Quality in Action: Health Plan Leaders Call for a Simpler, More Outcomes-Focused Future

Healthcare organizations have never had more data, more measures or more accountability requirements. Yet many healthcare leaders are asking the same question: Are all these measurements helping us improve health outcomes, or are they creating complexity that distracts from the ultimate goal of better care?

That question was at the heart of a panel discussion at the Health Innovation Summit, “Quality in Action: Health Plan Focus on Quality.” Moderated by Dana Erickson, President and CEO of Blue Cross and Blue Shield of Minnesota, the panel included Andrew Bindman, Executive Vice President and Chief Medical Officer of Kaiser Permanente; Gabriel Waterman, Chief Clinical Officer of SCAN Health Plan (known simply as SCAN); and Kelvin Holloway, Deputy Executive Director and Senior Medical Director for the Medical Assistance Plans Division at the Georgia Department of Community Health.

Together, they offered a candid look at how health plans, clinicians and public programs can improve care while reducing administrative burden.

Key Takeaways From This Session

Quality Must Start With the Member

A central theme emerged early in the conversation: quality cannot be defined solely by measurement.

For Waterman, quality begins with understanding what matters most to members. “Quality has to be defined in terms of our members and not measures,” he said.

Waterman explained that quality metrics such as HEDIS^®, CAHPS^® and CMS Star Ratings are important, but should be viewed as validation tools rather than the ultimate objective. The real goal is ensuring members receive reliable, compassionate and easy-to-navigate care when they need it most. He noted that health plans must think beyond scorecards and focus on the experiences that shape trust, satisfaction and health outcomes.

Similarly, Bindman emphasized that quality, affordability and outcomes should not be competing priorities. In value-based care models, he argued, investing upstream through prevention and coordinated care creates a virtuous cycle that improves outcomes while lowering costs. “You get great outcomes and you get great affordability when you’re able to move upstream,” he said.

The discussion reinforced a growing sentiment across healthcare: quality measurement matters, but it should support better care rather than become an end in itself.

Using Data to Move From Measurement to Action

Panelists agreed that data remain the foundation of modern quality programs, but how organizations use data is rapidly evolving.

At SCAN, Waterman described a cross-functional “quality SWAT team” that combines information from quality programs, pharmacy data, member experience scores, call center interactions and other operational sources into a single view. This integrated approach helps the organization identify risks earlier and coordinate interventions more effectively.

The ability to leverage previously untapped sources of information is proving especially valuable. Waterman highlighted how organizations are increasingly using predictive analytics and artificial intelligence to identify members at risk of poor clinical outcomes or poor experiences before problems become more severe. He pointed to AI-enabled appointment scheduling and member outreach as examples of technology being deployed to solve real-world access challenges.

For Bindman, data’s greatest value lies not in tracking process measures, but in understanding outcomes. “It isn’t about chasing down the quality metric for the sake of passing the test,” he said. “It’s actually doing the things that are meaningful for our members.”

Looking ahead, he sees data helping organizations move beyond evidence-based care to generate new evidence from real-world practice and continuously improve care delivery.

The Growing Need for Alignment

One of the strongest points of consensus at this keynote session centered on the burden of fragmented measurement systems.

Across Medicaid, Medicare and commercial markets, plans and providers frequently navigate multiple sets of measures, methodologies and reporting requirements. Panelists argued that this complexity consumes resources that could otherwise be devoted to improving patient care.

Bindman described the challenge as a “scavenger hunt” across different metrics and payers, noting that clinicians generally do not change how they care for patients based on insurance coverage.

Holloway echoed that sentiment from the perspective of a state purchaser, emphasizing that clinicians face increasing stress as they attempt to satisfy numerous measurement programs simultaneously.

“It shouldn’t be about the measures, it shouldn’t be about the metrics, it should be about the outcomes,” Holloway said.

The panel also discussed how excessive focus on process measures can unintentionally discourage innovation, particularly when payment incentives are heavily tied to achieving specific scores. Several speakers suggested that future quality programs should place greater emphasis on improvement, outcomes and learning rather than rigid compliance targets.

A Vision for the Next Five Years

When asked what single change could have the greatest impact on quality while reducing complexity, panelists delivered a remarkably consistent answer: standardization.

Holloway called for consensus around the measures and outcomes that matter most.

Bindman urged the industry to become more disciplined in focusing on what is truly important and expressed optimism about AI’s potential to illuminate previously inaccessible aspects of quality.

Waterman offered perhaps the clearest vision: “One standardized set of measures across Medicaid, Medicare and commercial, that would go a long way.”

Combined with stronger interoperability and shared data standards, the panel suggested that a more unified quality ecosystem could reduce administrative burden, accelerate innovation and allow organizations to focus on what matters most: improving health outcomes for the people they serve.

Learn More

We will post more insights from the Health Innovation Summit on our blog, so stay tuned.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CAHPS^® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).