Inside Health Care: Presented By Ncqa



Every month on the Inside Health Care podcast, the NCQA Communications team interviews the health care industrys most prolific thought leaders to extract their secrets on how they work to improve health care quality. Listeners can count on us for up-to-date information on everything from delivery reform to patient experience.


  • Inside Health Care #125: The Digital Drive from Sick Care to Value-Based Care

    14/02/2024 Duração: 34min

    In this episode, we highlight two companies that leverage data from many different sources to create a more complete picture of a person’s health. The ultimate goal? Shifting away from the current model of “sick care” - where patients primarily see their doctors when they aren’t feeling well – to care models that prioritize long-term health and self-management with guidance from providers. These companies are helping lead the way to value-based care, from using AI to sift through patient-reported data and provide actionable insights, to integrating NCQA's HEDIS measurements into their data platform, thereby putting quality at the center of everything they do. Here, you’ll get a glimpse into the challenges and opportunities in our current data-rich health care ecosystem.The episode begins with a conversation with leaders from Welldoc. Welldoc is a health tech company developing patient-facing apps to support self-management of chronic conditions. Using an omnichannel approach, their apps gather as much data as

  • Inside Health Care #124: Targeting Health Equity Gaps with Digital Tools

    31/01/2024 Duração: 23min

    The course of the Digitalization of Health doesn’t always run smooth. But for every set of pain points a provider might experience, there are companies developing technological solutions – platforms and tools – that not only guide us through digital transformation but identify crucial patient and population data along the way.In this episode, we talk with two health tech leaders, interviewed during NCQA’s 2023 Health Innovation Summit in Orlando, Florida, about their strategies and successes in using digital tools that can ultimately reveal and resolve gaps in health care delivery.Sebastian Seiguer, is co-founder and CEO of Scene Health. Scene Health is a company focused on medication “engagement”, a comprehensive approach that means more than just getting patients to take their medicine. They provide personalized medication support by combining video technology, clinical coaching, and validated interventions to improve medication adherence rates. Within the tapestry of their mission is the clear goal of reac

  • Inside Health Care #123: Health Equity & Making the Commitment to Change

    17/01/2024 Duração: 52min

    This episode of “Inside Health Care: a Podcast by NCQA” features three interviews recorded live at our Health Innovation Summit in October 2023. Among many panels and presentations was an incredible session titled “Health Equity Trailblazers: Where Vision Meets Commitment.” Health equity leaders discussed their organizations’ health equity strategies, vision and lessons learned, delving into how leaders can commit to and advance health equity priorities. Each of this episode’s guests sat on that panel then sat with me for a deeper dive. These leaders, each in their own way, want to inspire us to action.Dr. Joneigh Khaldun is Vice President and Chief Health Equity Officer for CVS Health. In this role, she advances the company’s data-driven strategy to improve access to services, address social determinants of health and decrease health disparities. She is a sought-after speaker and thought leader who has appeared on Meet the Press, MSNBC and CNN, among others, and she has testified before Congress.In her past

  • Inside Health Care #122: Teaching Medical Residents to Follow a Value-Based Model of Care

    03/01/2024 Duração: 32min

    In this Inside Health Care interview, we explore GME — graduate medical education — and explore a few fundamental questions. How can we make sure today’s medical residents are paying attention to their patients? How do we teach residents to ask the right questions? And even more fundamentally, how do we make sure that the next generation of clinicians knows how to implement value-based models of care in order to focus on person-centered outcomes?A value-based model helps patients envision what their lives could be a few months, or even years, down the line. And that’s the point at which clinicians can help patients develop a treatment plan to get them from point A to point B. That may be the best way to keep a patient healthy, boost their interest in their self-care and prevent repeat visits for the same problem.So the questions stand regarding graduate medical education. How do you teach med school students the value of quality? How do you train them to follow a model of value-based care? And if your hospita

  • Inside Health Care #121: Peggy O'Kane and Driving Digital Transformation in 2024

    20/12/2023 Duração: 30min

    We close 2023 with our annual year-end State of Health Care interview with NCQA President Peggy O’Kane. In this interview, Peggy talks with Vice President for Public Policy and External Relations, Frank Micciche, about NCQA’s progress in 2023—both in improving equitable access to health care and implementing digital transformation across the ecosystem. As you’ll hear, we’re hitting the ground running in 2024. With new digital products, digital quality implementers and digital solutions to reveal—and reverse—health care disparities, NCQA stands ready to take the lead on advancing quality for everyone.Don't forget to sign up for NCQA’s next big event: the Health Equity Forum, coming up March 4th and 5th, 2024, at the Westin Los Angeles Airport. The Health Equity Forum convenes state officials, advocates and health care providers, showcasing the blueprint for creating and implementing statewide health equity strategies. Our next Quality Talks event is planned for Spring 2024. And as mentioned in this episode's i

  • Inside Health Care #120: Bringing PCMH Back Home and Digging into Supplemental Data

    06/12/2023 Duração: 56min

    In this episode of our “Inside Health Care” podcast, we hear two interviews that each demonstrate how close we are to solving the challenges of health disparities and digital transformation. Our first interview finds a real-life, “Last Mile” solution that will bring historically under-served populations to the health care services they need and deserve. Our second interview reveals how improved efficiencies in digitalization actually make it easier to add even more data – and more data crunching – into the mix. PHIT4DC stands for the Public Health Informatics and Technology for the District of Columbia Workforce Diversification Program. PHIT4DC brings together public health programs at two HBCUs—historically Black Colleges and Universities—namely, the University of the District of Columbia and Howard University. Together, these esteemed institutions train professionals from historically under-served neighborhoods in 21st-century IT knowledge and skills so they can return to their neighborhoods and give back

  • Inside Health Care #119: Coordinated Care through CBOs & Bringing Alcohol Screening to the PCPs

    22/11/2023 Duração: 01h41s

    In this episode of Inside Health Care, we present two interviews that each ask really basic, yet complex, questions about health care.The first question: Why are patient alcohol and substance use issues so often overlooked in primary care? This interview will not only answer that question: it will point patients and providers in the right direction: toward adoption of universal alcohol screening and follow-up. Three experts remind us that there is help to implement evidence-based alcohol health care—free resources from NCQA and the National Institute on Alcohol Abuse and Alcoholism [NIAAA], part of the National Institutes of Health [NIH].At NCQA’s second annual Health Innovation Summit, we interviewed Dr. Thekla Brumder-Ross, Dr. Katharine Bradley and Dr. Laura Kwako.Dr. Thekla Brumder-Ross is a clinical psychologist and national leader of addiction medicine. In her 14 years at Kaiser Permanente, Thekla led and implemented large-scale practices and policies in addiction medicine, treatment protocols and prima

  • Inside Health Care #118: Collaboration Is the Key to Interoperability and Equity for All

    08/11/2023 Duração: 47min

    In this episode, we explore a much-discussed Inside Health Care topic: interoperability. Within the process of health care digitalization, interoperability deals with the multi-lane, multi-directional transfer of electronic health records, or EHRs. But more and more, in that transfer process, companies discover data they hadn’t considered using, data needing refinement, and data that tells stories of patients being overlooked and left behind.In the first interview, my guest and I discuss the best way to smoothe the road to health equity: form a patchwork of different types of health care companies that can safely and efficiently shepherd data along the patient journey. Later, I co-interview a team that discovered a disparity gap and closed it—permanently. Their secret? Ask the community how to reach those patients.Mo Weitnauer is MRO’s Chief Product Officer. She drives its product strategy and roadmap. Throughout her high-level career, Mo has helped develop tech-based strategies for managing medical costs and

  • Inside Health Care #117: Live from NCQA's Second Health Innovation Summit

    25/10/2023 Duração: 24min

    In this episode, we hear clips from four interviews recorded live at NCQA’s 2nd annual Health Innovation Summit.Parker Holcomb is Chief AI Engineer at Elevance Health. At NCQA’s 2023 Health Innovation Summit, he participated in a session titled “Building Trust in Clinical Data for Value-Based Care”. Parker stands at the forefront of data quality, constantly seeking to perfect data quality standards, all towards closing gaps in health equity. So how do professionals and technologists align the movement toward digital health transformation in the direction of value-based care?Dr. Joseph Betancourt is president of the Commonwealth Fund. One of the nation’s preeminent leaders in health care quality, Dr. Betancourt formerly served as senior vice president for Equity and Community Health at Massachusetts General Hospital (MGH), overseeing a number of entities including the Center for Diversity and Inclusion.A prolific author, lecturer, and board-certified internist who focuses on Spanish-speaking and minority popul

  • Inside Health Care #116: Fighting Structural Racism and Promoting Virtual Care

    11/10/2023 Duração: 56min

    In this episode of “Inside Health Care,” we meet two guests, in two interviews. Our first guest advocates for birth, racial and gender equity, driven by her own distressing experiences as a patient. Our second guest developed effective ways to implement virtual care on a large scale to improve equity and representation for rural communities.Sinsi Hernández-Cancio, JD, is a vice president at the National Partnership for Women & Families, where she leads the Health Justice team. Born in Puerto Rico, Sinsi is a national health and health care equity policy and advocacy thought leader dedicated to advancing equal opportunities for women and families of color. The Partnership worked with health care experts and partner organizations to develop a report that includes recommendations for improvement in resolving gaps in health equity that executive leaders can tailor to their organizations.Debbie Welle-Powell, MPA, is CEO of DWP Advisors and an Adjunct Professor at the University of Colorado Executive MBA. But D

  • Inside Health Care #115: Telehealth, Adult Immunization, and the Pandemic in Retrospect

    27/09/2023 Duração: 49min

    In this episode of “Inside Health Care,” we take a look back at what we’ve learned since the pandemic hit over two years ago. We first chat with an upcoming star speaker at NCQA’s 2023 Health Innovation Summit on what we’ve garnered from the growth of telehealth in remote medicine. Then in our second interview in this episode, we discuss the public’s conflict with immunization and new strategies on encouraging vaccination.Dr. Leslie Eiland is an Associate Professor of Medicine in the Department of Internal Medicine, Division of Diabetes, Endocrinology & Metabolism at the University of Nebraska Medical Center. She is Medical Director of Patient Experience and Digital Health at Nebraska Medicine, and has been Medical Director of the endocrine telehealth program there since 2014. The program provides care via telehealth to eight rural community hospitals in Nebraska and Iowa. Dr. Eiland’s clinical areas of interest and expertise are remote delivery of endocrine care and providing endocrine support for primar

  • Inside Health Care #114: Dr. James Tcheng and the FHIR Side of Hypertension

    13/09/2023 Duração: 29min

    In this episode of “Inside Health Care,” we talk interoperability with a cardiologist who helped develop a new standard for data records exchange. Fast Healthcare Interoperability Resources, a.k.a. FHIR, can improve efficiencies in use and transfer of electronic health records. It can ease pressure on medical staff while also improving health equity measurement.In our discussion with Dr. James Tcheng, we focus on the CardX Hypertension Project. CardX, or cardiovascular data exchange, was launched in 2022 by the University of Nebraska Medical Center’s Center for Intelligent Heath Care. The project stems from the greater CodeX FHIR Accelerator project. The project seeks to use FHIR as a standard for data transfer and parsing. The project’s stated objective is to “facilitate the communication of hypertension management data between clinicians and patients to increase the proportion of individuals with hypertension who are treated to goal.”Our guest is Dr. James Tcheng, cardiologist and professor of Family Medici

  • Inside Health Care #113: Fee-Based vs. Value-Based Care and Careful Credentialing

    30/08/2023 Duração: 49min

    In this episode of “Inside Health Care,” we chat with a prominent NCQA board member about flipping fee-for-service models to value-based models, all in order to ease digital transformation. Then, we talk about the challenges and true rewards of pursuing Credentialing Accreditation. Dr. Craig Samitt is the CEO and Founder of ITO Advisors, an advisory and investment firm committed to value transformation of the health care industry. Dr. Samitt sits on many boards in addition to NCQA’s Board of Directors. He also serves as a strategic advisor to federal agencies, public and non-profit health plans and numerous digital health and care delivery organizations.At the Health Innovation Summit, Dr. Samitt will panel alongside NCQA President Peggy O’Kane and other experts. In a session called “Payment Models and Digital Transformation,” they’ll discuss the opportunities and challenges associated with digital transformation in a fee-for-service landscape. Bill Vargo is Program Manager in the Northwestern Medicine Physic

  • Inside Health Care #112: Patient Focus, Equity Lensing, and Next Steps for Long-Term Services and Supports

    16/08/2023 Duração: 48min

    In this episode of “Inside Health Care,” we talk digital transformation with a prominent medical informaticist. Then, we hear a conversation on NCQA’s long-term services and supports programs, a.k.a. LTSS, from a long-time accredited managed care supporter.Dr. John Glaser is Executive in Residence at Harvard Medical School Executive Education. Previously he was Chief Executive Officer of Siemens Health Services. He is former Chair of the Global Agenda Council on Digital Health in the World Economic Forum, and former Senior Advisor to the Office of the National Coordinator for Health Information Technology. He’s also a member of NCQA’s Board of Directors.Dr. Glaser will also be at NCQA’s second annual Health Innovation Summit in October 2023. In addition to helping open the Summit, he’ll sit on a C-suite panel alongside NCQA President Peggy O’Kane and other industry leaders, discussing, among other things, the transition to a digital health ecosystem.Centene is the largest Medicaid Managed Care Organization in

  • Inside Health Care #111: Cozeva, Data Aggregator Validation, and Data Credibility

    02/08/2023 Duração: 47min

    In this episode, we talk with two leaders of an amazing NCQA partner company, Cozeva, while revisiting one of NCQA’s cutting edge digital products, our Data Aggregator Validation program [DAV]. Cozeva, a member of the original program cohort, is an integrated, comprehensive population health platform.Our Data Aggregator Validation program now forms the backbone of Cozeva’s services. Cozeva currently provides health care data solutions to nearly 37,000 providers across 16 states. For more details on NCQA's data analysis work, check out our Data Measures Roadmap.Dr. Khanh Nguyen is Chief Executive Officer of Cozeva. Khanh has a doctorate from the University of California San Francisco School of Pharmacy, focusing on health policy and management. She has over 15 years of experience in creative payer-provider collaborations. Khanh is an expert in data crunching, discussing how improving and easing the flow of health care data will then improve efficiency for both payers and providers.Dr. Rosh Singh is Cozeva’s Ch

  • Inside Health Care #110: Dr. Xiaoyan Huang, Danielle Christensen and the Value of Patient-Centered Specialty Practice Recognition

    19/07/2023 Duração: 41min

    In this episode, we’re focusing on NCQA’s PCSP—Patient-Centered Specialty Practice Recognition program. As noted on our website, the PCSP Recognition program focuses on coordinating and sharing information among primary care clinicians and specialists. It requires clinicians to organize care around patients—across all clinicians seen by a patient. Patients and their families or other caregivers are included in planning care and considered partners in managing conditions.Specialty practices that earn NCQA’s PCSP Recognition communicate more effectively with primary care, integrate services better with primary care and improve the quality of their care. Patients see the difference through reduced costs, better data and records management, improved identification and oversight of chronic conditions, and more face time with a more satisfied medical staff.For this interview, we found one of our greatest advocates of the PCSP Recognition program, an extremely busy and dedicated medical team from Providence Heart In

  • Inside Health Care #109: The End of the Emergency and the Rise of Medicaid Redetermination

    05/07/2023 Duração: 56min

    On this episode of Inside Health Care, we talk Medicaid with a large, equity-focused provider about the end of the Fed’s pandemic-related emergency Medicaid provisions. Following that, a chat with one of our 2022-2023 PCMH Certified Content Expert Quality Award winners. Later on, some fast facts for you in observance of World Hepatitis Day.Elevance Health, a large multi-state health insurance provider, is the largest managed care company in the Blue Cross Blue Shield Association. In September of 2022, an Elevance Health subsidiary, Simply Healthcare Plans of Florida, became one of the first health care organizations in the U.S. to earn accreditation in NCQA’s Health Equity Accreditation Plus program.We interview Elevance Health Medicaid President Aimée Dailey alongside Staff Vice President for Medicaid Whole Health Kalunde Wambua to find out more about the company’s continued commitment to Equity improvement.We also talk with one of NCQA’s 2022-2023 PCMH Certified Content Expert Quality Award winner, Susanne

  • Inside Health Care #108: Dr. Alex Keuroghlian and the State of Health Equity for LGBTQIA+ Patients

    21/06/2023 Duração: 45min

    On this episode of Inside Health Care, we celebrate Pride Month with discussions on gender health equity, sexual orientation and gender identity health care quality issues, and health care access and representation for the LGBTQIA+ community. Later, some tips on improving the provider experience for transgender patients.Dr. Alex Keuroghlian is an expert in Sex- and Gender-Informed Medicine and Sexual and Gender Minority Health Care. As a psychiatrist, Dr. Keuroghlian’s work often centers on patients suffering from post-traumatic stress disorder, or PTSD, especially within the LGBTQIA+ community. They hold numerous leadership and teaching positions at Massachusetts General Hospital and Harvard Medical School. They also support and educate health care centers and clinicians in gender equity with their leadership as Director of the Division of Education and Training at The Fenway Institute, and Principal Investigator of the National LGBTQIA+ Health Education Center, a HRSA-funded cooperative agreement to improve

  • Inside Health Care #107: Dr. Ava Jones and the Pursuit of Health Equity for the Homeless

    07/06/2023 Duração: 52min

    On this episode of Inside Health Care, we feature two interviews celebrating winners of two different NCQA awards: a NCQA 2022 Health Innovation Award and a 2022-2023 PCMH CCE Quality Award Winner. Later in the show in our Fast Facts segment, we discuss gender equity-related health care terminology.In our first interview, we talk with Dr. Ava Jones, PhD and RN, the Director for Health Equity and Accreditation at United Health Care Community and State’s Florida Plan. Dr. Jones' workplace won an NCQA 2022 Health Innovation Award for the “UnitedHealthcare Community Plan of Florida Housing Navigation Program.” A healthcare navigator assists plan members with advice or suggestions on how to pursue a medical issue affecting them or their family. Dr. Jones explains the nature and importance of a housing navigator.NCQA PCMH Recognition is like a seal of approval for quality assurance. A health care practice that earns that seal can be trusted for their dedication to delivering quality care—which means they’re dedicat

  • Inside Health Care #106: Dr. Ben Kligler with Integrative Medicine through a Quality Lens

    24/05/2023 Duração: 45min

    On this episode of Inside Health Care, we talk about acupuncture, yoga and a host of other “alternative” therapies with a health leader in the U.S. government. After that, we explore a newly announced breakthrough in digitalization exploration with NCQA’s Chief Technology Officer.Our first guest is one the foremost experts in the U.S. on integrative medicine. He answers some difficult questions. How have some alternative therapies become legitimized? And what are the risks of unregulated therapies?Benjamin Kligler, MD, MPH, is Executive Director of the Office of Patient Centered Care and Cultural Transformation (OPCC&CT) at the Veterans Health Administration. He is a board-certified family physician, working as a clinician, educator, researcher and administrative leader in the field of complementary and integrative medicine.At NCQA’s 2023 Quality Talks, Dr. Kligler talked about “whole health” and how it relates to his work.In our next interview, NCQA Chief Technology Officer Ed Yurcisin breaks down our ne

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