Hello, everybody. Welcome. We're giving it one moment for folks to join, and we'll get started. Alright. Welcome everyone to Digital Health that Delivers Driving Engagement and Value. I'm Rachel Harrington, Senior Product Strategist at the National Committee for Quality Assurance or NCQA, and I am very happy to host today's discussion. If you're interested in how digitally enabled health solutions, things like applications and technology that are supporting people in their day to day with wellness, chronic condition management. If you're interested in how those sorts of solutions can be implemented into an outcomes driven model of healthcare, then this is the conversation for you. Today's discussion will explore where evidence is emerging, how we think about outcomes, and really how we integrate these technologies into a value driven healthcare system. Next, please. Before we go further, I just wanna do a little bit of housekeeping. If we go to the next slide, you'll see we will have time for Q and A closer to the end of the hour. Throughout the discussion, you can use the Zoom Q and A feature to submit a question. It's a little Q and A icon. Usually you see it at the bottom of your screen. Also, the webinar is being recorded and will be available afterwards, so you will have access to this after. With that, next, please. I am very excited to spend the next hour with all of you and with Meg Barron, Managing Director of Engagement and Outreach at the Peterson Health Technology Institute. At PHTI, Meg focuses on providing rigorous evidence based evaluations of healthcare technologies to improve outcomes and lower costs. And this includes convening and leading a purchaser advisory council that has leading health plans, employers, and health systems, as well as the digital health collaborative, a group of nonprofit health care and consumer organizations who are really focused on raising the bar for digital health solutions. Before joining PHTI, Meg was the vice president of Digital Health Innovations and Strategy at the American Medical Association. And she has published in journals like Health Affairs and the Harvard Business Review and has participated on numerous advisory and editorial boards, really shaping the discussion on digital health and healthcare. So I really can't think of a better person to have today's discussion with. Meg, welcome, and thank you so much for joining us today. Well, thank you so much for having me, Rachel, in NCQA. I'm excited for today's discussion. Yeah. Alright. So before we get started, first, we're gonna take the slides down because this is really designed to be a conversation between the two of us and with the the audience today. But to that point, I'd like to bring up a quick poll just to get a sense of the audience's experience with digital health solutions and outcomes based contracting. So if we can launch that poll real fast, should be a quick one. There we go. So has your organization participated in an outcomes based contract that covers these digitally enabled solutions or technologies? There are a couple of different options here. There is no right or wrong answer, but we're really just trying to gauge sort of what the experience basis as we go into the discussion today. So give another couple seconds for for folks to respond. Alright. We can go ahead and end the poll. And broadly, I'll say about sixty percent of the audience hasn't had experience with this yet. So we can spend a little time kind of setting the stage here. But about forty percent of the audience has and it's really kind of spread out between about, you know, fifteen percent, eighteen percent who are solution vendors or payers or purchasers, and then around ten percent who are in a consulting role or an advisory role in this space. So that gives us a sense of who we have with us today. So Meg, as I think about it, both of our organizations have really focused on the role of digital solutions in the healthcare ecosystem. And at NCQA, we saw how these digitally enabled solutions were being used to bridge into people's day to day life, patients, consumers, really extending the reach of traditional care. For us, when when we went into this, we were really looking at it from a lens of healthcare quality and trust. Were solutions contributing to high quality outcomes focused high trust ecosystems? But what drew Peterson Health Technology Institute to the topic of digital solutions? Why are the two of us having this conversation today? Yeah. Well, again, just first, a huge thank you for the invitation. And, Rachel, and to NCQA, thank you for the collaboration and PHTI's digital health collaborative. We're really appreciative of that. And I'll first just take a maybe a little step back. And for those not as familiar with PHTI, which, again, is the Peterson Health Technology Institute, we are an independent assessor of digital health solutions, and we are a self funded nonprofit. We're based in New York City, and our focus is to conduct evidence based digital health evaluations. And we do this by category area. So think for diabetes, for hypertension, for mental health, for MSK. And our goal is really to determine which of these solutions and solution categories can really help the industry improve health outcomes and lower costs, which I know is near and dear to the heart of NCQA. And then how do we scale the adoption of those that do meet or exceed the mark among nationwide purchasers? Meaning, for purchasers, this is health plans, this is employers, this is health systems that, you know, are historically and currently purchasing these on behalf of patients. And the why we're doing this and why digital health solutions is really because, I mean, health technology, as we all know, has massive potential to reduce costs and improve patient health, but only if decision makers have the evidence that they need to understand what works both clinically and financially. And despite billions of dollars that have been invested into digital health really over the past past decade. You know, historically, it's been really difficult to be able to assess the clinical efficacy and the economic impact of the whole kind of swath of different health technologies that are out there. And that's made it really difficult for health care purchasers and really as well as investors and providers and policymakers to really have the data and evidence that they need to make as informed decisions as possible. And, you know, ultimately, this can end up leading to wasteful spending, missed opportunities. And, again, there's really opportunity cost to every net new thing that you're bringing in. The one last thing I'll say is, you know, I have the opportunity as part of my role at the purchase the Peterson Health Technology Institute to lead something called a purchaser advisory council. And this is a group of direct decision makers across leading health plans, employers, and health systems who really have echoed this need. And, you know, I spent, as you alluded to, more than a decade at the American Medical Association primarily in digital health and ultimately was just fielding inquiries from end users, be it from health systems or practices or individual providers, to some degree plans and employers. Ultimately, they just wanna know, can you just tell me what works already or what's worth it? Right? And I say that because that's ultimately where we focus each of our assessments is to answer three key questions. And those three questions are, what clinically works as it relates to, again, all of the digital health solutions and categories out there? For whom do they work best? So meaning by category area, which solution category works best for what patient types? And then are they worth it, or is that solution category worth it? Meaning, in comparison to usual care and what's currently the status quo, is it worth it to adapt that one more thing into your existing workflow or into your existing offering set based on both the clinical outcomes and the economic outcomes? Yeah. So I I remember looking at when the the first assessments were coming out in the assessment framework and really seeing that balance between evidence, cost, population, and and ultimately, that's the equation that gets you to value. Right? And it it was really exciting to me as for those who know me, I'm I'm a research nerd at heart. And seeing some of that rigor and and some of those those methods applied to this area that, like you said, has has so much dynamic growth and and also noise that's happening in And using that evidence as a way to cut through it and really inform decision making has been so interesting and exciting to see come out as each of the condition reports came out following along has fascinating. So when we think about where these solutions fit, there's almost a definition problem. Right? There's such a wide range of is it a self management app? Is it a wearable with its app? Is it condition specific or not? Where do you see digital health solutions fitting into our health care ecosystem, and who are the key players in in this dynamic? Yeah. It's a great question. And, you know, it is really interesting. And I was reflecting on this a bit, you know, from being in digital health for more than fifteen plus years at this point. You know, it's been quite the journey from the days when most of the discussions were really rooted in electronic health records and frustrations a lot of time from physicians, like, related to that or interoperability discussions and, to some degree, remote patient monitoring and telehealth solutions being discussed to really where we're we are now in more of a post pandemic environment where, you know, people rightfully have much higher expectations that virtual options both exist and that they're wanting to utilize those, but also just expectations in general for convenience and for, really, efficiency across the board. And to me, you know, digital health really went from being more of a fringe supplement, one could say, right, or a nice to have to really more table stakes that people expect this, but they also expect that it needs to work and, again, that it's going to equate to outcomes. And, you know, I mentioned earlier that there is opportunity cost to everything. And, ultimately, people, again, want to ensure that any investment that they're making is ultimately going to improve outcomes for their end users, be it their members, be it their patients. One other thing I'll note, you know, for example, this will be the third year that PHTI has done a state of digital health purchasing survey where we survey nationwide purchasers from health plans, health systems, and employers. And, you know, we found that while investment continues to rise, especially among health plans and health systems, you know, about seventy three percent of those contracts last about two years or less right now, and more than half of purchasers really review these offerings on an annual basis. And if anything, I feel like that gets accordioned in more and more each year. But what this means is that solutions have to work, again, back to that, and that purchasers are demanding proof of both clinical effectiveness and of ROI. And, you know, this all relates to the stakeholder question that you asked in that, you know, this is a new expectation both for vendors to understand, but also for the VCs that are, you know, again, investing in them and wanting to make sure that that solution is really meeting the mark in market. Yeah. So I heard you you kind of list a a couple of different. There's the purchaser side, right, which we can explore there the different dynamics between different types of purchasers. If you're looking at a health plan and the different markets there, if you're looking at an employer who's looking at a benefits package. There's the the the vendors, the solutions themselves who are doing this. Then there's also the clinicians, the care teams that are are sort of in this intersection as well. And fundations members, consumers at at the back end of this or hopefully at the front of this. Right? Who should be benefiting from this. If they are putting it on their phone, if they are trying to do these activities, is it is it getting you what you you hope it will? Right. Where do you see tensions between these different perspectives? Particularly, you've done all of these these engagements, and you have your counsel. Where where have you seen the tensions between this? Yeah. It's really interesting because, again, even amidst our purchaser advisory council, as you alluded to, we've got health plans who are purchasers. We have employers who are purchasers. We have health systems that are purchasers and all part, you know, of, the bigger picture. And, again, all making determinations on behalf of patients all across the country of what will work best based on x y z problem I'm looking to solve. But even amongst, you know, the purchaser advisory council that we lead, you know, you have at times, instances where, of course, employers are the customer of their health plan or their carrier. They're also, in essence, a customer of which health systems that they're engaging with as part of their broader network. So a lot of times, like, those decisions can help to inform, well, which digital solutions do the health plans want to utilize based on interest or, again, demand from employers on behalf of their members or employees. And to some degree, the same could be said for health systems who wanna stay as competitive as possible and wanna make sure that they're staying as state of the art as they possibly can be on what technologies that they can use. But, you know, these are just drivers for usage. And, ultimately, all three groups where there is definitely alignment, and we've seen this resonate or really come become true in our state of digital health purchasing survey that I mentioned. But at the end of the day, no one wants to adopt something that doesn't have clinical outcomes to be able to back it up. And, of course, in a perfect world, you're looking for something that can have both that, meaning clinical outcomes as good as the usual care kind of status quo that they've been utilizing. But better yet, they're looking for efficiencies. Right? Like, can this help me get to x, y, z problem I'm looking to solve faster, better, and even ideally at better cost so that access can be expanded and that needs can be met, especially in areas like rural environments or for more marginalized, you know, communities that have been harder to reach at times, in general, but even with digital. Yeah. It's interesting to think around how all of this works together, right, from a patient human perspective. Life's complicated. You have limited time. Getting into the doctor can be hard. Having something available at your time in your setting where you're at without having to deal with transportation or childcare, like that is a huge plus. Yes. But at the same time, you know, making sure that you know, if if your your employer, if your health plan says, hey, use this app for your, you know, arthritis or your musculoskeletal, you know, condition, that you're actually if you're doing the exercises, you're getting something out of it. You're not just clicking and, you know, what what So as we look at how these these solutions are being integrated into the ecosystem, where is the biggest change needed to make this work? Is it in data? Is it in the technology itself? Is it in relationships? What where do we need to be be making change? Yeah. I think, you know, this is a huge reason why we assess by category area because it really varies based on what the problem to be solved is or what the use case is. Right? I'd say some common themes, though, across the board, everyone wrestles with what's the secret sauce for engagement. Meaning, eve even if you have an amazing solution that clinically works and, you know, potentially can lower cost, if the user experience of that or if you're really struggling to be able to even get awareness that this solution exists to your members, to your patients, let alone, again, the downstream of getting someone to utilize something and to sustain utilization in order to meet that outcome, that's an ongoing theme that I think everyone, right, like, meaning all the stakeholders we just discussed wrestle with and something that the industry at large, I think, will need to continue to improve upon. And sometimes that means quality over quantity in that there is a lot of point solution fatigue, and there's just fatigue in general with kind of marketing messages that get pushed to you every single day. So I think having a very zoomed out view of your patient, of your member, of who you're, again, purchasing a solution or really care for big picture is absolutely essential to make sure that you've got the right mix of solutions. And then, of course, we want to ensure that people are utilizing our assessments and our reports to really distill that what works and for whom does it work best, and is it worth it by both use case area and based on the problems that they're looking to solve. Yeah. So we've talked a lot about outcomes. It's it's sort of come up in in every part of this discussion so far. First off, straightforward question, maybe. Is it reasonable to expect these solutions to have an impact on outcomes? Well, I would say absolutely. It's entirely entirely reasonable. And, you know, again, for all the reasons I mentioned that purchasers are looking for solutions that can prove this, like, you know, hard stuff. Evidence is there. You've seen this in your evaluations. Right. And this, again, is really just table stakes at this point. And think about it. In any other industry, you purchase something for a desired outcome. You know, that could be you're working with a contractor to fix or update something, or it's a reason that you buy anything tangible, right, be it from a local store or from Amazon, and your expect expectation is that this is going to work for the reason that I'm purchasing it for. And if it doesn't, you will return it. Right? Or you will not purchase this again. And I think, you know, same can be true or is true for for digital health solutions. And, also, I think it's worth noting that the outcomes that purchasers are looking for can very much vary, again, by use case, but also based on who their patients or their patient population or member population is. And there is often a spectrum of why someone is purchasing a solution, and, you know, that can range from improving member experience, like, potentially from a plan or a I mean, really, employer or health system perspective to, of course, improving clinical outcomes. And then, you know, on the far end of the spectrum, you've got controlling total cost of care. And, usually, they're looking for something that can address all of the above in the same way, right, anything that you're purchasing Yeah. You're wanting it to do it all as much as possible. Right? And the solutions or really anything tangible that best meets the mark understands that persona or who their customer is as best as possible, and that's usually who ends up winning at the end of the day. You know? And historically, I think there's also a huge hurdle in that there's been a lack of trust in vendor reported outcomes and and also a lack of standardized metrics, like, at times, especially for digital. And, also, you know, I touched on this, but in the past, engagement, you might be able to get by simply defining this as someone opening an app. And this bar has definitely been raised for this. And I mentioned, you know, in a post pandemic environment where we're at rightfully so, people need more, people expect more, and purchasers are looking for validated clinical measures, be that a solution that can help them improve, you know, a one c reduction or help improve blood pressure control, really rather than just relying on more self reported vendor data or things that can feel a little more black box. Yeah. And the point Oh, go ahead. I was gonna say the point you make on trust, I I think, really hits home in in the conversations that we've been having too with clinicians, with systems, with payers, with Yeah. The solutions themselves. Right? Like, two things always came to the top. One was a lack of trust. And that was always the first. And it was not trusting the data, not trusting the outcomes, not trusting your your to your point that when you buy it, you're getting what you're buying really. And and then the other that I I think was really kind of central to how we were looking at things with the was this lack of shared language or quality infrastructure. Right? And and you mentioned measurement. It was very similar. Like the the purchasers have long standing expectations of here are the ways that we measure success. They've been in value based contracts, they've been in payment models, they've been Medicare stars, all of that. Yeah. And some of the vendors and solutions didn't necessarily. And so that disconnect really, they fed into each other, right? We weren't speaking the same language, so we weren't seeing the outcomes we thought we'd see, so we don't trust. And then it sort of back around. So how can we build trust in the outcomes? Like in your work, you've done some of this to develop value based purchasing playbooks that have some of these very specific details. Right. Is that part of it? Is it, you know, contracting terms? Like, how do we how do we start establishing this? I I think, you know, it's all of the above. But I also think trust gets built by being able to prove out things work and seeing kind of proof in the pudding, like, related to that. Right? And Yeah. The good news is is that from the six, you know, digital health assessments we've conducted so far, we know this is possible to accomplish. So, you know, for example, our report on, you know, virtual MSK solutions or virtual physical therapy solutions, which was our second report that we produced, you know, found that these solutions do improve outcomes in both pain and function for patients. And because these virtual options are often substituting in person visits versus solely augmenting visits, they can also lower cost to purchasers and to patients. And, you know, this is a prime use case too where a patient doesn't want to have to necessarily hobble in to in person PT if there's a more convenient or at home option, especially if it clinically works as good as in person PT and that it could be more affordable, right, either directly to them or via via their purchaser. So I think, you know, these are the type of things that are really important to be able to surface so that confidence builds across the board. And it's always, you know, I'd say, exciting for us to hear that, especially in positive reports, where we hear that that resonates with purchasers and that they've seen similar things. This is validating for them to additionally, you know, scale this to, again, their members and their patients. One other, you know, good news story that I'll mention is the latest assessment that we completed on virtual GI solution. So, think for IBS and for IBD. And as many know, especially amongst the purchasing community, I mean, GI care is a significant cost driver for employers, for health plans, really the system at large, and it can be just so disruptive for patients and for members. So, again, it was really great news to see that the virtual options that we assessed that are available and, again, getting pretty readily utilized do improve clinical outcomes for patients with IBS and IBD. But, you know, even more so than other reports we've conducted, they can also generate substantial cost savings, like, per user per year. So We found, like, upwards of three thousand dollars per member per year for the clinician led solutions that we assess that focused on moderate to severe, IBD as well as IBS. I mean, those really help to bring savings, right, to those purchasers due to avoided hospitalizations, ED visits, and, you know, the avoidance of extra test scopes, etcetera. And, you know, I bring these up because for either of these instances, purchasers, again, are looking to ensure that, obviously, they need these outcomes, but then these outcomes need to translate to their contracts, what you were saying, Rachel, and, again, make sure that the performance guarantees and outcomes that are getting integrated in are contractually in the terms as well. And that builds trust. That builds confidence Yeah. For both purchasers. But, also, that's what the vendors want too. And, ultimately, of course, that's what the patients want. Yeah. It seems like there's an opportunity here. You know, you've you've identified in these condition specific areas which outcomes really the evidence base supports change in. Maybe it's cost, maybe it's a clinical outcome, maybe it's an experience outcome, you know. And that almost gives a sense of write your contracts to include the things you know the tool should be able to do. Like don't write it for five hundred million dollars however much in cost savings. Right. The evidence actually points to, well it might be cost neutral, but you're getting an Yes. I'm wondering, could you talk maybe if we could explore like one of the you've mentioned a couple of conditions so far. Is there one that that we could dive into a little bit more in detail of like, what was the approach you took in doing the validation? What went into the development of the report? And, really, what did that translate into in terms of specific contracting implications or recommendations? Yeah. Sure. So, again, maybe I'll take a step back and say, excuse me. Related to our approach, I'll reiterate that PHTI, we are fully self funded. So we were founded in twenty twenty three by the Peterson Center on Healthcare to help purchasers, as I've alluded to, make as informed decisions as possible about digital health solutions. So as part of our approach, you know, we have no financial ties to the companies or technologies we assess nor to really the health care purchasers in that vein. But in short, we have no stake in the outcomes. And our assessment framework and methodologies, really, as well as our evaluations, we make publicly available because we wanna ensure that there's rigor and transparency to what we're putting out. Now to unpack that a bit, for each assessment, we bring together clinical experts, purchasers via, you know, our purchaser advisory council, as and all, as well as, you know, we connect with academic institutions, health economists, but we also do primary research with patients and patients with lived experiences in any area that we're assessing to really help inform the results and to help us prioritize which topics that we should be focusing on based on both the cost drivers that purchasers are experiencing as well as areas that have historically been difficult to be able to really get your arms around. And all of this is really to get at those questions. You know, I I keep mentioning and harp on and, you know, others on the team. You know, they've really become part of our tagline of does it work, who does it work best for, and is it worth it at the end of the day. And that clinical effectiveness piece of is you know, does it work means is it safe? Can you, based on a systematic literature review, which we conduct of all the available outcomes data and published literature on any given topic, can you feel confident back to the trust equation that this solution category will get me the outcomes that I that I need, be it for diabetes, be it for hypertension, be it for MSK? And then second, related to economic impact, we do budget impact modeling from a one to three year time duration. And we do that because we recognize that's really the time horizon that purchasers are needing to determine, did this work for me or not? Did this raise cost, or did this actually help lower cost? Or it could be neutral. And, you know, again, there's different weighting that you're placing on anything based on what your goals or needs are. But this is the approach that we've taken for all six of our assessments today over the last three years. And I'd say, you know, it is exciting because we're starting to see some key themes and really lessons almost emerge, which I'm happy to dive into a bit more. Yeah. It's interesting to hear you build that out and and also the the thoughtfulness that in terms of of stepping through it. And what you're saying about, you know, who does it work for, does it work, and what are the economic implications. The first two in particular remind me a lot of, you know, when we've been thinking of it from a quality process, right? Yeah. We sort of mapped out What was it? It was identify the population, engage the population, change the behavior, evaluate the outcomes. And so the who, who should you be focusing on? Right? Are you identifying the right population? And then there's sort of the behavior change component, that engagement component. Because you're not gonna change outcomes if you can't effectively get somebody Correct. To adapt behavior. And then are you measuring the right outcomes? Are you are you looking at the the right element there? That's right. We spend a lot of focus on that question of engagement because it's such an important middle ground in getting from you have the the people and you have the outcome, but how do you how do you get there? That's right. I'm wondering, you know, when you started kind of building this into your your assessments and you identify the right population, look at the outcomes. You mentioned earlier engagement is like this one nut that everybody's trying to crack. What did you find, or what has been a consistent theme across the different conditions that you've looked at? Yeah. Well, maybe I'll touch on, you know, some almost more meta themes that we've seen, and I'll come back to engagement because, admittedly, I I see that as an area that we'll end up diving even deeper on. And I know we'll speak to more of the work related to performance based contracts, but very much so, I mean, that's an element that, again, it takes a lot of work up front to be able to clearly define what does meaningful engagement mean and who is that audience that should both get access to this solution or, again, kind of meet some mark for that? And then how do you want that to translate to outcomes? Right? And how will you measure that at the end of the day? But, again, to take a quick step back just from, you know, now evaluating over fifty plus leading digital health solutions that have had really more than fifty billion dollars invested in them over, you know, the last decade or so And, again, from the six assessments we put out the last almost three years at this point, I'd say there's really about four key themes that have emerged. And, you know, the first is scale what works and use technology to amplify proven care models. Right? So start with what's already working and leverage technology to scale it. I'll give you an example here. For the report that we did for, virtual hypertension solutions, you know, we found that and we always break each of our reports into different subcategories based on both the kind of mechanism of action that the solution is taking as well as, again, how they're going to market. And this is always a huge part of the lift of doing kind of this breakdown of the subcategorization of any solutions. But what we found was that the subcategory of solutions that include medication management, and meaning they include medication management offerings as part of it, and that means that they have a connected RPM cough for more regular or accurate home readings, which then allows a virtual prescribing team to adjust patients' medications. And what we found was that these can actually help patients achieve blood pressure control in as little as four to five months compared to what often has been a year with in person visits. And, again, as part of us, doing the entire assessment, we also found, though, that solutions that only offered remote patient monitoring and without the ability for a clinician to act on the data or if a solution only offered behavior and lifestyle management options. Unfortunately, we didn't see the clinical benefit in those subcategories, but we did see added cost. Right? And this is where, again, the context and the detail matters, meaning the medication management function of these solutions was essential and, again, really proved to be does prove to be incredibly valuable and that the virtual capability of these solutions can really help to optimize this. So as part of that first, like, key lesson, it's scale what works. We know medication management works, and here's a instance of where virtual solutions can really help you accelerate, expand access, and, you know, improve outcomes at the end of the day. You know, the second I would mention is targeting does matter. So back to kind of the right engagement, both mix and what does meaningful engagement mean. Meaning, digital tools aren't one size fits all and that the right patients need to be engaged at the right times. Sounds easy to do, very difficult to execute at times, especially without having information like our reports or, again, being able to talk with, you know, peers in this space. But this is where our results can help really any purchaser cast a more refined net in order to have more impact with the patients who really can benefit the most. And an example here is our first report was on digital diabetes management solutions. And, you know, what we found is often these solutions aren't being deployed to patients that have very high starting a one c's. And if they were, right, you could see likely much more impactful, like, clinical outcomes at the end of the day. So that was a nugget or kind of key learning for us of an opportunity area for the diabetes report. The third and fourth, I'll touch on quickly, is replacement often beats augmentation. So from an economic value perspective, finding solutions, and I mentioned this for both MSK and for GI, that allow you to substitute in person care versus layering on, you know, an additional tool can really create meaningful savings. And, ultimately, this is a nirvana that people are looking for. And then lastly, I would just say, you know, behavior change is hard, and that's with an app or that's without an app. So, you know, unfortunately, apps alone can't just totally fix habits. Right? And this is where And when you have categories like diabetes or hypertension or we saw this a bit in our opioid use disorder report, You know, there's a lot of opportunity to lean into the what's working and then build on that and, again, recognize the well, what does good look like and what are those outcomes that purchasers are looking to achieve? Yeah. As you were walking through that, I think the the crux of not assuming a one size fits all solution. Right? And this holds, you know, from the work that we've been doing, it holds for the the condition specific management that you focused on around diabetes, MSK, chronic kidney. Yes. But it also held very much for the sort of prevention side, which NCQA has also been looking at around how do you take lower risk populations and keep them healthy. It's still not one size fits all. Right. You need to understand the dynamics of the population, the underlying risk factors, the socio demographic factors, that all intersect here. And that's been central to a lot of our work. For those who have been following what NCQA has been doing, we recently launched the accreditation digital health engagement. And a big part of that is segmenting understanding the population that you're working with, and then evaluating variation in process and outcomes to support quality improvement. Which I think was a big part of going back to this this trust where the gaps, how do we build a stronger system here? That for us really seemed to be be foundational. Shouldn't say it was just for us. The the working groups and the the partners that we were were collaborating with highlighted this as well. That, you know, to your point, use what you know works already. Right. That that works from the process side too. We have really tested quality improvement evaluation, you know, population management strategies that can be applied in the solution space as well To build more consistent, you know, platforms and and progress and and performance there too. Yeah. So it sort of all comes together. You you build that infrastructure along the same principles, and then you evaluate your success consistently off of a set of metrics that is tailored to the outcomes that you're trying to achieve Tailored to the population that you're contracted for. And hopefully, altogether, this gets rid of the concerns around cherry picking, the concerns around, you know, can you really put risk behind things and Right. Go forward go forward there. Alright. So we're we're coming to the back half of the discussion. We have a couple of questions in the Q and A already. I want to invite everybody on the call, you know, please feel free to add in or submit questions via the Zoom Q and A function. But one one question that that came up, and I think it gets to this this population segmentation understanding the the dynamics here, was the question of language access and how that plays into these digital solutions and applications. So if a purchaser is contracting a solution, and how do you understand how language and access kind of interplay in this tailoring and targeting to the right population? Has that come up at all, or or can you kind of think around this? I think it's a great, you know, question, and I think that, know, it's twofold. Right? I think number one, it's, of course, a purchaser being a health plan, a health system, a employer recognizing their own kind of population of who they're looking to sell for and going into any discussion with a vendor, accordingly related to that. I think too and, you know, this is and we haven't somehow even mentioned AI quite yet. Right? But I think in the same way, it's difficult almost, to find a solution that doesn't have some sort of AI enabled, like, component to it or where, again Yeah. The ability for a solution to now offer more languages, right, like, seems a lot more doable than maybe what it's been in the past. But I think more than anything, it comes down to, of course, knowing your audience both as a purchaser and as a vendor Yeah. But then not assuming that that will be an automatic turn on. And I think this is where the specificity and, again, even though it can seem extremely laborious to go through all the various elements of what ends up in a performance based or outcomes based contract is absolutely essential. Because even as it relates to kind of the operational components, be it the duration of the agreement, the specifics of, again, what languages, right, like, to, be able to be accessible as part of any tool that you're using. That information has to be there, and it also has to be in your contract at the end of the day. And happy to touch more on some of the performance based contract aspects if we have time here, Rachel. Yeah. No. I definitely wanna come back to that. I think it's sort of a two way street. Right? The the contracting organization should have underlying data on their population that can be shared back with the solution vendor. You know what your threshold languages are. You know sort of where your your needs are. But then simultaneously, you know, the the solution side needs to have the capabilities to manage in different situations with different language needs, be it in flat files and assessments or via AI or via, you know, staff language capabilities. And that that's actually, you know, thinking of that in the the accreditation on digital health engagement. On the structural side, we have a whole set of standards on assessing language, understanding population language needs, and having the translation capabilities to support that. So it's gonna look different for different contracts and different populations. We're not coming out and saying, thou must have x y z languages. But having those structural capabilities are really critical to be able to succeed when you get into a specific contractor relationship. And hey, here are the the populations and the languages that we're we're working with. Absolutely. So we've we've talked about it's almost like we've teased the performance based contract design and and and what this looks like. What for you has been kind of the biggest or for you, for PHTI, this body of work, has been the biggest breakthrough on how to set up these contracts and really move towards value based contracts? Yeah. Let's see. It's hard to pick just one. And, you know, again, I always think the context is helpful, but I'll say that a big one was speaking with all of our members of our purchaser advisory council and realizing that they were all struggling with this in their own way. And this was across plans. This was across definitely employers and to some degree health systems. And everyone ultimately wants to know are we getting what we paid for, right, at the end of the day. And once you know what good should look like either from PHTI reports or from our you know, their own due diligence, how do you, again, best translate that to contracts? And we are also consistently really just hearing a desire to move beyond clawbacks and which can end up being quite contentious at times and ultimately more of a time drain for everyone that's involved as well as some pretty loud and clear consensus that per member per month agreements, like, we're cutting it anymore. And, again, people wanted to go a level deeper. So that's why we worked with our purchaser advisory council members as well as had numerous conversations with vendors all across the country really for feasibility testing to better understand how do we meet in the middle. Here, how do we come to terms on here's what we all can agree good should look like or at a minimum amongst the purchaser community what good should look like and then get agreement from vendors in various categories that we've talked through today and their ability to be able to meet purchasers where they are or where they need to be. And we ended up developing two things. The first was a playbook that really distills fifty plus interviews that we did with purchasers all across the country as well as vendors and some other stakeholders like data warehouse partners or Some others in that realm, vendor wise. And then we ended up creating a playbook that really, again, in a digestible way, puts the seven key design elements of what an optimal performance based contract should look like. Now that's helpful, but we wanted to take it a step further. In that, we created model template contracts specific to use case area. So for MSK, for mental health, for diabetes, for hypertension, based on those design elements we outlined, here's what those are, but then here are the specifics that we recommend you include that really translate over the what good should look like from each of our assessment reports to actual terms that they can take and utilize and really slide across the table to their vendors as partners to say, how do we get here? And, again, recognizing that there could be some customization. So while that's, you know, a longer way to say what the was, to me, the was this was not a, you know, a one person issue. This was really across the board, which is why we decided to really tackle this more holistically Yeah. And do a year long project specifically on the topic of performance based contracts. And moving forward, we'll create a model template toolkit for each of the reports, meaning each use case area that we tackle moving forward. So we'll have one coming out soon on our report that we just did solutions. Yeah. I think I remember first seeing the the performance based contracting work and when that came out and the seven decisions there and being really excited and also feeling like, to your point, the sense of no, we're seeing the same challenges, and we can work towards Right. Similar solutions. Because it was so in line with what we were hearing and seeing. We were bringing plans together, bringing payers, vendors together. And when you really dug into it, you're like, here's what we need help. You you would hear the purchasers be like, this is a due diligence nightmare for us, and then we have to sit here and feels like we're dragging data. The solutions would on the flip side say, we need data. We if you want us to show return on investment or outcomes, we need some of the data that you have. And so I remember seeing those seven decisions and seeing, hey, eligible population, engagement criteria, metrics, data sharing, and lining that up with how we were thinking of it on the structure side of what are the structures and capabilities that organizations need to execute on these decisions. That's right. And it lined up so clearly that it was like, okay, Maybe, you know, we put this together, we build the structures, we have the the outlines for how to approach the contracting, you know, it can really create a a change in the the dynamic and the and the environment here. I totally agree. I think, you know, back to it really then raises the bar across the industry both, of course, for purchasers to back to that trust and building confidence piece, but two for vendors. I mean, no one wants to kind of spin their wheels building something. They wanna build to spec. Yeah. They wanna meet the mark for what purchasers are looking for. And, you know, at times, they can be, you know, crowded categories to where they wanna differentiate themselves, and this is really a way to be able to do that. And what I think is extremely exciting, of course, is to hear from purchasers, be it employers, plans, who are telling us they're utilizing these for their renewal conversations, for, you know, relationships or partnerships that they're just starting off for new categories. But it's very exciting to also hear from companies and vendors who tell us that they're taking these, and they're utilizing these, and they're including elements of the performance based contract toolkits in their contracts too. And, you know, you need both both sides to be able to really create impact. So, you know, I think that's quite a positive that we hope continues to translate into this year and beyond, of course. Yeah. I mean, that's really the the proof in the pudding. Right? Is that Right. You can put something out there, but but seeing people that it resonates and it makes their lives easier, and it it makes things work better. It was when we were doing some of our work on measuring engagement, which was fascinating. You get five together who are doing this digitally enabled solutions based member engagement, different chronic conditions, some are more on the wellness side prevention, some more on that, and all with very similar aims, but their underlying data on engagement was totally different. Interesting. And trying to kind of hone in on what can we have as a common patient centered, individual centered definition of engagement that reasonably links to outcomes and that goes beyond, you said it earlier, goes beyond a login, goes beyond a click because That's right. That's that's not helpful. And so we we were doing this work around the concept of goal setting and goal attainment. There are many ways to approach that, but even our testing partners on that were like, wow, the exercise of organizing our own data to submit it Right. To go through this. We learned something our I'm like, Okay, job done. We feel good about Yeah. Like This was helpful. Totally agree. Another one of the questions in the chat I want to come to, and I think there's an element of this for both of us. It's around preventative medicine versus condition specific. So I know the majority of PHTI's work so far has focused on specific chronic conditions and really looked at it from that perspective. On the NCQA side, our program that we've launched, the digital health program, engagement program, that looks at both. It looks at the wellness prevention sort of lower risk population management side of things, as well as the chronic condition management. I'm curious for PHTI, why you focused on specific chronic conditions and you know, if you see the potential for some of this to expand into the prevention and and wellness space as well. Yeah. And, you know, I think that there's probably more of a Venn diagram there, right, than we even can think of right from the get go. I'd say the areas that we focused on today, and I alluded to this earlier, are areas that we heard directly from purchasers have both a high degree of need for their patient and member populations, but two are driving significant cost, right, for them. So diabetes, MSK, hypertension, mental health, opioid use disorder, and then our latest on GI. Up next, we'll have a report for chronic kidney disease, followed by virtual solutions for maternal health. So, again, you know, we do, our own kind of assessment of the landscape to help to get at some of that, but very much it's also informed by what we're hearing from purchasers, both in our purchaser advisory council, in terms of needs that they're looking to tackle or retackle if it's not working as well at this point in time. But it's also a huge reason we do that state of digital health purchasing survey every year where we ask nationwide purchasers, again, across plans, employers, and health systems, what are you using? What's working? What's not working? And what are you planning to purchase or continue using in, you know, the year ahead? And I e, where can we be most helpful in tackling when you think of the kind of sea of solutions, point solutions, etcetera, that are out there. But back to Venn diagramming, I think that there is, of course, blurred lines. Everyone's attempting to get more upstream in terms of, you know, tackling issues both from a quality of life, outcomes, cost perspective, if and where possible. I think the engagement conundrum that we've been talking about today, Rachel, definitely definitely does also play into this is everyone's competing for both mindshare and kind of marketing, like, real estate at any time, if you wanna say it that way, which, again, how upstream can you get and where are there opportunities to improve. And I think it's also a building block, a massive building block of why the trust and kind of confidence needs to be there for solutions kind of already mainstream in market and to hopefully work backwards accordingly based on the patient populations and all. Yeah. No. I think you're right with the Venn diagram. And that's you know, from our perspective, because we were focused on a lot of these structural, you know, processes and and capabilities that need to be built in and the digital health engagement accreditation, A lot of that is shared, Yeah. Data sharing, the ability to do subpopulation analysis, a lot of the evaluation and improvement. It's a shared capability where you really see it at the engagement piece as well. Right? Right. What is your ability to engage? What are your strategies for for getting somebody to to kind of come in on your program? But the what it varies is the outcomes. Right? You're not gonna necessarily be looking for a PHQ nine or depression score on somebody who's, you know, just trying to get healthy and more active and reduce their cardiovascular risk. And for us that really sort of played out in how we set up. We have some measures that are required for every type of program, like the engagement measures And then others around ROI and outcomes where it's more flexible and organizations can define based on a certain set of best practice criteria what their outcomes are. And we actually point to PHTI's work as here are examples of Yeah. Of outcomes that you could could look at for some of these different conditions. Hopefully to to exactly do that, to to build on the commonalities. You don't have to recreate your systems for for different things. Right. But demonstrate the right outcomes for the target and the program that you're you're looking at. You know, I think that's so essential, and it's also a massive reason we felt the need to do use case specific performance based contract toolkits. Because while there's often, you know, maybe, like, a seventy thirty rule, right, across the board Yeah. You do have to have different weighting based on, again, the clinical outcome goals and to some degree, of course, like, the member eligibility, like, percentages that you want to see. And that's where, you know, we've inserted recommendations in there, but we give users, of course, the ability to off road from that based on their own goals, patient populations, etcetera. And, again, it will vary based on what the use case is. Like, for MSK, you your clinical measure will be, you know, patient reported pain levels or functional improvement or, I e, ability to perform daily tasks versus for, you know, depression and anxiety. You alluded to this, but it would be reduction in, you know, symptom scores for p PHQ nine and GAD seven and engagement with content. So it will vary, and hence, the toolkits, the performance based contract toolkits, I e, your contracts need to vary as well. Yeah. For sure. Well, on that note, it's hard to believe an hour has passed. I know. It's almost. It's really fast. So that's great. Past. Thank you so much, Meg, for joining us and joining on this conversation and sort of the all of the lessons learned from the work that you have been doing. I know for those who've been following in the chat, there are a bunch of resources and links to the performance based contracting resource, the contracting tool kits, the assessments. We've also added a link. So I've mentioned this in passing, but NCQA actually earlier this week, yesterday, it's Tuesday, launched our digital health engagement accreditation program. So it is an overall accreditation. It includes a module on health assessment and a module on digitally enabled interventions, which flows right in line with the conversation today. And sort of hopefully to this point of raising the bar, builds the structures and processes and really gets us towards the outcomes that can reflect in our performance based contracting and really move us forward. So if folks are interested in that, the link is in the chat. And then I would be remiss if I didn't mention NCQA's Health Innovation Summit, October fourth through seventh this year in Atlanta. We do have an entire track around digital health, AI and technology, which will include discussion of many of these topics as well. So if you're interested, you can check out more. Thank you so much everyone for joining us. Thank you Meg again for Yeah. Being a part of today's conversation. And I hope everyone has a great rest of your day.