In its latest set of recommendations to the new administration, the National Committee for Quality Assurance (NCQA) laid out a clear and compelling vision for transforming American healthcare. The document calls for a digitally enabled, interoperable ecosystem centered around value-based care, chronic condition management, true incorporation of behavioral health, and seamless provider-patient-payer coordination.
While the recommendations are aimed at policymakers, they also present a clear roadmap for the private sector to step up with scalable, tech-enabled solutions. Here are five key insights from NCQA’s recommendations that highlight where healthcare innovation is urgently needed:
1. Interoperability as a foundation, not an afterthought
Data fragmentation remains one of the most persistent challenges in healthcare. NCQA’s push for widespread FHIR® (Fast Healthcare Interoperability Resources) adoption and open exchange of health data underscores the need for flexible infrastructure that integrates across diverse electronic health record (EHR) environments—particularly in small or underserved provider networks. Solving this challenge is foundational to driving more coordinated, efficient, and personalized care.
2. Unlocking the potential of digital quality measures
Traditional quality measurement methods are resource-intensive and disconnected from real-time clinical decision-making. NCQA’s recommendations make a strong case for expanding digital quality measures (dQMs) that are machine-readable, standardized, and captured seamlessly within clinical workflows. Doing so reduces provider and care team burden while improving the accuracy and utility of performance data across care settings.
3. Enabling scalable Value-Based Care across all networks
With a goal of moving all Medicare beneficiaries into value-based arrangements by 2030, there’s a growing need for technology that works within existing provider workflows—especially among smaller, non-integrated practices. Enabling actionable insights at the point of care and through payer-aligned workflows can drive adoption and help value-based care scale beyond large, sophisticated health systems.
4. Prioritizing whole-person care through integrated models
The report reinforces the importance of integrating physical and behavioral health, including the need for shared care plans that reflect patient goals and are accessible to multidisciplinary teams. This vision calls for infrastructure that supports real-time, bi-directional data sharing and tailored interventions, particularly for individuals managing multiple chronic conditions.
5. Public-private collaboration as a path to systemwide change
NCQA emphasizes the role of public-private partnerships in shaping next-generation care models. Technology companies that can bridge gaps between payers and providers—and do so at scale—are positioned to play a vital role in shaping policy, informing pilots, and supporting the operationalization of value-based care in hard-to-reach corners of the healthcare system.
The direction is clear: a more connected, transparent, and accountable healthcare system isn’t just an aspiration—it’s an expectation. As national policy continues to align with these principles, now is the time for innovation to meet the moment.
