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

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

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

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

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

In this episode of Quality Matters, Julie Seibert, Assistant Vice President of Behavioral Health at NCQA, joins host Andy Reynolds to explore the rise of—and the relationship between—two trends in behavioral health: measurement-informed care and peer support. Julie breaks down how these strategies improve outcomes, engage patients and close gaps in access and accountability.

Listen to this episode to discover:

•  How Measurement-Informed Care Engages Patients: Learn how measurement-informed care supports patient engagement and treatment adjustments in behavioral health. We explore the importance of ongoing assessment, tracking symptoms and outcomes and empowering patients to understand their journey.
•  Friction and Fuel for New Approaches: We unpack historical challenges to measurement-informed care. These include the omission of behavioral health from key legislation and the costs of EHR integration. We also discuss how NCQA depression measures and person-centered outcome measures relate to measurement-informed care.
• Benefitting From Peers’ Lived Experience: We discuss how people who have been through mental health or substance use treatment can provide non-clinical support to help others navigate the system, subvert stigma and fill care gaps.

This discussion is a valuable resource for providers, policy leaders and others who care about improving access, engagement and outcomes in behavioral health.

Key Quote:

"Measurement-based care has been around for a long time and only 20% of behavioral health providers adopted it.

Traditionally, these are trained clinicians. And in the course of a session with a patient, probably in the back of their mind, they’re evaluating whether an individual is improving or has worsening function.

Payers would like some numerical or standardized way of seeing the clinician’s clinical judgment. Measurement-informed care offers that."

Julie Seibert

Time Stamps:

(03:04) Who’s Behind Measurement-Informed Care

(05:08) HEDIS and Measurement-Informed Care

(08:13) Person-Centered Outcome Measures in Behavioral Health

(09:58) The Power of Peer Support Specialists

(11:57) Addressing Workforce Shortages

(15:37) Why States Support Peer Support

(16:32) Peer Support’s Connection to Measurement-Informed Care

Dive Deeper:

Blog: How Peer Support Can Help Close the Gaps in Behavioral Healthcare
Blog: Measurement-Based Care in Behavioral Health
Quality Matters Episode 13: Getting Clear About Behavioral Health
Connect with Julie Seibert

In this episode of Quality Talks With Peggy O’Kane, NCQA President Peggy O'Kane sits down with Dr. Rita Redberg, a cardiology pioneer and fierce advocate for evidence-based care. Dr. Redberg, who famously served as Editor-in-Chief of JAMA Internal Medicine for 14 years, shares her "Less is More" philosophy — a perspective that challenges the view that "more" care is always better.

Join Peggy and Rita as they explore:

• The Problem with "More": Why a health care culture focused on technology and volume over patient needs leads to runaway costs and poor results.
• The Stent Story: How a widely adopted procedure in cardiology gained traction without initial evidence of patient benefit, and the uphill battle to integrate rigorous clinical trials.
• Mary Caldwell's Odyssey: A cautionary tale illustrating the dangerous cascade of unnecessary testing and interventions, based on a desire for reassurance rather than clinical need.
• Re-evaluating Statins: Rita’s unconventional view on the use of statins in asymptomatic people. She advocates lifestyle changes over medication when the evidence of benefit is thin.
• Rebuilding Trust: How the fee-for-service payment model erodes the patient-doctor relationship and how regulatory reforms can shift incentives towards patient wellbeing.

Rita reminds us that health care quality isn't about more tests or interventions. It’s about thoughtful, patient-centered decisions and a commitment to "first, do no harm." This episode is a must-listen for anyone curious about improving health outcomes and reducing waste in health care.

Key Quote:

Most statins are prescribed for people that have not already had a heart attack or have established coronary disease. In that higher risk group, there is some benefit to taking statins. It's not huge but there is some benefit.

But most people I see, and most people taking statins, are not in that category. They're healthy people that want to prevent a heart attack and want to live longer. They definitely are not going to feel better. 

Rita Redberg, MD

Time Stamps:

• (02:09) Misconceptions in Medicine
• (10:01) Mary Caldwell: A Cautionary Tale
• (13:35) Choosing Wisely Campaign: A Step Towards Better Care
• (16:32) Debating the Use of Statins
• (21:31) Trust, Incentives and the High Cost of US Care
• (27:05) Technology, Teams and Trust

Links:

JAMA Internal Medicine “Less is More”

Choosing Wisely

Connect with Rita

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.