This episode of Quality Matters features highlights from the NCQA Health Innovation Summit panel discussion on data interoperability, held on November 1st in Nashville. Moderated by Arcadia’s Aneesh Chopra, the panel explored how to make health data accessible and usable for improving patient care. Panelists (Laura McCrary of KONZA, Dr. Marc Overhage of Elevance Health and Abdul Shaikh of AWS) emphasize interoperability is critical for quality reporting, care coordination and closing care gaps. Emphasizing trust as the cornerstone of data exchange frameworks such as TEFCA, panelists outline the need for alignment between payers, providers and technology organizations to ensure better health outcomes.

The panel unpacks technical and operational challenges surrounding interoperability, such as integrating fragmented data sources and transforming raw reports into insight practitioners can use at the point of care. Panelists compare HIEs and QHINs to highways, illustrating how these systems enable cross-border data sharing. But delivering actionable information, rather than overwhelming clinicians with reports, remains a challenge. Solutions such as Bulk FHIR and cloud-based technologies are highlighted as promising ways to help data reach its best, highest use.

The discussion closes with an appeal for greater collaboration and participation in initiatives like the NCQA Bulk FHIR Quality Coalition to test modern quality measures. As Laura McCrary points out, the interoperability challenge isn’t just technological—it’s cultural and contractual. By aligning incentives and fostering trust between stakeholders, health care can evolve from fragmentation to seamless, person-centered care.

Key Quote:

"Bringing data together for a particular patient so we have a comprehensive view for clinical care, quality assessment, predictive modeling, whatever it might be–it’s still the golden ring that I'm trying to get to.

We have standards and that's great, and those continue to improve.

It's pretty amazing the volume of data and the number of people that we're able to access and share data between payers, providers, other participants in the healthcare ecosystem."

Marc Overhage, MD

Time Stamps:

(2:55) Data exchange is all about trust.

(4:38) QHINs are the superhighways of health data exchange. HIEs are the on- and off-ramp.

(5:25) QHINs were created to work around geographic limitations of HIEs.

(6:12) QHINs’ challenge is providing information in a way that practitioners can use.

(7:21 ) To understand where data exchange can go wrong, focus on the interfaces between steps.

(9:12) Data exchange agreements often require legal expertise as much as technical expertise.

(11:13) The industry faces a big binary choice about how to organize quality information.

(12:46) Bulk fire and cloud computing are a powerful combination.

(14:31) Join the Bulk FHIR Quality Coalition.

Links:

Bulk FHIR Quality Coalition

Quality Matters Ep: 07

Quality Matters Ep: 08

Connect with Aneesh Chopra

Connect with Laura McCrary

Connect with Marc Overhage

Connect with Abdul Shaikh

n this episode of Quality Matters, host Andy Reynolds sits down with Tosan Boyo, President of Sutter Health East Bay Market, to discuss his inspiring journey from Nigerian immigrant to leading a major health care institution. Boyo shares how his early experiences as a patient in a safety-net hospital shaped his commitment to health equity and continue to shape his leadership. He reflects on key moments that drove his passion for providing equitable care and the responsibility health care leaders have in ensuring access for all.

Boyo highlights the importance of community engagement in health care workforce development, emphasizing the need for institutions to reflect the communities they serve.
He also highlights the crucial role of transparent data reporting in driving improvement and building trust. Boyo discusses the impact of partnerships and how collaboration sets a precedent for addressing inequities.

Tosan will participate in a panel discussion at NCQA's Health Innovation Summit, where he will discuss ongoing efforts and challenges in advancing equitable care. His insights offer a roadmap for ensuring that health care systems evolve to meet the needs of diverse communities.

Key Quote:

“Health equity gives us tools and to validate we are living up to the thesis that motivates us to come to work every morning.  Fundamentally, delivering high quality outcomes is always the number one priority with that thesis being a foundation, how are we ensuring every patient is achieving the high quality outcome? We verify that by Saying let's stratify your outcome metrics by race and ensure that race is not a factor that one population is not getting the same high quality outcome Let's do it by language and ensure that language is not a barrier to access and not a barrier to following the instructions that you get from a physician. Let's verify by zip code, to understand socioeconomic status. How are we ensuring that regardless of zip code, you are getting the best care? These are different ways we can verify we are living up to the priority to deliver high quality outcomes.”

-Tosan Boyo

Time Stamps:

(00:57) Tosan Boyo's Journey into Health Care

(02:58) Defining Health Equity and Its Importance

(09:59) Building Trust and Community Relationships

(15:25) The Future of Health Equity

(18:45) The 2024 NCQA Health Innovation Summit

Links:

Connect with Tosan Boyo

CMS Universal Foundation

Tosan Boyo at Quality Talks 2022

Institute of Medicine: Crossing the Quality Chasm

In this episode of Quality Matters, host Andy Reynolds previews the upcoming Women in Quality panel at NCQA’s Health Innovation Summit. He speaks with Vanessa Guzman, CEO of SmartRise Health and Ella Es Health, who will moderate the panel. Vanessa shares her insights on empowering women in quality by cultivating self-awareness, fostering connections and building a culture of quality. She also introduces two thoughtful panelists, Khanh Nguyen, CEO of Cozeva, and Lynn Todman, Vice President of Health Equity at Corewell Health, who bring unique perspectives on resilience, community impact and health equity.

The discussion emphasizes the importance of trust, community and personal reflection in leadership, with personal stories from each guest about navigating challenges and creating meaningful change. The episode concludes with practical advice for attendees of the Women in Quality event on November 1, encouraging self-reflection and a focus on personal growth.

Key Quote:

“The Women in Quality reception will focus on three segments.

The first one will focus on cultivating oneself, understanding your purpose, walking your journey. What does that look like? The second segment will be focused on connection and collaboration. How to build meaningful relationships; how to build a trusted network. And then the third will be focused on creating and expanding that culture of quality. What areas of your life and workforce meet your goals and objectives? How are you tracking and measuring those processes?

When you combine those, you're manifesting the goals that you have set.”

• Vanessa Guzman

Time Stamps:

(2:23) Co-creation at the 2024 Health Innovation Summit’s Women in Quality event

(5:18) Finding growth and impact as a quality professional

(9:14) Improving quality, building community

(11:55) Building trust

Links:

NCQA’s Health Innovation Summit

Connect with Vanessa Guzman

Connect with Khanh Nguyen

Connect with Lynn Todman

In this episode of Quality Matters, host Andy Reynolds is joined by Dr. Tiffany Inglis, National Medical Director for Women’s and Children’s Health at Carelon Health, to explore the Elevance Health Obstetrics Practice Consultants program. A winner of an NCQA Health Innovation Award, the Elevance Health program breaks new ground by bringing value-based care to obstetrics, a field where value-based strategies remain rare. Dr. Inglis discusses the program’s focus on improving maternal health outcomes by addressing racial disparities and providing practitioners with insight and know-how. By emphasizing collaboration and data-driven support, the program improves the care of mothers and babies.

The conversation further examines the growth and impact of the program since its inception in 2015. Dr. Inglis highlights measurable indicators of success, including double-digit reductions in low birth weight and preterm births. The discussion addresses implications of integrating value-based care into obstetrics, showcasing how this model not only improves outcomes for mothers and babies but also fosters an effective, sustainable health care system.

Key Quote:

“For me, the surprise has been the impact you can have by taking this approach of value-based care, tied to quality, and then aligning it to provider supports. The member gets better care, the provider gets their value-based care contract stuff taken care of, and the plan gets a better outcome for mom and baby. It's the triple win, a good outcome for everyone. And I think the thing that caught me most off guard was just the scale at which we can improve outcomes and see better care.”

• Dr. Tiffany Inglis

Time Stamps:

00:43 Elevance Health OB Practice Consultants Program’s Impact on Maternity Care

01:45 The Role and Growth of OB Practice Consultants

05:10 The Relationship to Other Quality Initiatives

08:36 Challenges and Misconceptions in Value-Based Care

12:17 Tips for Implementing Value-Based Care

Links:

Connect with Dr. Inglis
NCQA Health Innovation Awards
NCQA Birth Equity Accountability through Measurement (BEAM) Program

On this episode of Quality Matters, we explore the growing importance of Health Information Exchanges (HIEs) and Qualified Health Information Networks (QHINs) with Laura McCrary, President and CEO of KONZA National Network. Laura discusses the pivotal role these systems play in quality care, enabling the secure and efficient sharing of medical records across diverse networks. By advancing the digitalization and interoperability of health data, these networks enhance patient safety and care coordination.

We explore how integrating claims data with clinical data enhances quality, underscoring the critical importance of trusted networks for data exchange. Laura dispels common myths surrounding HIEs and QHINs, while offering practical tips for health care organizations curious about connecting to these essential systems.

Additionally, we examine national efforts to expand connectivity and ensure that all health care organizations are part of a growing, robust data infrastructure. This episode serves as a handy guide for how to leverage HIEs and QHINs to participate in more capable and coordinated health care ecosystem.

Key Quote:

“There is a lot more information available. It really is both a blessing and a curse. In the past, there was no information available for the doctor. Now there's so much. The first problem was how did we actually move the data from Florida, say, to New York? It's been solved through QHINs. As we solve one problem, we've created a new one, which is there's too much information available. We've got to address this new problem.”

-Laura McCrary, Ed.D

Time Stamps:

• (01:48) Challenges and Change in Data Exchange
• (03:48) Myths and Realities of HIEs and QHINs
• (07:35) Connecting Different Kinds of Data
• (10:27) Dimensions of Trust
• (14:29) Reducing Burden with Digital Measurement
• (16:06) Future of HIEs and QHINs

--

Links:

NCQA resources on digital quality

Learn about KONZA

Connect with Laura

In this episode of Quality Matters, host Andy Reynolds delves into the transformative impact of the Trusted Exchange Framework and Common Agreement (TEFCA) on health care data interoperability. Joined by Amol Vyas, NCQA Vice President of Interoperability, and Eric Musser, Vice President of Federal Affairs, the discussion uncovers how TEFCA is reshaping the landscape of health information exchange.

Amol explains TEFCA’s function as a voluntary, national network (analogous to the postal service in its role as a connector) and highlighting implications for the free flow of HEDIS data. Eric provides insight into TEFCA’s bipartisan roots in the Cures Act of 2016, emphasizing TEFCA as a model of public-private partnership and standards-based improvement.

Key Quote:

“I think TEFCA has kind of been the underdog in health policy for a while now. Value-based care, patient safety, whole-person care, all those things are really salient topics that are brought up a lot. I think TEFCA is about to have its moment and I'm excited to see it come to greater fruition. I'm really happy to see all the progress we've made. It's going to take a full government, full industry approach to make this work for people. I think we're well on our way,”

-Eric Musser

Time Stamps:

(00:28) Understanding TEFCA

(01:42) New SOPs and Their Impact

(06:36) Public Policy Perspective on TEFCA

(10:00) Public-Private Partnership in TEFCA

(12:10) Looking Ahead with TEFCA

Links:
Bulk FHIR Quality Coalition

Digital Hub

Connect with Amol

Connect with Eric

In this episode of Quality Matters, host Andy Reynolds sits down with Rebecca Jacobson, CEO of Astrata, to explore the challenges and opportunities in transitioning to digital quality measurement in health care.

Rebecca offers an in-depth look at the sociotechnical shifts required for this evolution, sharing practical strategies to help organizations navigate this complex process. Discover how to overcome common obstacles, and learn about the real financial benefits that can convince even the most skeptical CFOs to invest in this transition.

Rebecca also provides a candid assessment of the industry's current state of readiness, emphasizing the importance of starting early for long-term success. She discusses why progress has been slower than expected and shares her updated timeline for widespread adoption.

Key Quote:

“I'd want my billboard to say: “Digital quality, you can do it.” Big things like this, big transformations that impact so much of the organization, they can be daunting, but we've seen plans make substantial progress that are clearly going to do very well. It can be done. Every quality team has it in them to guide this transformation and derive benefit. Just start now and have the confidence that you're able to do it, that there are a lot of resources that help you.”

-Dr. Rebecca Jacobson

Time Stamps:

(00:00) Introduction to Digital Quality Measurement

(01:03) Understanding the Industry's Readiness for Digital Transformation

(02:17) Challenges and Benefits of Digital Transition

(09:53) The Role of AI and Machine Learning

(14:55) Current Progress and Future Directions

Links:

Connect with Rebecca

Learn more about Astrata

Join the NCQA Industry Council

Explore the NCQA Digital Quality Hub

In this episode of Quality Matters, host Andy Reynolds discusses the U.S. Playbook to Address Social Determinants of Health with its lead author, Dr. Sandra Elizabeth Ford. Dr. Ford, a pediatrician and public health advocate with extensive experience at both local and federal levels, highlights the necessity of looking beyond clinical care to factors like housing, nutrition, and transportation. She emphasizes the importance of expanding data gathering and sharing, supporting flexible funding, and investing in backbone organizations to improve healthcare outcomes.

Dr. Ford also tackles the disconnect between local and national levels, advocating for leveraging local expertise and strengthening local programs before seeking federal support. The episode concludes with practical insights on integrating social needs into healthcare delivery and the importance of addressing these determinants to foster a sustainable healthcare system. Dr. Ford dives into what makes a successful organization in public health, focusing on the critical role of data. From the challenges of data standardization and sharing to the importance of good governance and leadership, this episode offers invaluable insights. This conversation is a must-listen for anyone passionate about creating a comprehensive healthcare system that truly considers the full spectrum of social determinants of health.

Key Quote:

“We are not going to doctor ourselves out of the healthcare crisis. If we really want to address healthcare crises in this nation, we need to understand how are people living, what they're missing. We need to ask questions around how people live their lives. It’s cheaper to give somebody a food prescription than it is to treat an amputee from diabetes. So if we ask the questions on the front end of what people need, we’re better able to serve them from a clinical perspective.”

-Dr. Sandra Elizabeth Ford

Time Stamps:

(00:51) The Necessity of the Playbook

(02:48) Expanding Data Gathering and Sharing

(10:32) Challenges and Solutions in Data Management

(15:55) Common Misconceptions in Healthcare

Links:

Learn more about the Playbook

Connect with Dr. Sandra Elizabeth Ford