Access Health: NCQA President: Quality Systems Manage This "Like Crazy"

Newsweek

22-05-2025

Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources.
Each week, I jot down a few quotes that stick with me. Sometimes they're from interviews, other times they're from news articles or LinkedIn posts and—occasionally—I dig around in an industry report and get a nugget of solid gold.
This week, my favorite quote was from Dennis Dahlen, CFO of Mayo Clinic and one of many contributors to the HFMA's new report, "The Healthcare CFO of the Future."
"We can disappoint pretty profoundly in health care," Dahlen said. "The way we can make some progress around the consumer experience is by making sure we're not disappointing customers."
Now, for a quote to make my all-star list, it must contain some element of surprise. The content of this one didn't catch me off guard, but the speaker did. I've heard CEOs and CNOs and even chief AI officers acknowledge the pitfalls of patient care, but coming from a CFO? Most of my conversations with finance chiefs have centered on budgets and bottom lines, expressing more concern for disappointed board members, donors or (in some cases) shareholders.
As I pondered this, I realized I call CFOs to talk about a pretty limited list of topics: earnings reports, mergers, the occasional hospital closure. If I ask anything big picture, I'm typically directed to the CEO with the same energy my dad gave when I'd ask to go to a party as a kid: "I don't know. Ask your mother. Come back if you need $20."
But the tides are shifting, according to the HFMA's report, based off a survey of 116 industry CFOs. Ninety percent of respondents agreed that new CFOs face a more challenging road to success than their predecessors. Their scope is expanding, requiring them to partake in conversations about value-based care, consumer experiences and risk management.
This didn't happen overnight. The CFO role has been evolving for three decades, per the HFMA. But now—especially with the advent of AI and an increasingly unpredictable geopolitical situation—the demands on CFOs are really revving up.
On Wednesday morning, I hopped on a call with Ashraf Shehata, principal and U.S. sector leader for health care at KPMG and a contributor to the HFMA's report. I asked him why 88 percent of CFOs think they'll spend more time on strategy over the next three years. Ultimately, they'll have to consider a fuller slate of fast-moving factors and craft more nimble plans, he told me.
"In the past, we were able to lay out strategies that may span two to five years," Shehata said. "Now you can see strategy revised, edited, built, redeveloped in 30-, 60-, 90-day periods."
The whole C-suite will have to rally around the CFO and provide them with the metrics they need to create a living, breathing business plan, Shehata continued. Financially successful health systems will leverage tech and predictive analytics to bring insights to the CFO's office in real time.
"The higher performing organizations are the ones that establish very strong interpersonal communications and collaboration across the C-suite," Shehata said. "We've always read about it, we've always been part of it through our business training, but now it's becoming a reality and we're actually seeing the data."
CFOs and colleagues, what do you make of all this? Let me know at [e-mail].
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Essential Reading
What happens when the CEOs of CHAI and Alignmt.AI, the chief data scientist of Duke Health and a health AI lawyer get together? You learn a lot about AI governance. On Tuesday, I moderated Newsweek's virtual panel "Health Care's AI Playbook: Building Safe, Smart and Scalable Systems." We discussed vendor transparency, post-market surveillance and the risks and rewards of a public AI registry like CHAI's(among other things.) If you missed the live conversation, you can watch the full webinar and read a recap here , courtesy of my colleague Lauren Giella.
On Tuesday, I moderated Newsweek's virtual panel "Health Care's AI Playbook: Building Safe, Smart and Scalable Systems." We discussed vendor transparency, post-market surveillance and the risks and rewards of a public AI registry like CHAI's(among other things.) House Republicans were still working overtime to pass President Donald Trump's so-called "big beautiful" spending bill at the time of writing on Wednesday, May 21. The packagewould implement work requirements for Medicaid recipients above the federal poverty line, increase co-pays and mandate more frequent eligibility verifications. It would also prohibit Medicaid from funding gender-affirming care for children, would restrict non-profits from providing abortion services. If the bill becomes law, it could result in 7.6 million fewer Americans being insured. During a Tuesday webinar, several Catholic health system leaders urged Congress to rethink the cuts. Providence CEO Erik Wexler said health care is facing a "poly-crisis" including "inflation, labor shortage, tariffs, but most impactfully, what is being proposed in Congress right now, to cut Medicaid." Meanwhile, NewYork-Presbyterian laid off 2 percent of its systemwide workforce, or approximately 1,000 employees. The system said "macroeconomic realities and anticipated challenges ahead" spurred the decision, the Rockland/Westchester Journal News reported. NYP didn't elaborate, but health system leaders across the country have been clear: What happens in Congress will undoubtedly pose new financial challenges for health care organizations.
at the time of writing on Wednesday, May 21. The packagewould implement work requirements for Medicaid recipients above the federal poverty line, increase co-pays and mandate more frequent eligibility verifications. It would also prohibit Medicaid from funding gender-affirming care for children, would restrict non-profits from providing abortion services. Cleveland Clinic struck a new three-way partnership with Oracle and G42 , the Abu Dhabi-born technology holding group. They intend to develop an "AI-based healthcare delivery platform" that is secure and scalable, starting with patient populations in the U.S. and the United Arab Emirates. The platform also aims to support precision medicine and "the transition from reactive treatment to proactive wellbeing," according to a joint news release.
, the Abu Dhabi-born technology holding group. They intend to develop an "AI-based healthcare delivery platform" that is secure and scalable, starting with patient populations in the U.S. and the United Arab Emirates. The platform also aims to support precision medicine and "the transition from reactive treatment to proactive wellbeing," according to a joint news release. UnitedHealth Group paid nursing homes thousands of dollars to reduce hospital transfers for sick patients, leading to several cases of delayed or prohibited care, according to an investigation published Wednesday in The Guardian.
leading to several cases of delayed or prohibited care, according to an investigation published Wednesday in The Guardian. "To reduce residents' hospital visits, UnitedHealth has offered nursing homes an array of financial sweeteners that sounded more like they came from stockbrokers than medical professionals," wrote Guardian investigative reporter George Joseph.
wrote Guardian investigative reporter George Joseph.
The paper said it investigated thousands of corporate and patient records and conducted interviews with thousands more than 20 current and former UnitedHealth and nursing home employees. It also reviewed two whistleblower declarations submitted to Congress earlier this month.
UnitedHealth Group issued a 42-word statement alleging the article contained "significant factual inaccuracies," and noting that the DOJ declined to pursue litigation
Pulse Check
Margaret O'Kane is the founder and president of the National Committee for Quality Assurance (NCQA).
Margaret O'Kane is the founder and president of the National Committee for Quality Assurance (NCQA).
NCQA
Margaret "Peggy" O'Kane is the founder and president of the National Committee for Quality Assurance (NCQA). She started the organization in 1990, aiming to build consensus around key health care quality issues, measure them and drive improvement.
What started as a one-person team working out of borrowed office space has evolved into a 400+ person enterprise—and a rigorous industry standard-setter. NCQA's Healthcare Effectiveness Data and Information Set (HEDIS) is the most widely used performance measurement tool in health care.
This week, O'Kane called me from her D.C. home for a Pulse Check.
Editor's Note: Some responses have been lightly edited for length.
Over the past 35 years, how have you seen health care organizations change in their approach to quality?
There's been a lot of consolidation and a lot of mergers. When we started, there weren't that many super large delivery systems or health plans. There's a lot of antitrust issues with some of these mergers, and people are struggling to keep some measure of competition in the market. I think it's a tough thing to have in health care, even if people do have a lot of choices. There are a lot of big players and if you're a [health] plan and you're trying to only contract with the best providers in your region, it may be that you have the best hospital, and it's associated with many mediocre or not-so-great hospitals (this happens all the time). But if you want to contract with the best one, you have to take all of them.
[Another] thing that we noticed and were distressed about was, many times, reporting on quality was a pain for the providers, and especially primary care providers—and often the busiest ones were feeling most harassed by quality measurement. It's kind of what got us started on our journey towards digitalizing quality measurement. Ultimately, we think quality measures should just fall out of the care delivery process. ...There's this cliche of a doctor in pajamas with their laptop late at night filling out quality forms. We think that should never be happening.
Ah, I'm familiar with that cliche! Despite digitalization efforts, doctors still have a lot of administrative work to do. What steps need to be taken to make quality reporting more efficient and less taxing on primary care providers?
We started out with the idea that digitalizing quality measurement was going to do a lot of good, which we think it can. But it's actually ultimately about digitally enabling the care that people get so that if I'm going to the doctor and I have a number of health care issues, my medical record is giving the doctor some kind of cues about what we should be talking about in the visit and what things need to be followed up on—especially in busy practices, and especially for people that go in once a year. That's a tall order so that can be digitally enabled.
Let me give you an example of something with pretty dramatic consequences: Type 2 diabetes. We have a lot of people in this country that have Type 2 diabetes, and if they're not managed effectively, many of them will progress to kidney failure. That is something that can be slowed by proper treatment.
I remember talking to a big system that does pretty well on this [prevention], and asking, "How do you do it?" And they said, we have a registry of all our people with Type 2 diabetes, and particularly the ones that are showing signs of renal disease, and we just manage them "like crazy." We call them back in, we see what we can do to get them to lose weight, all the things that they need to do to slow that progression.
So we know it's possible. And when you think about renal failure, it's a pretty terrible situation, both for the patient and for taxpayers. Cost and quality can be a trade off at times, but many times it's not a tradeoff. Many times, the better care is going to be less expensive than the failed care.
To provide that upfront, proactive care management, do you feel that there needs to be a shifting of resources in the health care system?
Yes. We have some value-based care models that are doing that, but they still haven't penetrated the system in a very deep way, and so we're still leaving a lot of money and quality of life on the table.
Some health systems are looking to AI agents to handle this upfront care management. Read my reporting on that strategy here.
C-Suite Shuffles
Ascension Texas selected Jamie Youssef as its next CEO . He joins the health system from HCA Healthcare , where he was senior vice president of network development and service lines.
selected as its next . He , where he was senior vice president of network development and service lines. The care coordination company Quantum Health tapped three leaders to its executive team. Saurabh Kumar was named CFO (previously, he held the same title at venture capital firm Triple Aim Partners, Kelsey-Seybold Clinics and UnitedHealth Group's employer and individual division). Mike Cooper was named chief transformation officer (most recently, he was senior vice president of strategic initiatives at Dayforce, a HR software company). And Nancy Sansom was named chief marketing and communications officer (she joins from Versapay and PlanSource, where she helmed commercial and marketing operations).
tapped three leaders to its executive team. was named (previously, he held the same title at venture capital firm Triple Aim Partners, Kelsey-Seybold Clinics and UnitedHealth Group's employer and individual division). was named (most recently, he was senior vice president of strategic initiatives at Dayforce, a HR software company). And was named (she joins from Versapay and PlanSource, where she helmed commercial and marketing operations). Gordon Wesley is the new chief strategy and clinical integration officer for UChicago Medicine AdventHealth. Most recently, he served as vice president of the Heart, Lung and Vascular Institute at AdventHealth in Orlando.
Executive Edge
Antoine Robiliard is the vice president of health solutions at Withings.
Antoine Robiliard is the vice president of health solutions at Withings.
Withings
Antoine Robiliard is the vice president of health solutions at Withings, a France-based health tech company focused on remote monitoring solutions. You might recall that they invented the first smart scale back in 2009.
Robiliard's work at Withings has taken him around the world, allowing him to live in Paris, Shanghai and now Boston. Like many health care executives I speak with, he enjoys immersing himself in new cultures—but sometimes, incessant demands from his phone and computer put a damper on those adventures.
This week, I connected with Robiliard to learn how he is balancing a busy work schedule with family life and his own wellbeing. Here's what he said:
"By the beginning of 2024, my health was at an all-time low. My metrics were all going in the wrong direction—I was barely walking 5,000 steps per day, and my sleep apnea was rapidly worsening. This was a moment of clarity: I realized I had to make changes to my daily habits if I wanted to get healthier.
My metrics were all going in the wrong direction—I was barely walking 5,000 steps per day, and my sleep apnea was rapidly worsening. This was a moment of clarity: I realized I had to make changes to my daily habits if I wanted to get healthier. "Walking has helped immensely. It's the best medicine and it's free. I'm committed to walking everywhere: to work, to pick up my children from day care, during phone calls that don't require me to be at my desk and even after dinner. I've more than doubled my steps now and this simple yet powerful habit has improved energy and overall well-being. One of my favorite activities in Boston is walking with my children to the South Boston beaches, especially on the weekends. Compared to France, one of the greatest advantages of living in Boston is how easy it is to get outside and discover new places on the weekends; so many spots are just a short drive away.
to work, to pick up my children from day care, during phone calls that don't require me to be at my desk and even after dinner. and this simple yet powerful habit has improved energy and overall well-being. One of my favorite activities in Boston is walking with my children to the South Boston beaches, especially on the weekends. Compared to France, one of the greatest advantages of living in Boston is how easy it is to get outside and discover new places on the weekends; so many spots are just a short drive away. "I've also always loved cooking and have become more mindful about what I put on my plate. I focus on increasing my protein intake, loading up on vegetables, and balancing my meals. I'm not eating less; I'm eating smarter, without sacrificing the joy of meals —which is extremely important to me. I started packing my lunch for the office instead of buying takeout and I'm enjoying cooking dinner at home.
—which is extremely important to me. I started packing my lunch for the office instead of buying takeout and I'm enjoying cooking dinner at home. "As a father of two young children, my motivation to improve my health has never been greater. I'm determined to lead by example and embrace an active and healthy lifestyle for the sake of my children. In my role at Withings, I support programs and care teams that help others manage their health. Over time, this has influenced me personally, making me more cautious and aware of my health."
Before you go, when was the last time that you reflected on the ratio of decisions you make to actions you take? In this article, Dr. Victor Raúl Castillo Mantilla—president and CEO of the Hospital Internacional de Colombia and a member of Newsweek's CEO Circle—discusses the value of hands-on leadership.
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