We sat down with Peter Fournier, Director of Product Management at the NCQA. We discuss everything from how the NCQA has modernized its tech to adapt to new models of care delivery, to his team's approach to capturing and synthesizing some of the most wide ranging stakeholder viewpoints in the industry.
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For the full YouTube video: https://youtu.be/e9oFX9I-9Jw
Chris Hoyd 0:07
Welcome back to Product in Healthtech: a community for product leaders by product leaders. I'm Chris Hoyd, the Director of Product Management at Vynyl. Today I sat down with Peter Fournier, Director of Product Management at the NCQA. We discuss everything from how the NCQA has modernized its tech to adapt to new models of care delivery to his team's approach to capturing and synthesizing some of the most wide ranging stakeholder viewpoints in the industry. Let's jump into that conversation.
Peter, good to see you. Thanks for joining us today, our audience is very likely to be you know, PMs in healthcare, but still might not have a great sense of what the organization does. And it's, you know, quite an influential one. So I think it's worth spending a little time kind of really exploring that. So I'll maybe hand it off to you. And if you just want to give a quick summary, we can go from there.
Peter Fournier 0:56
Yeah, I would be happy to so thank you again for inviting me happy to talk about NCQA. Truth be told, I didn't know a lot about NCQA until I came here. I have been in the industry for a really long time, and certainly it heard of NCQA, but really didn't appreciate the role that NCQA plays in health care until I started here in December of 2021. So NCQA is a nonprofit that is based in downtown DC, literally just a couple of blocks from the White House actually. And so the the organization was started 35 ish years ago by are still president and CEO, Peggy O'Kane. What she had recognized at the time was that she was actually working in healthcare and didn't see a lot of emphasis around quality and quality improvement in health care. So she actually created I believe a major and created a company, an organization that was focused specifically on measuring the quality of health care to in an effort to raise the bar, right and to improve health care across the board. Some of our earliest customers were health plans back in the HMO days who came to us and said, we're paying this money, or actually was that customers of health plans, who are coming to us and saying we're paying all this money to health plans. We don't know what we're getting, we don't understand the quality of what we're getting. Can you help us. And so we actually started where the heat is health information data information set came from, that's where our health plan accreditations came from, we started to say, alright, well, we can evaluate the quality of the health care provided by requiring health plans to report to us certain metrics. And so what health plan started to have to do is to report to us this HEDIS dataset, which is metrics on a population level about quality within the health plan's population. And so typically, almost every health plan or every major health plan in the country, reports HEDIS data to us, it's a huge effort every year to go through and report those measures. Over time, we expanded from just a health plan focus to include health IT companies, other health related companies that might work with health plans in like a delegated arrangement. So managed behavioral health organizations, credentialing organizations, utilization, management, etc. Some of those larger health plans will delegate a lot of those. And so those organizations now can get accredited by us as well. We also then built out some clinician facing programs. And so that's really where my role today sits, is on the clinician side of NCQA. So we have programs that measure the quality of services provided by primary care offices, specialist offices, urgent care, retail clinics, some disease specific programs like diabetes, pop health, etc. And so we've really started sort of expanded beyond just measuring health plans. Now a huge part of our organization is actually contracts and grants where we are contracted with different organizations to research different topics, you know, philanthropic organizations will come to us and say we have an interest in improving diabetes, we know you have the ability to do research on this we'll fund this research if you will go and do research, you will, if you will go and do this research. Health Equity is another topic that we were among the first organizations to really dig into. So it's really it's a really interesting organization. really influential in a way that you would not expect for an organization that is our size, we're about 400 or so employees. But really, we touch the lives of pretty much almost every American in one way or another whether they know it or not.
Chris Hoyd 4:43
So you're probably a little busy.
Peter Fournier 4:46
Always. Yeah, yeah,
Chris Hoyd 4:48
I may kind of dive into different bits and pieces of that that's an incredibly broad, you know, spectrum of sort of responsibilities and projects and it's not a responsibility to I think.
Peter Fournier 5:00
It really is. Yeah, I mean, on a day to day basis, you might be talking with an individual provider in a rural office, then you might be talking to the CEO of a large health plan. And you might then your next meeting might be with a VA or with CMS and or a state Medicaid agency. It's really like a very varied and broad group of constituents that we work with on a day to day basis,
Chris Hoyd 5:25
The sort of product manager or product leader role is typically thought of as kind of the connective tissue within an organization. The NCQA is like the connective tissue of the entire US healthcare systems that's like, so yeah, you've got a lot to track. How do you do it? Describe your role within the NCQA. And yeah, I'll be I'll be very curious to hear what your sort of day to day is like and and how that how it all works.
Peter Fournier 5:50
Yeah, it is, it is a lot, and we definitely are the glue. So within NCQA, we have a product organization that we've been building out over the last three or so years, increasing every year and our sophistication and maturity. Today, that organization is probably about 15 to 20 individuals give or take. And so we've divided each of our products into portfolios, I have peers that support different parts of the organizations, I happen to support our clinician facing programs. But there's so much overlap, I have a peer who's focuses on health plan relationships, one who focuses on data quality, one who focuses on digital measurement of quality. But all of our work overlaps so much that we spend a significant amount of time together not only because we need to be closely connected, but because of the constituents that we have are changing so much. And it's healthcare is rapidly evolving so much that all each of our constituent groups tend to overlap. So when I came to this organization, and came from the health plan world, and I immediately, you know, focused on okay, what are the things that health plans are driving that are impacting clinicians that we need to start to focus on and that has been really helpful in the work that I'm doing today? In some of the things that I'm leading right now.
Chris Hoyd 7:09
Interesting. Okay. So you mentioned the organization has been around for a good while at this point. But the product team is a bit newer. So have you know, the last few years - have you been focused more on kind of modernizing and updating infrastructure and data quality and security? Or are you building out, you know, new capabilities, new internal products, or is it kind of a mixture?
Peter Fournier 7:35
It's definitely a mixture. One of the things that we're leading at NCQA, with LMC and with CMS and with others is the move towards digital measurement of quality. So we have a Digital Measures roadmap or working with CMS on that working with OMC, and others to move from the way that quality has been measured historically. And for those who may see this podcast and know a lot about NCQA and HEDIS. They're familiar with the literally printed paper documents that we used to release every year that describe the HEDIS specifications, we're moving away from that that's not a reliable or efficient way to measure quality anymore, there's better ways to do that. And so we're moving towards digital measurement. And so as we do that, that's actually going to change a lot of the ways that quality works in the country. Instead of people spending hours and hours, literally, keying - entering data, we will be eventually able to pull that directly from source systems and from secondary systems, which is ultimately what we want to be able to do and, and get much more timely, much more robust reporting, and just more accurate in general. So yeah, that is definitely a big, big piece of what what we're trying to do as an organization in that move actually force us to think about product a little bit differently. Our products have gotten, they've been in the market for a long time. And as I mentioned, a second ago, healthcare has just changed so much COVID made the country and the world really adjust and adapt and innovate in ways that our programs haven't necessarily caught up with. So in addition to moving towards digital, which we will be moving that way anyway, I think with or without COVID, we've had to start to think about how care is delivered. And so things like virtual care and in home care and digital health, all of those things were not huge focuses for our programs in the past. But that's how everybody is is interacting with health health care today. At the same time, the organizations that are providing the health care are not the same as they were today. Your provider might actually be a CVS employee, and or they might work for Optum. And so we need to be thinking about what those constituents need and how our programs are serving those clinicians who are part of a health plan or health plans that own clinicians and all the different permutations. So we've had to adjust the way that we think about product to bring new things to market to adjust the things that are already there working to our current environment that we're in, and then to really just move the healthcare industry along.
Chris Hoyd 10:06
Wow, that's just, that's huge. That's really cool to hear about. And I guess good to hear that someone's doing.
Peter Fournier 10:12
Yes. Yeah.
Chris Hoyd 10:13
As a leader of products on the on the clinical side, you know, you've got a team maybe of designers, researchers, maybe PMS, what are your approaches to to prioritization? How do you kind of manage to wrangle the voice of the customer, especially in your case, where it sounds like you've got kind of, you know, many different kinds of customers, and they may not know their customers or their users? It's just it's very complicated. And you've got kind of non traditional incentives in there, I think. So it's curious how you find the truth and all that.
Peter Fournier 10:46
Yeah. I mean, it Is it constant effort, I would say, probably about 40% of my time right now is spent talking to external organizations, whether they be customers, whether they be alliances that represent a certain facet of the industry, whether they be Medicaid agencies or others, to really try to understand what are the unmet needs that they have? What are the problems that they want solved - and how can NCQA help them and try to synthesize that down to something that we can actually provide support for. NCQA while we're doing a lot, we can't do everything. And there's definitely times that we will take a step back and say, that's a problem that needs to be solved, but it's definitely outside of our lane, we need to think about where we can actually influence and where we can have a positive effect. So let's come back and let's think about what it is that that we were where we can help and what are the things that we can help to solve. So it's spending a lot of that time - and NCQA is a fairly small organization, so it's really having dedicated people who care a lot about solving these problems, who know a lot about these problems, who have a context around the country, I can help getting get us in front of the people who know about about the problems and trying to really listen to as many people as possible, you know, as I was mentioning, you know, we may go and we may speak with someone who's leading an effort in rural Appalachia, and we really want to hear about what they're doing. And then the next call might be the chair of some influential industry council that we want to hear about. And those two people are both different facets of the same problem. And so we want to make sure that we're representing all of them. That's one of the things that's unique about NCQA, our name is actually a National Committee for Quality Assurance. So everything that we do is committee driven. So we can't just look at it and say, Well, we're going to solve this problem for this subset, or we're going to solve this problem because these people are speaking the loudest, we really need to take a broad look at what's going on. And then bring it back to panels of experts and bring it back to internal advisors and say, this is what we're hearing, this is how I think this problem needs to be solved, this is the way that I propose to do it and get constant constant feedback and constant iteration on what it is that we're trying to do.
Chris Hoyd 12:57
I want to give you a platform here to brag about your team for a minute, what's something that you know, that they've accomplished, or maybe shift in the last few months that you're proud of?
Peter Fournier 13:08
So I'm very excited, my team has been working for the last about a year to define and create a new quality program related specifically to virtual primary care. So my team has multiple parts right now - we have one section that's working on virtual primary care I have another that's working more broadly in digital health and digital health integrated in chronic disease management, I have a team that's also working on behavioral health. So I've got lots of different teams working on similar and very related problems. Right now our group that's working on virtual primary care just launched a pilot, we've sent out solicitations or participate in a pilot just last week. We're waiting to hear back we have a couple of weeks window for folks to reply or to respond. We've gotten lots of feedback already, we're meeting with people who want to know more, and they want to understand what, what's what it entails. So we're super, super excited about that. We're reviewing our virtual primary, and it's actually virtual primary and virtual Urgent Care Program as the first step in what will ultimately become a much more robust and comprehensive primary care strategy that we will ultimately bring to market in the next couple of years. But this was a unmet need. Clearly, everyone's got lots of experience in that probably you do. I certainly do. There really weren't any quality programs that were specifically looking at that problem. And so we're very excited to get out there and to bring organizations in to help us really refine that idea.
Chris Hoyd 14:35
That's incredible. Okay, so what kinds of sort of new quality measures, you know, filter into a virtual approach?
Peter Fournier 14:43
Yeah, so when you think about virtual primary care, two things come to mind. One is we don't want virtual primary care to be thought of as less than a 'lite' version of or somehow not as good as in person care. It's really a compliment to and in some cases, cases is better than in person care, you can reach people a little bit more easily through a virtual visit, you can put hands on them, so not everything can be done. But there's great things about it. But that also introduces challenges. For instance, we're having a video conversation right now. If your provider is recommending a virtual visit for you, but you can't have you don't have access consistently to electricity to WiFi, etc, then a whole host of health equity issues start to come into play. And so that raises new concerns about who is this intended for? And how do they benefit from it? So those are problems that we're looking and how do we solve that. There's also problems about data security. So lots of companies are doing lots of really great things about around virtual care, we want to make sure that your patient records are being protected and shared in a way that's secure and protected the same as if you were in your provider's office. So so we're looking at ways that we can consider patient safety and patient data security. Interoperability is a huge component of this, that we're spending a lot of time about the interoperability and the record sharing between multiple organizations, if you're seeing a virtual provider, as your primary provider, and your based, like I am in Raleigh, North Carolina, but that provider happens to be sitting in Seattle, Washington, how do they know that WakeMed Cary is right down the road from me? And that's where I should be transferred in an emergency? And how do they get that record to them? They don't necessarily know that. So those are things that we're looking at and saying, Well, they should know that and they should have protocols for that. And they should, this is how it should work. There's also lots of things that can happen when you're in a virtual visit that don't happen in person, if you were to go into your doctor's office, they would look at you physically, they might be able to put hands on you and say, okay, this is wrong, this is a problem or this doesn't look right, or whatever. As we are today, we can see each other's backgrounds, they can suddenly see into your home, and they can start to see drivers of health concerns that might be going on in the background, they might see things that don't look safe and don't look secure. They can say, hey, take me over to your to your refrigerator and show me what's going on in your refrigerator. So all those things need a protocol. They're great, and they're giving us more information to better to better care for people. But how did they take that data? And what did they do with it?
Chris Hoyd 14:46
Well, it was a brave new world.
Peter Fournier 17:02
It's amazing, isn't it? Yeah, I think credible? It really is.
Chris Hoyd 17:17
I just curious now sort of on the on the clinical side, another big, you know, sort of trend right now is the for lack of a better buzzword, the 'hospital hospital at home' How are you guys looking at that?
Peter Fournier 17:30
So interesting that you bring that up, I actually met with an organization today about that. When we started down this path that we ended up launching a pilot around virtual care, we started by looking at hospital at home. So we we started with the public health emergency and some of the legislation that was associated with that, and the push to get patients out of the hospital to free up beds per COVID patients. Over time, the industry has recognized there are lots of things that can and should be done at home. And lots of reasons why we should no longer make frail elderly patients come into an office, right? It's not good for them, it's not good for the provider, they can be better treated at home. So we started to look at that ultimately said this, we need to spend more time on this. So that will probably be a fast follow to the program that we just launched. And in fact, when we do launch that we will not only be looking at the home based care, so providers that go into the home for chronically ill and severely ill patients, we're also going to start to look at things like mobile clinics and other ways that other locations, where care is delivered nowadays that are not necessarily in your provider's office. So lots of digital health tools are used to support those patients, lots of care is brought to you perhaps through a mobile clinic through a van through a barbers office, barber, etc. Like all those things we're looking at and saying there's other ways that care can be delivered just as well, and that standard should be just as high for those people. But what are the nuances of that? So those are things that we're spending time on as well. We expect to launch something in the future around that too.
Chris Hoyd 19:08
Very cool. Okay, so maybe wave your sort of magic wand - we're out, let's say five years in the future. What do you think your organization, you know, the product department within NCQA - What does it look like? What's it focused on? How does it sort of flow into the broader healthcare ecosystem?
Peter Fournier 19:26
Yeah, so hopefully, by that point, we will have translated all of our existing measurement all of our HEDIS measures into clinical measures and into digital measures. And what we want to be able to do at that point is to be able to pull the data directly from the sources and then provide it back so that we can show areas of improvement to our customers, whether they be ACOs and clinically integrated networks, whether they be health plans for managing their value based contracts, whether they be providers who are participating in value based contracts, we want to be able to provide that data so that we can raise the bar and we can help everybody improve. We also want to start to provide the tools to allow other organizations who might not yet be value based contract ready, the tools that they need to actually get there. Because we believe that ultimately, if you're measuring quality, and you're measuring outcomes, you should be able to participate in a value based contract. And if the you have stake in the game, you are going to perform lots of studies show that you are going to perform better over time than those who are strictly in a fee for service arrangement. So that's where we see the industry going, there'll be lots of use of tools, lots of use of technology that's starting to evolve, that will be just inherent in everything that we access going forward.
Chris Hoyd 20:39
That's a beautiful vision. Given that this is a, you know, kind of a, these, these conversations are for practitioners who are sort of, you know, product focused within healthcare - we occasionally go, you know, a little bit deep into some of the technical details of how we get this work done, which can be can be tricky, in some ways, trickier than I think, you know, some other kinds of product work. So I'm just curious, maybe if you can help some of our PM, you know, viewers, help them feel seen, what are some difficulties or some some kind of, you know, industry oriented friction that you that you run into in your day job? Is it HIPAA concerns of doing user research? Is it getting, you know, what I must imagine, given the the scale and responsibility of what you guys are up to, you know, a whole host of, you know, legal and regulatory approvals before anything gets shipped? Yeah, what are some of the things that that maybe slow you down a little bit, but ensure that you're, you're building stuff in a compliant way?
Peter Fournier 21:43
I think those are, those are definitely some of them. And I'll come back to them. I think it's that we serve such a broad constituency, that there are times when there are so many good, important problems. To solve that we really have to prioritize what - we're a small organization, we're a nonprofit, we do like everybody else need to prioritize where our resources go, are smaller than most. And so we need to prioritize what where is the biggest opportunity for us to participate right now and to solve a problem. But then we do run into problems about real help people's actual health is impacted by the way that we ask and design these programs in the way that we ask our customers to participate in them. If we are making providers report more information to us, that could ultimately mean A) you know that maybe they're not spending as much time with the patient. And that's not what we want. So what are the ways that we get involved with that, and that we can make decisions about the way that health should be provided health care should be provided that don't detract from what providers are trying to do and that ultimately help to improve health care. So those are very real concerns. We we as an organization typically do not have a need for PHI like most most healthcare organizations do, but we typically do not, that's we don't want that. So we do sometimes get it. So like everybody else, we have to have protocols in place. And we need to be secure in the way that we deal with things. So there's that - there's lots of legal and regulatory hurdles that we go through, because we work with CMS, and we work with health plans, and we work with Medicaid. So there's lots of different things that we're always having to spend a lot of time really, really understanding what how our work impacts those existing regulations and legislation.
Chris Hoyd 23:35
I think we're coming up on time here, Peter, I've really enjoyed this conversation, super enlightening to hear more about what the NCQA is up to. And honestly, like, exciting to hear that you're you guys are really, I think on the floor of what the industry is doing. And it's changed a lot. And you know, it seems to be in a real kind of inflection point right now. So to hear that you guys are, are all over that is cool. As we close, Peter, maybe, can you you know, if anyone wants to reach out to contact you or have any questions for you? What are the best ways for them to do that?
Peter Fournier 24:07
Yeah, definitely LinkedIn, I get lots of people reaching out to me on LinkedIn, love to chat with people in the industry who have interesting things that they're doing and to share experiences. Certainly, you can email me as well. And I think we're going to share that contact information. Either way, I'm happy to talk with people in the industry and to get their thoughts and we are doing a lot of interesting things. But lots of people are doing lots of other interesting things. And that is as a product person, what's awesome about being a product person, but what's hard is that there's always someone who's doing something really, really interesting. And you're like man, like that is so awesome. How do we do that too?
Chris Hoyd 24:42
Thank you so much for joining us. You can also connect with us on LinkedIn, YouTube, or on our website at productinhealthtech.com. If you have ideas or suggestions on what you'd like to hear in a future episode, or if you'd like to be a guest, please shoot us an email at info@productinhealthtech.com