Digital Quality Transformation Made Simple
Digital transformation impacts quality. But its jargon can be overwhelming. Two of NCQA’s top technologists tell you what you need to know, in clear, non-technical terms.
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About The Guests
Ed Yurcisin leads NCQA’s technology strategy and execution, helping advance continued digital innovation. As Chief Technology Officer, he is responsible for providing organization-wide leadership and direction across products and services, enterprise operations, IT infrastructure and security.
Ed is a proven technology leader with significant experience implementing technology and data solutions for health care payer and provider customers. Ed joined NCQA in 2022, after serving in C-level positions across leading health care and technology organizations, including Chief Technology Officer at Embedded Healthcare, Chief Product Officer at Onyx Technologies, Chief Data Officer at CareJourney, and Chief Information Officer at PeraHealth. Ed also led several initiatives to improve diversity, including developing a technical recruiting pipeline in Latin America.
Amol drives NCQA’s interoperability strategy and NCQA’s work with external partners that set information technology standards. Amol has over two decades of experience in enterprise information technology, with lead roles in strategy, architecture and implementation.
Amol is the former Chief Architect for Interoperability at Cambia Health Solutions, a parent company of health plans. Prior to that, he was part of the MedicaLogic team that developed Logician Enterprise, one of the world’s first Electronic Medical Record systems. Amol also led development of the Common Payer Consumer Data Set and the CARIN FHIR Implementation Guide for Blue Button, a resource that many federal health care mandates reference.
Episode Description
In this episode of Quality Matters, host Andy Reynolds and NCQA’s Chief Technology Officer Ed Yurcisin explore the role of high-quality data exchange in quality’s digital transformation. They discuss how digital HEDIS® measurement, and interoperability standards like FHIR®, aren’t just improving quality reporting, but also paving the way for broader advancements. Ed translates the technical side of digital quality measurement, explaining the importance of Clinical Quality Language—(CQL)—and highlighting NCQA’s work to standardize complex calculations through open-source tools.
As the conversation turns to CQL “engines,” Amol Vyas, NCQA Vice President for Interoperability, joins the dialogue to explain how a public-private partnership is bringing choice and confidence to the market for these important software tools. Ed also relates personal stories that illustrate the need for data interoperability, reinforcing that better data means better, safer care. As the conversation concludes, listeners are encouraged to use NCQA resources to keep current as digital quality evolves.
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.
Timestamps
(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