goal requires big changes in policy and practice, but could lead to better outcomes and more efficient care delivery.
• Creating innovative care models that leverage technology and dynamic care plans. These models would use advanced technologies like AI to integrate patient data more quickly and effectively. Dynamic care plans would allow for real-time updates based on patient data from various sources, including remote monitoring.
• Prioritizing patient-generated data and patient-reported outcomes. This approach focuses on incorporating patients' experiences and goals into their care plans. The aim is to improve patient engagement and ensure care matches what matters to patients, particularly those with chronic conditions.
• Promoting standardized data exchange in Medicare Advantage programs. This recommendation addresses the need for better data sharing between plans, providers and patients. This would mean dismantling data silos and creating more comprehensive, real-time views of patient populations.

There is tremendous potential for the Trump administration to improve health care quality. Listen to this episode to find out how.

Key Quote:

“ We know the Trump administration has a patients first agenda. They put the consumer first in the way they think about quality and payment. There is a desire in the measurement space to have more measures centered around patients’ goals. That's a person-reported outcome or a patient-centered outcome, as we call it here at NCQA. 

You want to make sure that the patient gets that strong clinical care. But the experience to ensure that they want to come back for that clinical care is also extremely important. 

So person-reported outcomes are about enhancing the experience of patients as they work with their care team. This is important for folks with chronic conditions, behavioral health. Having those goals that are patient-centric–like walking down the stairs, getting to church–are all ways which improve health and then get that buy-in to the care plan that we're seeking to support.”

-Eric Musser

Time Stamps:

• (01:22) Opportunities in the First 100 Days of a New Administration
• (05:30) Deep Dive: Value-Based Care and Care Integration 
• (07:12) Fixing Two Kinds of Fragmentation
• (10:49) Four Operational How-Tos 

Links:

NCQA’s Recommendations to the Trump Administration

Listen to Eric’s Episode on Data Sharing

Connect with Eric

In this special edition of Quality Matters, we explore what three powerful conversations have taught us about one of health care’s most pressing and perplexing questions: What do we know about the economics of care in America, and how can we make substantial, sustainable improvements? We look back at previous episodes of Quality Matters to reflect. 

We begin with health economist Sanjula Jain, who challenges conventional thinking around value-based care and urges a shift toward a more intuitive concept: “value for money.” With real-world examples (think hotels and Costco), she explains why the US health economy needs stability, and what it would take to rebuild trust and deliver real value to patients.

Next, Brittany Cunningham, of Vanderbilt University Medical Center, shares how My Health Bundles help employers rein in costs while improving patient experience and provider satisfaction. Her team’s approach flips the traditional payment model on its head—designing care first and payment second.

And obstetrician Tiffany Inglis, of Elevance Health, takes us inside a groundbreaking program that pairs OB/GYNs with dedicated practice consultants. The result? Dramatic improvement in maternal health outcomes that could affect a staggering 12% of the nation’s births.

Each voice in this episode offers fresh, actionable insight. Together, they offer a roadmap toward a more sustainable—and humane—health care economy. 

Key Quote:

“ Value for money is the ultimate consumer of the service is going to determine that value based off what they are paying. Value-based payment, it's different because value-based payment is ultimately a reimbursement scheme that doesn’t change the total cost of care. Value-based payment is really a policy scheme focused on the provider level, which doesn't even affect the patient or consumer. It's one pool of dollars that is being reallocated. Providers are just reallocating those dollars and actually reducing the total cost of care. Who is benefiting doesn’t actually translate down to the patient or the consumer.”

Sanjula Jain

Time Stamps: 

• (00:25) The Macroeconomics of Health Care
• (8:40) Value-Based Care in Action With Health Bundles
• 14:30) The Economics of Prenatal Care

In this episode, we sit down with NCQA leaders Stacy Grundy, Rachel Harrington and Kristine Toppe for a behind-the-scenes look at the upcoming Health Quality Forum 2025, and a discussion about the complexities and possibilities of modern health care, with a focus on data sharing and strategies to address health inequities.

Learn about data-driven collaborations in states like Maryland, Pennsylvania and North Carolina, where public agencies, health systems and community groups are uniting to improve outcomes.

And get an inside look at our hands-on workshops on NCQA Health Equity Accreditation and Virtual Care Accreditation, designed to give professionals at the leading edge of virtual services the tools they need to help reduce disparities.

The conversation and conference highlight stories of how virtual care is dissolving data silos and transforming maternal health in states like Arkansas. The emphasis of this episode—and the forum—is on curating diverse voices not often featured at national meetings. The common thread: Moving beyond identifying problems to showcase solutions that work.

Key Quote:

“ Data for the sake of data doesn’t help anybody. If it just sits there and you pat yourself on the back, ‘I’ve got this sitting in my database’;  that doesn’t help.  What you do with it, matters.

We have a couple of sessions  digging into  innovating to address health disparities, talking about  analytics  to understand  populations and how to address interventions. Also, we have  sessions  focused on creating equitable systems of care for populations with disabilities.

Understanding where  unmet needs are, how to  make things accessible, make things usable—data is part of that. It’s understanding who, what, when, where and how to take what you’re sitting on in your organization and understand it  so you can improve care.”

 Rachel Harrington

Time Stamps:

• (00:43) What’s Different About the Health Quality Forum
• (03:40) An Expanded, Regional Lens on Quality 
• (6:09) How NCQA Sees Data and Interoperability Differently 
• (10:38) Improving Care in Rural Areas 
• (16:04)  How-to Workshops on NCQA Accreditation
• (17:55) Personal Highlights at the Forum 

Links:

Register for the 2025 NCQA Health Forum

Connect with Stacy Grundy

Connect with Rachel Harrington

Connect with Kristine Toppe

Why does a potentially deadly condition that affects 1 in 7 adults fly under the radar, undetected and undiscussed? Join us on this episode of Quality Matters as we explore Chronic Kidney Disease (CKD), a silent killer that’s finally coming into the limelight of quality improvement.

Our conversation begins with Dr. Ben Oldfield, a primary care physician, who sheds light on the startling prevalence and hidden complexities of CKD. Why is it so hard to detect, even with simple blood and urine tests? And why does this condition, despite its extensive impact, often get lost in the shuffle of busy health care visits?

We’ll unpack the challenges of diagnosing and managing CKD, exploring the emotional weight the diagnosis carries for patients and the hurdles clinicians face in communicating about it. Discover why CKD is a “loaded term” and how we can shift the narrative from fear to empowerment.

But that’s not all. We’ll also tackle the big picture: How CKD fits into the broader landscape of cardiovascular, kidney, and metabolic (CKM) disorders. Could a holistic approach to these interconnected conditions revolutionize patient care?

The conversation ends with Ben’s thoughtful observations on how classic literature, particularly epic poetry, helps doctors make sense of health care’s emotional complexities, connect with patients and find empowerment in the face of life and death.

Join us as we explore how we can move CKD from the sidelines to the front lines of quality improvement, and how collaborative, longitudinal care can make a real difference.

Key Quote:

“Thinking about chronic kidney disease is a longitudinal process. It's only half the story to make the diagnosis in a snapshot in time. 

What's the follow up like? How are we doing with the patient over time? Because oftentimes quality measures can look at things in a snapshot in time. 

Chronic kidney disease really begs us to think more longitudinally.”“

• Benjamin Oldfield, MD

Time Stamps:

• (02:54) The Silent Nature of CKD
• (07:05) Quality Measurement and CKD
• (11:08) The Link Between CKD and Cardiovascular Kidney Metabolic syndrome
• (13:06) CKD and CKM as Quality Priorities 
• (15:45) Narrative Medicine and Personal Insights

Links:

NCQA Kidney Health Toolkit

Connect with Benjamin Oldfield

Continuing the last Quality Matters episode, host Andy Reynolds and NCQA Chief Technology Officer, Ed Yurcisin, break down the complexities of the digital transformation in health care quality and explore the importance of high-quality data exchange, particularly in the context of HEDIS reporting and the FHIR interoperability standard. Ed explains how NCQA’s work in digital HEDIS measurement not only improves health care quality reporting, but also lays the groundwork for broader industry advancements. By ensuring consistent, standardized data for digital HEDIS, NCQA is setting the stage for better measurement of public health, smoother prior authorization and general data accessibility.

The conversation also explores the technical side of digital quality measurement, focusing on Clinical Quality Language (CQL) and the role of HEDIS “engines” in the health care data ecosystem. Ed clarifies the difference between SQL and CQL, and underscores that NCQA’s focus is on measures’ content, not on building the end-to-end software systems that run measures.

Through collaborations like the Digital Quality Implementers Community, NCQA is working to ensure alignment across CQL platforms so everyone is “doing the same math.” Amol Vyas, NCQA Vice President for Interoperability, joins the conversation to explain how a public-private partnership is bringing choice and confidence to the market for CQL engines.

Ed reflects on how his international perspective and personal experiences shape his passion for health care data interoperability. He shares how challenges accessing medical records for his family members underscore the need for a seamless, patient-centered health care system. His real-world perspective highlights why creating standardized, high-quality data isn’t just a technical challenge, but a crucial factor in helping to ensure better, safer care for all.

As the episode wraps, listeners are encouraged to explore NCQA’s resources and upcoming events to stay informed on the future of digital quality.

Key Quote:

“ HEDIS measures are incorporated into government payment programs—for example, Medicare Star Ratings. 

There’s incentive to enable digital HEDIS because it is tied to your CMS Star Ratings and the money a Medicare advantage plan might receive from the government. That’s not the case for other important use cases, whether it be public health or prior authorization. 

So our infrastructure is tied to financial returns incenting organizations to make higher quality data accessible for digital HEDIS. 

And that means if it’s good enough for digital HEDIS, it’s been cleansed and analyzed in a way that could be used for public health, could be used for prior authorization—all of these different use cases.”

Ed Yurcisin

Time Stamps:

(02:10) Clearing a Path for Data Quality

(05:30) HEDIS “Engines” vs. HEDIS “Calculators”

(07:17) Measures’ Content vs. Software that Runs Measures

(11:18) Digital Quality Implementers Community

(19:35) The Need for Data Quality Cuts Close to Home

Links:

Bulk FHIR Quality Coalition 

Digital Quality Implementers Community

NCQA Digital Hub 

Connect with Ed Yurcisin

Connect with Amol Vyas

In this episode of Quality Matters, host Andy Reynolds is joined by Ed Yurcisin, Chief Technology Officer at NCQA, to break down the complexities of digital transformation in health care quality. Ed explains how NCQA’s push for digital measurement cuts through inefficiencies and inconsistencies in assessing quality. Traditionally, HEDIS® quality measures have existed as large, text-heavy PDFs, leaving room for misinterpretation. By digitalizing these measures into computer code—Clinical Quality Language (CQL)—NCQA removes ambiguity and standardizes interpretation. That makes it easier for health care organizations to implement and use quality measures. This shift reduces administrative burden and helps ensure that quality assessments are more accurate and actionable.

The conversation then shifts to FHIR® (Fast Healthcare Interoperability Resources), a standard designed to streamline health care data exchange. Ed explains that while FHIR might sound intimidating, it’s built on the basic web technologies that power everyday internet browsing. FHIR brings five essential components to the table—JSON files, Rest APIs, standardized value sets, a common data model and government-mandated data exchange. While the government requires organizations to “pitch” data (make data available), there’s no mandate to “catch” data (actually use the data). That means organizations that choose to use the data gain a competitive advantage.

The discussion ends by focusing on data quality, an issue that looms large over digital transformation efforts. Ed introduces the Bulk FHIR Quality Coalition, a collaborative initiative aimed at improving the reliability of data exchanged between health care providers and insurers. Using the analogy of water through pipes, Ed explains that current data-sharing efforts help ensure flow, but don’t always guarantee that data are “clean” enough to be useful. The coalition enhances existing provider–insurer relationships to test and improve large-scale data exchange methods. 

Ultimately, Ed underscores that digital transformation in health care is only as strong as the quality of the data being exchanged. Standardization, accessibility and interoperability are the foundations of progress, ensuring that technology-driven solutions improve enhance outcomes. Digital HEDIS, FHIR and the Bulk FHIR Quality Coalition are examples of how NCQA is reducing measurement burden to streamline measurement and improve quality. 

Key Quote:

“ The digital transformation of health care is necessary to deliver higher quality care. But that is dependent on high-quality data and the ability to exchange this data.  It starts with high-quality data–making it accessible, interoperable,  exchangeable. That is the foundation for being able to deliver digital health care transformation.  Nothing in digital transformation in health care makes sense without high-quality data exchange.”

-Ed Yurcisin

Time Stamps:

• (1:03) The How and Why of Digital Measurement
• (04:14) Understanding FHIR
• (08:32) From Data Exchange to Competitive Advantage
• (10:42) The Bulk FHIR Quality Coalition

Links:

• Connect with Edward Yurcisin
• NCQA Digital Hub 
• Bulk FHIR Quality Coalition