<v Jordan Cooper>We're here today with Rick Moore, founder and CEO of MTC Group, former CIO of the National Committee for Quality Assurance and Retired Air Force Major. Rick, thanks so much for joining us today.</v>

<v Rick Moore>Thanks for having me, Jordan. Appreciate it.</v>

<v Jordan Cooper>Yeah. So you've done a lot of work and a lot of different spaces. I'm interested in kicking off our conversation regarding NC QA and HEDIS measures in particular, many of our listeners or CEOs of large healthcare delivery systems and they participate in programs like Medicare and Medicaid Promoting Interoperability program. They deal with reporting of electronic health record derived electronic clinical quality measures like HEDIS measures and they also participate in CMS star ratings program.</v>

<v Jordan Cooper>I'm wondering if you could tell me more about what might what sort of topics or top of mind. What should people consider they may not otherwise consider maybe what would constitute a better measure or what do they need to do to make sure that they improve their ratings and increase revenues to their organization?</v>

<v Rick Moore>That's a lot. That's a lot. Yeah. It's a big question. So let me try to unpack some of that. So there the big shift in in the ecosystem is everyone knows that's driving a lot of this push for value is measurement, right? That's one of the one of the, if you have carrier sticks to try to get folks to move that way, right, getting out of the fee for service mindset and really doing a whole person whole patient.</v>

<v Rick Moore>What I said quality population level metrics, right? So he just has embedded in that ecosystem and has been for well over 2530 years now. So that shift created. The good news is there was already an ecosystem ready, he just was it. And I think the last decade or so has shown that they weren't necessarily digitally ready, right? We weren't ready to move at the speed of the data that was being coming at you, if you will. So now clinical data is so much more accessible in many ways than it was let's say.</v>

<v Rick Moore>When he just started back in 1990 Ish right mid 90s and with today's ecosystem that's evolving and it's evolving faster than ever with fire coming out, the fast healthcare interoperability standards, there is a huge opportunity for in sequoias measurement ecosystem to go digital. And I believe you know prior to my departure there in 2021, we had worked diligently on those standards on those metrics to improve upon the use and leveraging the clinical data ecosystem that has started to emerge.</v>

<v Rick Moore>Right when our high tech came out and we were all incentivized to start putting electronic health records in place. Unfortunately, the interoperability portion of that wasn't, I'd say, the focus of that first phase is what I think a lot of folks at ORMC or CMS would call that. Now we're in phase two, maybe someone call phase three of the meaningful use program now it's MIPS, right? And there are signs ahead that say clinical data is now going to become the norm. So if you're a CIO out there and you haven't been figuring out strategies.</v>

<v Rick Moore>To 1 acquire the data.</v>

<v Rick Moore>To assess the quality of that data. Because as we all know, when we get data when we first start shining the light on data, we start finding what data quality issues. So getting that data quality to a level that's usable for what I would call the secondary purpose of healthcare data, right? The primary purpose is what care on the secondary purposes, these things we're talking about here measurement I think clinicians and others would probably say we've been flipping that for some time and it seems like the primary purpose has been for measurement. But as we know this interoperability.</v>

<v Rick Moore>Infrastructure that we put in place, it's really for better care. So I'm excited about the future in the sense that insecure a solve the opportunity and we've been working on it while I was there working on that strategy for some time. They've also been working on a version of the measures earlier on. You probably have heard called the electronic clinical data systems ecds and now we're morphed that into with the fire CQL standards, right, clinical quality language.</v>

<v Rick Moore>There is now a way to format those clinically rich data into a digital quality measures. So DQM are now going to become more than norm. When I say more than Norm, if you look at the heat of Seco system of measures, there's about 100 or so and in that there's probably a good 20 or so that are what I say clinically dependent those measures would get, I would call it the first lift if you will from the DQM process, meaning it's going to shift those measures into that to that arena where clinical data is going to become.</v>

<v Rick Moore>More of the primary source than the secondary source right now, it's really a secondary source, right? Cause plans focus on the administrative data claims and whatnot to get their rates, then they have an opportunity to go do what we call supplemental data right to enrich those rates with sampling of records and whatnot. All of that creates burden right on the ecosystem to go to get those charts and it cost a lot of time and money and it certainly creates pain points for the ecosystem. So now that this digital ecosystem is involved, there is now an opportunity here for the infrastructure.</v>

<v Rick Moore>Of how measures defined how the data is pulled in to become a whole lot more, what we've all been wanting is that you know S7 key on your computer to actually get a measure out of the system right away. So that reality, while it's not gonna be 2 years, it's probably gonna be another five or so before you start seeing, I'd say a critical mass of fire endpoints stood up where you're going to start seeing clinical data, more flu, more fluid going through the ecosystem, right where there's more and more of the what I'm calling externality parts outside the EHR.</v>

<v Rick Moore>Labs.</v>

<v Rick Moore>Other types of ancillary services are going to get more ubiquitously interoperable, and I believe plans are gonna be able to reach down into the ecosystem of clinical data and pull out what they're gonna need for measurement in a much more facile way than they can do today. So that's where I'm very excited about the future. So thanks for asking.</v>

<v Rick Moore>Sure.</v>

<v Jordan Cooper>Sure. So we've covered a bunch of topics already so far just on that first question, we ran across clinical data acquisition interoperability, integration. There's many areas that we can delve into to explore further. I would like to talk for a moment about automation of that data extraction and measure reporting. So I'm a scenario of a large healthcare delivery system and I want to participate in these programs. I mentioned the public payer program.</v>

<v Rick Moore>Yep.</v>

<v Jordan Cooper>There are also private payers as well who would like me to report on these on these measures. How am I going to start making inroads to instead of having my data quality analyst pull these operational reports and and send those results out to the plans manually, how am I gonna automate the collection, the dashboards and then the sending of those measures to plans?</v>

<v Rick Moore>Yeah, that's a. That's another good. I think a good outcome of this ecosystem I was describing earlier is that the fire standard now that there's been, whether you wanna call them mandates or nudges, take your pick to start having these endpoints stood up at payers, providers and even in some cases for patients to access right via apps. Once those start becoming more normal normalized within the ecosystem, I believe that's going to be a signal for. And if you're not already there yet, you're gonna have to get your internal operations as a CIO of thinking more about how you're going to.</v>

<v Rick Moore>Consume that data because a lot of plans, and I'm really speaking from a planning perspective as a CEO, if CIO, if you will, because that's where a lot of this ends up, if you will, from a reporting perspective. Yes, it's true that the providers are having it report, that's absolutely correct. And they're usually doing that via their EHR. Now there's some other modalities that they're allowing their CMS or allowing for reporting right now that are more manual based or what have you. But I believe they're gonna move and they're putting signals out that's gonna come straight out of your electronic health record, right. So what you're going to start seeing is the move to make the measures.</v>

<v Rick Moore>More machine readable, more machine executable back to your point about automation. More cookable. When I say hook able where other apps like clinical decision support can hook into the measure. Because really what the goal of measurement is instance to get a performance rate and and that's not the intended reason. It's really to help the clinicians with decision making at the point of care. And so clinical decision support can be benefited in this way with this new digital ecosystem by which the measurement ecosystem will then derive what.</v>

<v Rick Moore>They clinician should be.</v>

<v Rick Moore>Umm. Thinking about in the course of care so that they're correct names and correcting that's not the right word so that they're providing the right levels of services at the point of care. And so the measure itself will be automated, if you will, and helping out the clinician sport. So what's going to start seeing is some of that.</v>

<v Rick Moore>Automation is going to help at the local point of care where they're gonna build dashboards to your point where they're going to see real time.</v>

<v Rick Moore>Quality not.</v>

<v Rick Moore>Retrospective quality right now he this is a retrospective quality we're trying to get.</v>

<v Rick Moore>Prospective quality into the play right? So that it is helping at the point of care. So that's where I believe a CIO should be looking. If I'm a plan should be looking for the ecosystem, leveraging those endpoints where they're starting to see them stand up. You know, there's always going to be what I call the.</v>

<v Jordan Cooper>Mm-hmm.</v>

<v Rick Moore>Early adopters and I would encourage health plans to start thinking about parts of their network where they're seeing early adoption work with those early adopters and start building out prototypes and proof of concepts around these. I'm going to call them digital ways of getting their data and their reports. It's not going to happen all at once, but you're going to have to start using an evolutionary model to pick out market spots where you see the inflection point in the critical mass starting to occur so you can actually start doing these digital reporting concepts is that.</v>

<v Rick Moore>Makes sense?</v>

<v Jordan Cooper>It does make sense and I like how you mentioned the shift from retrospective quality to prospective and making an active impact on care. As you were speaking. I was thinking that many of our listeners being in provider settings often are very focused on their own process driven metrics. Maybe there are a few outcomes driven metrics as well, but they're very focused on the delivery of care and enabling those clinicians, I think lessen the forefront of their mind is what health plans are thinking of and doing with their data.</v>

<v Jordan Cooper>I think generally, uh provider organizations aren't in our most providers in an organization and administrators may not be interacting on a daily basis with health plans. So since you have insight into what their perspective might be, I'd like to ask what do health plans wish providers would do better? What do they see with these measures? And they say, you know, I just wish I can get that health system CIO to do X. What would that be and how would they go about doing it?</v>

<v Rick Moore>Oh, wow, man. You're gonna get me in trouble with that question. I not having been directly involved in the health plan operation, which I've only been on the peripheral predict in QA. And I've worked with a couple of organizations since my post in Qi time. I think that a lot of.</v>

<v Jordan Cooper>Umm.</v>

<v Jordan Cooper>Mm-hmm.</v>

<v Rick Moore>A lot of the old ways of, you know, this sort of. I'm gonna call it the US, them sort of mentality around you know it's it's the plans fault, you know, it's insurers keeping me from like say prioritization, right. That's a big pain in the bottom for everybody, right? It's just it creates a burden, it creates slows, stagnates the system. So there's another opportunity for some digital automation, right. That's going to hopefully we'd some of that burden out. I think really it comes down to sort of this culture between it's than us them. So if you get out of the S them and it's a we.</v>

<v Jordan Cooper>Mm-hmm.</v>

<v Rick Moore>Or on us. I do think that that kind of an arrangement is going to be more supportive of this shift. Right now, if you can hit, if you continue to think it's an US or we day and well it's our data, you know that's our data, that's your data, that's gotta stop. And I believe the signals are out right now about that. You know, no more information blocking, right? No more exorbitant fees to get access to data. These kinds of things are being teed up. And if you're not reading those tea leaves, you're probably going to not do well in the future ecosystem so.</v>

<v Jordan Cooper>Mm-hmm.</v>

<v Rick Moore>It's I think a if I were plan, I think I'd be nudging my network of providers that I'm working with to be more open to the concept of sharing the data both ways, right and bilateral way, so that you both benefit in the risk and the sharing of improving quality for the populations that you're both responsible for. That's where I believe it's headed. And I think the ecosystem is going to make that a lot more possible, whereas before it was data siloed, those things, those barriers are going to come down. They're slowly melting away. Not as quick as we like.</v>

<v Rick Moore>But they're slowly melting in a way, and I believe what the message would be to from a plan to provide and probably back is let's stop the nonsense. Let's start working together more fluidly.</v>

<v Rick Moore>Sure.</v>

<v Jordan Cooper>And you're talking about the shift from US versus them regarding plans versus providers to more of an US or a we it it calls to mind the general market trend of a shift to value based care to merging payers and providers together, you have on the extreme end of the spectrum, the Kaiser Permanente, the Inter Mountain and UPMC's are a little bit more further away from Kaiser, but much further more integrated than the fee for service model. And then you have ACOs somewhere in the middle.</v>

<v Jordan Cooper>How are plans reacting to this shift to value based care and to provide our environment? Is it threatening to plans? Do they see it as competition? How should providers kind of think about plans as they're moving to more value based care?</v>

<v Jordan Cooper>The.</v>

<v Rick Moore>Wow, yeah, I think Umm, I think there's all different sorts of models emerging, right? There's pay biters like you said, ACO models and other good example there. There are many different I think 1000 you know or they go 1000 blooms or thousand points of like sort of models emerge which which will win out. I mean there's some that say value based care has been going on for 1015 years now depending upon when you want to put the clock start on that right and there's all interoperability is another one. I've been working at this operability thing and I may have been healthcare since 1995.</v>

<v Rick Moore>So we're going on 30 years now and we're still not there, is they all saying goes, we've we've come a long way but we still have a long way to go. Are we at the midpoint?</v>

<v Jordan Cooper>Umm.</v>

<v Rick Moore>Now, I wouldn't say we're the midpoint. I'd say we're past the midpoint on some of these things. But ultimately what you know what's gonna drive this is gonna have to be quite candidly, the financial incentive model. I mean, that's what's driving sort of this lunacy within our healthcare ecosystem, right? Who's going to be the winners, who's going to be the losers in terms of? We know there's waste in the ecosystem, right? So and people are people, some parts of the ecosystem were benefiting from that waste, right, because those are someone's waste is someone else's treasure, if you will, right. One man's trash and the man's treasure.</v>

<v Rick Moore>So there are tightly held.</v>

<v Jordan Cooper>Umm.</v>

<v Rick Moore>You know, whatever you wanna call them beliefs or sacred cows, if you will. That will be held on to you and those will be the ones that I think are going to have the hardest time with this. And the more you hold on to those sacred cows of the mid 90s to the mid 2000s and you're not waking up to this new phenomenon of having to build out these relationships in a way that benefit both of you mutually. It's not a winner or loser. You got to figure out a way for.</v>

<v Rick Moore>Winners to both.</v>

<v Jordan Cooper>Umm.</v>

<v Rick Moore>Umm. Continue and I think the value based cares that opportunity or you know is a way for game sharing to occur. And I think to your point it's coming, it's showing up in things like.</v>

<v Jordan Cooper>Umm.</v>

<v Rick Moore>The contract in terms of who's getting a service for what and for what pieces, right. So if I as a plan reduce hospitalizations with the network of my provider, right? Well, should they not share in that right return in that efficiency gain, I think those are the kinds of relationships that I'm starting to see happen more frequently. I'm involved in some other activities around this in terms of companies that are supporting, I'm going to call the carrier extender model where they're getting in between the, let's say, primary care referral care and the plan.</v>

<v Rick Moore>And helping coordinate those kinds of infrastructural issues that, let's say, a primary care practice never was built to do.</v>

<v Rick Moore>And so you're starting to see these other entities, intermediaries, what have you emerged to help support that part of the ecosystem to build a bridge between, let's say, care coordination with those community based organizations that were kind of off on their own that didn't get to leveraged as well as social term social determinants of health? And I believe plans, those sort of community providers and social determinants of health and HealthEquity have, as we know in the last two years gotten a lot more attention because of what went on with COVID. And I think those are.</v>

<v Rick Moore>Very strong.</v>

<v Rick Moore>Indicators for where the ecosystem needs to move right, we're gonna break down these barriers and. Well, no, that's not a medical issue. It's it's related to medical issues, but they're not paid for, right. They've got different rule sets around how we can use money to pay for those kinds of events. Those things are starting to melt away as well. And when you start looking at healthcare, more community based like that, then I believe you can start building winners and everybody gains in that right now standing on a fee for service model is holding us back.</v>

<v Jordan Cooper>So Rick, we're approaching the end of this podcast episode, but there is an elephant in the room alone last, there are many more topics, but there's one last remaining topic I'd like to address in this call.</v>

<v Rick Moore>Sure.</v>

<v Jordan Cooper>You're talking about merging of organizations. You're talking about reducing barriers between payers and providers. You're talking about the automation of reporting of HEDIS quality measures. And as you're remove these barriers, it begs the question, what about privacy and security? What sort of concerns should a CIO have as we will reduce these barriers, that the information which is?</v>

<v Jordan Cooper>Phi is is being limited to good actors and that bad actors are being kept out and even good actors who shouldn't have access to the data are not accidentally given an access. How should CIOs approach these new headwinds with regards to privacy and security?</v>

<v Rick Moore>While another my you've got some great questions. Jordan's I could probably spend in a day or you know hours on either one of these. But you know I'm a precision security guy myself, so I'm.</v>

<v Rick Moore>Certified Information Security Manager and all that good stuff. So I know all the protocols that we should be doing. And quite candidly, there's there's probably more than we'd care to cover, but ultimately it does come down to a culture shift in the US healthcare system around how we as patients and how we as consumers of healthcare think about our privacy and security in this regard, right. So let's just talk about Elephant room, to your point, we need a national patient identifier in this country. It is holding us back in many, many, many ways and creating unintended consequences. As far as I'm concerned from rich perspective around.</v>

<v Rick Moore>For example, for me to find a patient in a another ecosystem, I have to give him 5 to 10 different data elements that are covered under hi. You know whether it's name, address, drivers, license, whatever you might, whatever. So we're passing around all these elements of Phi that are probably more revealing than just a single number that we've got encrypted somewhere. That's a national registry that only you know. And I think that's where it's a little scary for people. So, like, well, wait a minute. Do I want the national government having that? Well, we have something like that now called the Social Security number. Right.</v>

<v Rick Moore>So at the end of the day and we have got to get more comfortable as a society around this note this, this notion that not having or that by not having a national patient identifier that were somehow better off. And my thing is is I think we're works off and we created more holes in our privacy and security by requiring us to do patient matching because we're having to pull all these other databases together and link them up so that we can make sure that you're really Jordan Cooper. You're not another Jordan Cooper from another part of the country or what have you.</v>

<v Rick Moore>And that's happening more often than not because we're having and that's increasing error into our healthcare records systems because we're linking you up. And I can't tell you that the actual statistics, but I've heard it could be as low as it as high as a 20% variation in the accuracy of some of those algorithms, right, depending upon what.</v>

<v Rick Moore>Uh segment of the population you're talking about, so it's it's more nuanced than just. Well, if we added blockchain for example, that's gonna solve everything. No, I'm not a believer of that either. I believe we have to start at the cultures level and that starts with policy that starts with getting government to understand that this is needed and that would reduce a lot of these things. So one of the things I learned a long time ago as an operations manager never perfect that we should never be done. I think that's a dimming motto and we're perfecting that, which should never be done. We shouldn't have to do patient matching like this. It's creating.</v>

<v Rick Moore>Unintended consequences. We have national facility facility ID. We have national provider ID. Now we're missing who's getting the care. So if you know where the care is given who's giving it to you and who is given on those are three the basic elements that you need to do what watch someone go through the ecosystem and when you start having those kinds of abilities to find the data and match the data you get then get into a much more robust way to do this digital automation and actually get to a learning health system because we can then start using real.</v>

<v Rick Moore>Analytics and all. By the way, we're not gonna get into AI yet, but artificial intelligence is gonna be doing a lot of the sports as well. So great questions. Thanks for having me. I enjoyed every one of them.</v>

<v Jordan Cooper>Thank you. And for our listeners who joined us in the middle, this is been Rick Moore, founder and CEO, MTC Group, former CIO of NCQA and a retired Air Force major. Rick, thanks so much for joining us today.</v>