About NCQA’s Public Comment

NCQA releases program updates for public comment to generate thoughtful feedback and suggestions from interested parties. Many comments lead to updates to our standards and policies, strengthening them for all stakeholders. NCQA asks respondents to evaluate whether the proposed requirements are feasible as written and clearly articulated, and to identify areas that may need clarification.

Summary of Proposed Changes

Below is a summary of the proposed changes to NCQA’s programs and standards. You can review the full details on NCQA’s website.

New Accreditation Program for Advanced Primary Care

NCQA developed Advanced Primary Care Accreditation in response to evolving expectations for how primary care is delivered, financed and evaluated across the healthcare landscape. It reinforces the shift toward payment models that reward longitudinal, coordinated, team-based care management.

The program builds on NCQA’s Patient-Centered Medical Home Recognition by incorporating enhanced capabilities, greater accountability and improved infrastructure. Program standards proposed for public comment are organized into six domains:

• Population Health Management.
• Coordinated, Team-Based Care.
• Patient Safety and Experience.
• Behavioral Health.
• Clinical Quality.
• Data Management and Exchange.

The program also includes a quality measure bundle designed to balance near-term feasibility with long-term innovation. Established electronic clinical quality measures (eCQM) that many organizations already collect and report are used to assess current performance, while separate utilization reporting requirements provide insight into care delivery patterns. A limited set of FHIR^®-enabled digital quality measures (dQM) signals future expectations and offers a clear roadmap for advancing digital quality reporting over time.

This Accreditation was developed with extensive market engagement, feedback from advisory groups and a pilot program that offered real-world insights across diverse primary care delivery models.

The program will be released in November 2026, with survey availability beginning in July 2027.

Proposed Health Plan Accreditation Update

NCQA proposes updates to the 2027 Health Plan Accreditation to reduce administrative burden, streamline evidence expectations and encourage continued alignment with external regulatory requirements, while continuing to support meaningful evaluation of health plan performance.

Proposed updates include:

• A focused set of requirement reductions and refinements to streamline the program and reduce administrative burden, particularly for Renewal Surveys.
• Clarifications to improve consistency and usability of requirements.
• A new requirement addressing oversight of AI-generated outputs within the Utilization Management domain.

These changes represent a targeted, evidence-based step toward a more streamlined and modernized Health Plan Accreditation program.

How to Participate in Public Comment

Visit My NCQA to submit comments through our new and improved public comment process.

The public comment period ends at 11:59 p.m. (ET) on Friday, July 10. For details on proposed changes, visit the NCQA website.

HL7^® and FHIR^® are the registered trademarks of Health Level Seven International and their use does not constitute endorsement by HL7.

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Across the industry, initial efforts have focused on defining governance principles and foundational controls for responsible AI use. The next challenge is translating those principles into complex workflows while measuring the impact on quality, outcomes and experience.

To support healthcare organizations in navigating this transformation, NCQA is launching an AI Learning Collaborative, with our first use case focused on prior authorization. Building on conversations from NCQA’s prior AI convenings, the Learning Collaborative provides a structured, in-depth engagement model designed to support implementation and evaluate outcomes at the workflow level.

Responsible Use of AI in Prior Authorization

Prior authorization represents a high-risk area for AI adoption given its complexity, visibility and direct patient impact. While AI offers meaningful opportunities to improve efficiency and turnaround time, it also raises important questions about transparency, process integration and measurable outcomes.

This Learning Collaborative is timely, as organizations prepare to implement the CMS Interoperability and Prior Authorization Final Rule (CMS-0057), which focuses on reducing friction for clinicians and patients, improving information exchange and demonstrating explainable, timely decisions.

How the Learning Collaborative Works

The Learning Collaborative is a fee-based experience designed to help you learn from peers, engage with national experts and develop best practices for responsible AI implementation and impact evaluation. Participants will:

• Engage in peer learning on real-world AI implementation.
• Strengthen governance, accountability and outcomes measurement frameworks for specific use cases.
• Share anonymized outcomes metrics and evaluate implementation effectiveness and variances against peers.
• Contribute to and access evolving, use-case-specific implementation playbooks and outcomes-monitoring frameworks.

Benefits of Participating in the AI Learning Collaborative

NCQA’s AI Learning Collaborative is designed to support organizations across the maturity spectrum, offering both foundational guidance and opportunities to validate and optimize existing strategies. Participating organizations can:

• Shape emerging industry best practices.
• Accelerate AI innovation responsibly.
• Develop new metrics and evaluation methods within workflows.
• Align with regulatory expectations, including CMS-0057 and state-specific requirements.
• Build public trust by promoting transparency and accountability.

Join Us!

Visit our website to learn more about the AI Learning Collaborative and find out how your organization can participate.

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The Problem: Fragmented, Manual and Inconsistent Data Exchange

Quality measurement has historically depended on manual chart reviews, point-to-point interfaces and inconsistent data feeds, resulting in administrative burden and delays in Healthcare Effectiveness Data and Information Set (HEDIS^®) reporting. As organizations transition toward digital quality measurement, retrieving accurate and complete patient rosters across organizational boundaries remains operationally complex.

While Fast Healthcare Interoperability Resources (FHIR^®) is recognized as the industry standard for exchanging healthcare data, adoption remains inconsistent. EHR infrastructure is typically optimized for one-at-a-time patient retrieval, so scaling to thousands of members introduces performance constraints. And many HEDIS-certified vendors do not yet accept FHIR-native inputs, requiring additional mapping from FHIR resources into proprietary vendor formats for HEDIS reporting.

The Solution: Moving Toward Adoption of Bulk FHIR

NCQA convened the Bulk FHIR Quality Coalition to perform real-world testing of data exchange using interoperable data formats at scale and to evaluate the quality of FHIR data. Cambria, MultiCare and eHealth Exchange were the first cohort of organizations to participate in the coalition.

Using a secure, Trusted Exchange Framework and Common Agreement (TEFCA™)-aligned network and a single connection between organizations, the teams built and tested systems that could exchange large volumes of standardized clinical data for quality reporting.

Each organization had a specific role:

• NCQA provided access to Digital HEDIS FHIR Implementation Guides and a sample of HEDIS measures codified in Clinical Quality Language.
• eHealth Exchange served as the interoperability intermediary, architecting a single-connection model that eliminated bespoke point-to-point integrations, enabling MultiCare and Cambria to transact Bulk FHIR data within a TEFCA-aligned trust framework.
• MultiCare implemented a production-grade Bulk FHIR endpoint within their Azure API and Epic ecosystem and leveraged a cloud-enabled data repository to support high-volume export requests.
• Cambria generated fully attributed member rosters, initiated Bulk FHIR export requests, built ingestion pipelines to retrieve the data, validated data completeness and mapped standardized FHIR outputs into its HEDIS-certified vendor’s proprietary calculation environment for reporting.

Results

The collaboration showed that regulated APIs and shared FHIR profiles can operate consistently at scale when supported by governance, attribution standards and data quality validation.

• Cambia and MultiCare successfully exchanged HEDIS-relevant clinical data for over 5,000 attributed members, validating data completeness for quality reporting.
• MultiCare reduced chart-chasing costs by approximately $50 per chart and improved medical record procurement performance by 175% compared to baseline manual workflows.
• Automated polling and retrieval reduced bulk export timelines from days or weeks to minutes, significantly accelerating quality reporting cycles.

Learn More

Read the full case study, Operationalizing Bulk FHIR for Scalable Quality Measurement.

Visit NCQA’s Digital Quality Hub for information and resources to support the transition to digital quality measurement.

FHIR^® is a registered trademark of Health Level Seven International; use does not constitute endorsement by HL7.

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

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The ARM is an opportunity for NCQA to share our research and perspectives on the healthcare system and engage in meaningful conversations about emerging research and innovations. This year, we will be participating in a panel discussion and two poster presentations.

Panel Presentation

NCQA’s President and CEO, Dr. Vivek Garg, will participate on a panel titled “Great Debates: Quality Measurement and Prior Authorization.” This discussion will examine these two key pillars of U.S. healthcare policy that are currently under intense scrutiny. National experts will debate whether these systems require evolution, revolution or elimination.

Poster Sessions

NCQA staff will share their research in two poster presentations.

Assessing Data Feasibility for Intimate Partner Violence Quality Measurement: Results from Two U.S. Health Plans. This study evaluates the feasibility of a proposed HEDIS^® measure related to intimate partner violence by testing the measure with two health plans.

Authors: Yuzu Saito Butler, Polina Lissin, Kaila Boyd, Adrianna Nava

Real World Evaluation of Methods for Measuring Equitable Quality of Care: Quantitative Findings and Qualitative Insights. This study evaluates four published approaches for building combined health equity scores that consider multiple factors and measures simultaneously in real-world settings.

Authors: Crysta Meekins, Rachel Harrington, Yazhini Ramesh, Polina Lissin, Shawn Trivette, Alana Burke

This work is supported by the California Health Care Foundation and the Commonwealth Fund. Learn more about Putting Advanced Health Equity Analytics Methods into Practice.

Join Us in Seattle

If you would like to see our presentations in person, register for the 2026 AcademyHealth ARM. We hope to see you there!

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

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To better understand how health plans can meaningfully reduce their climate impact, NCQA conducted new research to identify practical, evidence-informed strategies that health plans can implement today, even in a shifting policy environment.

Why We Did This Research

Existing research on healthcare decarbonization has largely centered on delivery systems, highlighting strategies such as care coordination, appropriate prescribing, telemedicine and avoiding unnecessary testing. These efforts matter—and the rapid expansion of virtual care during the COVID‑19 pandemic demonstrated real climate benefits. For example, one California health system avoided an estimated 17,000 metric tons of GHG emissions over three years by increasing virtual visits.

What has been missing is a comparable focus on health plans. Health plans influence care delivery through benefit design, provider contracting, network management and investment decisions. Yet there is limited guidance on where plans should start, which strategies are most feasible and how sustainability efforts can align with existing quality and performance goals. Our study was designed to help fill that gap.

How the Study Worked

NCQA used a structured, consensus-building research method to identify leading decarbonization strategies for health plans. We brought together health plan leaders from across the U.S., representing commercial, Medicare, Medicaid and Exchange lines of business, as well as both for-profit and not-for-profit organizations. Between August and October 2024, participants completed two surveys and joined a panel discussion that was convened between the two survey rounds.

Participants evaluated 29 potential decarbonization strategies across three criteria:

• How critical the strategy is for reducing emissions.
• Whether health plans can realistically use the strategy.
• Whether the strategy can be implemented without undue burden.

This approach allowed us to move beyond theory and focus on strategies that health plan leaders see as actionable in real‑world operations.

Key Insights

Three themes emerged consistently across the two surveys and the panel discussion.

Climate progress depends on the broader policy environment—but plans do not have to wait.

Participants were clear that government leadership and national climate narratives influence how quickly organizations act. At the same time, there was strong agreement that health plans can—and should—take action within their control, regardless of shifting federal priorities.

Strategies within a plan’s direct control rise to the top.

The highest‑rated strategies focused on areas that health plans directly own or manage, especially facilities, energy use and internal governance. These areas allow plans to act, measure progress and demonstrate impact without relying on external partners.

Climate action gains traction when aligned with quality goals.

When sustainability strategies align with goals that health plans already prioritize—such as access, efficiency, equity and affordability—they are more likely to be adopted and sustained. Telemedicine emerged as a strong example because it reduces emissions while improving access to care.

The Most Actionable Strategies for Health Plans

Participants identified seven priority strategies for health plans:

• Appointing a dedicated sustainability officer or team.
• Integrating climate considerations into strategic planning and forecasting.
• Investing in energy‑efficient lighting, heating, cooling and equipment in plan‑owned or controlled buildings.
• Electrifying building systems where feasible.
• Increasing use of renewable energy at plan facilities.
• Measuring and tracking Scope 2 emissions (energy-related emissions).
• Supporting government accountability mechanisms for emissions reporting.

For health plans, the takeaway is clear: you do not need to solve everything at once. By focusing on high‑impact, controllable strategies, health plans can make meaningful progress today and help shape a more sustainable healthcare system for the future.

Learn More

Read the full study, Top Consensus-Based Strategies for Health Plan Decarbonization: A Modified Delphi Study, published in the Journal of Climate Change and Health, here: https://www.sciencedirect.com/science/article/pii/S2667278225001385.

Acknowledgements

This research was made possible with support from the Commonwealth Fund (Grant Number 23-23436, 2023-2025).

The post New NCQA Research: What Health Plan Leaders Can Do to Reduce Climate Impact appeared first on NCQA.

Why is the HEDIS Technical Update Important?

HEDIS is a set of standardized performance measures that enable consumers, purchasers and policymakers to compare the performance of healthcare organizations. NCQA publishes HEDIS Volume 2 in August of the year prior to each measurement year. The Technical Update helps ensure that:

• Organizations have access to the most up-to-date technical guidance needed to implement HEDIS measures accurately and consistently.
• Coding resources, such as value sets and medication lists, are up to date.
• Any necessary changes are made in response to the evolving healthcare and policy environment.

The Technical Update was sent to all purchasers of the HEDIS MY 2026 Volume 2: Technical Specifications, and a release letter was posted to the HEDIS website on March 31.

What Is Included in the Technical Update?

The Technical Update includes:

• A re-released full-text HEDIS MY 2026 Volume 2 publication with edits in red text.
• Updated HEDIS MY 2026 Medication List Directory.
• Updated HEDIS MY 2026 Value Set Directory.
• HEDIS MY 2026 Risk Adjustment Tables.
• HEDIS MY 2026 Audit Timeline.

NCQA released four new measure-specific risk adjustment tables for MY 2026 and updated the shared risk-adjusted table. Read our blog, HEDIS Risk-Adjusted Utilization Tables: New Measures, Shared Table Updates and FAQs, for more information regarding these changes.

Changes in the Technical Update

Below are some highlights included in the Technical Update; this is not an exhaustive list.

Social Need Screening and Intervention (SNS-E)

• Removed ICD-10 diagnosis codes from the intervention denominators.

Rationale: ICD‑10 diagnosis codes can no longer be reliably linked to documented social determinants of health (SDOH) assessments. The measure will continue to rely on LOINC codes to capture standardized screenings and positive screening results.

• Removed SDOH assessment G codes from the screening numerators.

Rationale: HCPCS G0136 no longer aligns with SDOH screening activities included in the measure following the change in the CY 2026 Medicare Physician Fee Schedule.

• Added a Food Insecurity Screening Item Response Exception for the PRAPARE^® tool.

Rationale: Clarified that because of the structure of screening item LOINC 93031-3, a null result is considered a valid response to this question.

Read our blog, Social Need Screening and Intervention: What’s Changing in the MY 2026 Technical Update, for more details about these changes.

Tobacco Use Screening and Cessation Intervention (TSC-E)

• Updated the age criteria to identify the person’s age as of 180 days prior to the measurement period.

Rationale: Updated the measure to align with current age criteria for FDA-approved tobacco cessation medications.

Race and Ethnicity Stratification

• Updated references from “Some Other Race” to “Other Race” in the Race and Ethnicity Stratification general guideline and in each applicable measure specification.

Rationale: Updated to align with the U.S. Core Version 6.1.0 Model Definitions.

Learn More

If you have not  already purchased the HEDIS MY 2026 Volume 2: Technical Specifications, you can order the publication in the NCQA Store and you will automatically receive the Technical Update with your purchase.

Join the HEDIS Users Group to get timely guidance, expert clarifications and practical support directly from NCQA. You will gain access to exclusive webinars, resources and a collaborative community designed to help you confidently navigate HEDIS updates and reporting throughout the year. Visit our website to learn more.

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

PREPARE^® is a registered trademark of the National Association of Community Health Centers (NACHC).

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“People with behavioral health conditions tend to have more medical health issues,” says Vivek Garg, MD, MBA, President and CEO of NCQA. “If you have medical health issues and you have poorly supported mental health issues, the medical issues get worse. We’ve gained clarity as a country that this issue affects all of us.”

A New Partnership to Drive Industry Alignment

To address these challenges, NCQA and West Health recently announced a strategic partnership to advance the integration of behavioral health into primary care. The collaboration combines NCQA’s leadership in quality measurement and accountability with West Health’s expertise in care delivery innovation to identify and test a core set of behavioral health quality measures in real‑world settings.

The initiative also includes the formation of a policy solutions coalition as well as payer workgroups to align with state and federal policy initiatives and ongoing advocacy for behavioral health integration.

Improving outcomes will require more than isolated initiatives or one‑off interventions. Sustainable progress depends on alignment across policy, payment, technology and clinical practice, supported by measurement approaches that reflect real‑world care delivery and enable continuous improvement.

“Heroics aren’t going to change the health of our population,” says Dr. Garg. “That is not systematic, and that is not scalable.”

Measurement Gaps Undermine Behavioral Health Integration

Although there is broad agreement that integrating behavioral health into primary care improves outcomes, the field still lacks consensus on how to define and measure high-quality integration. Measurement gaps have made it harder for payers, policymakers and providers to align around shared expectations, creating barriers to scaling models that are proven to work.

Existing measures are often fragmented, overly complex or disconnected from clinical workflows—particularly in primary care settings already strained by workforce shortages, evolving digital requirements and uneven EHR capabilities. Without a clear, usable measurement framework, efforts to improve behavioral health outcomes remain difficult to sustain.

Convening National Leaders: The Advancing Behavioral Health Executive Forum

On April 21, NCQA and West Health convened national leaders from payer organizations, policymaking bodies and health systems in Encinitas, CA, for an Advancing Behavioral Health Executive Forum.

Discussions examined the disconnect between clinician‑driven, measurement‑based care and the process‑heavy metrics often tied to payment and accountability, underscoring the need for stronger alignment across policy, payment technology and clinical practice to support earlier identification and more consistent follow‑up in primary care.

The Forum featured a fireside chat between Dr. Garg and Zia Agha, MD, Chief Medical Officer at West Health Institute, who explored the real‑world barriers to integrating behavioral health into primary care and the system‑level changes needed to move from measurement to system-wide impact.

Moving From Measurement to Better Outcomes

Forum participants emphasized that reducing complexity is essential to driving improvement. The goal is not more measurement—but better measurement that supports clinical decision-making, reduces burden and enables learning over time.

“If you just measure and don’t provide the resources to fill those gaps, we often see resistance,” says Dr. Agha. “The beauty of the integrated care model is that it does make those resource changes in primary care.”

NCQA and West Health will continue working with stakeholders to advance scalable, measurement‑informed approaches that strengthen behavioral health integration in primary care.

Visit our website to learn more and stay updated on this work.

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NCQA has been exploring ways to drive improvement in data quality while reducing the burden of manual data verification. We have shared insights about this topic in our blog, Improving HEDIS Data Quality in a Digital World, and on the Quality Matters podcast, What the Quest for Data Quality is Really About.

“As we modernize our data quality solutions, we’re exploring how automation can help organizations assess the reliability and trustworthiness of clinical data sources,” says Ben Hanley, NCQA’s Director of Product Management.

A Framework for Evaluating Clinical Data Quality

NCQA is committed to developing automated, scalable methods of data validation. Our approach addresses four key areas:

• Ensuring data are complete and properly structured for HEDIS calculations.
• Showing that data are reasonable and likely to depict reality.
• Monitoring changes in data content and delivery for consistency over time.
• Understanding where data originated and how the data have been exchanged and transformed.

Data quality assessment is not a one-size-fits-all approach. “Organizations will need a combination of tools to validate different aspects of the data,” says Hanley. “The assessments will also vary based on the use case. Not all data sources need validation across all four areas.”

Announcing NCQA’s Data Quality Solutions

We are excited to announce our first product offering related to automated data quality assessment—and we are looking for early adopters to implement this new tool and provide feedback.

NCQA developed the HEDIS^® Data Quality Specifications to enable standardized assessments of the quality of electronic clinical data. It includes over 100 specifications for data quality metrics that cover a range of clinical domains such as encounters, medications, laboratory results, conditions, immunizations and demographics.

Each specification includes a metric denominator and a metric numerator. This enables organizations to calculate how often an electronic clinical data source meets the requirements identified in the specifications. Combining relevant data quality metrics for an electronic clinical data source can provide a snapshot of overall fitness for use in HEDIS.

Organizations can use the HEDIS^® Data Quality Specifications in the following ways:

• To evaluate the level of data quality between different electronic clinical data sources.
• To identify targeted areas for electronic clinical data quality improvements.
• To establish standards for how electronic clinical data should be received from or exchanged with external partners.
• To evaluate data sources being considered for use in HEDIS reporting.

The HEDIS^® Data Quality Specifications were released in March for beta testing. NCQA plans to release an updated version of the specifications later this year.

How to Get Involved

NCQA is looking for a limited number of partners to participate in beta testing of the new data quality specifications. To participate, organizations should be:

• Creating, sharing or aggregating data for HEDIS reporting.
• Exchanging and using clinical data files in a FHIR^® format.

Participation in the beta testing offers an opportunity to influence how automated data quality assessment evolves and to ensure the specifications meet real‑world implementation needs. To learn more, please fill out an interest form on our website.

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

HL7® and FHIR® are the registered trademarks of Health Level Seven International and their use does not constitute endorsement by HL7.

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“NCQA has been partnering with HRSA to improve quality and efficiency in health centers since 2010,” says William Tulloch, NCQA’s Director of Quality Services. “More than 3,200 health centers have earned NCQA PCMH Recognition to date. NCQA is ready to support the next generation of health centers as they pursue this valuable credential.”

This year, NCQA will expand our support for health centers by offering our Behavioral Health Integration Distinction—an important step toward helping patients achieve whole-person health.

Benefits of PCMH Recognition

The PCMH model of care can help build better relationships between patients and their clinical care teams, while meeting regulatory requirements. Here are some of the benefits of pursuing PCMH Recognition:

• Improve quality and efficiency. Health centers develop streamlined workflows and adopt a team-based approach leading to improved quality of care, increased efficiency, higher satisfaction among patients and staff, and reduced costs.
• Reduce health disparities. Health centers learn to identify, assess and address social drivers of health as a fundamental component of the PCMH transformation process.
• Comply with regulatory requirements. PCMH requirements are aligned with HRSA’s Uniform Data Systems Resources and state Medicaid requirements related to access and clinical quality outcomes.

Visit our website to learn how the PCMH model of care can improve health center operations and view testimonials from health centers that have successfully completed the program.

Benefits of Distinction in Behavioral Health Integration

Behavioral health conditions like mental illness or substance use disorder can often be identified and treated in a primary care setting, which can offer patients a seamless experience and lead to better health outcomes.

NCQA’s Distinction in Behavioral Health Integration helps health centers and LALs integrate behavioral healthcare into their practices. Here are some of the benefits of this distinction:

• Showcase your expertise. Demonstrate to patients, payers and partners that your organization has the right resources, evidence-based protocols and standardized tools to support the needs of patients.
• Deliver whole-person care. Expand your capacity to provide comprehensive care that acknowledges patients’ physical and behavioral health needs.
• Improve outcomes. Integrating behavioral health and primary care leads to improvements in access, clinical outcomes and patient experience.

Health centers and LALs that have already achieved PCMH Recognition or are actively working toward it can apply for the Distinction in Behavioral Health Integration.

How NCQA Supports Health Centers and LALs

In addition to covering survey expenses, NCQA will provide office hours, regional and national training sessions for health center staff, individualized technical assistance from NCQA PCMH Certified Content Experts and educational content.

“Health centers are already doing the work, so applying for PCMH Recognition is the natural next step in the process,” says Tulloch. “NCQA provides the tools and resources to help health centers succeed.”

Visit our training and technical assistance webpage to access recordings of past training sessions and office hours.

How to Apply

Federally Qualified Health Centers (FQHC) must submit a Notice of Intent (NOI) to indicate their interest in the program. Use this link to access step-by-step instructions for submitting an NOI.

LALs should follow these instructions:

1. Go to the BPHC contact form.

2. Scroll down to the Look-Alike Designation section and click on the Accreditation and Patient Centered Medical Home Recognition (APCMH)—LAL A new contact form will open.

3. Select the Notice of Intent option from the drop-down menu.

4. Enter the details about your request in the space provided.

Please submit your NOI as soon as possible to reserve your spot. If you have questions, please contact HRSA via the BPHC contact form.

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Dr. Ndumele shared his perspective on the challenges and opportunities in CKM Syndrome care and why we need to break down silos and work together to address what he refers to as “one of the largest public health issues of our time.”

What inspired you to become a physician?

Growing up, I liked math and science. When I was in high school, my mom took me to a community health program that was occurring in our area. They were doing health screenings and trying to connect people with resources to support them in their health journey. I was amazed by how providing screenings and enhancing people’s awareness of different risk parameters could have such a positive impact. People were coming back to us and telling us how they had made all these positive changes in their lives—just because we had provided that information to them! It was hard for me to believe we were making a difference to that extent in people’s lives, but it was the case, and I was hooked. I ended up going to Johns Hopkins University and then Harvard Medical School. I really loved studying the workings of the cardiovascular system and also appreciated that it was connected to multiple modifiable risk factors, which made it a natural fit with my interest in prevention.

What is the focus of your clinical practice?

I focus a lot of my efforts on cardiovascular disease prevention, but I also see patients with existing cardiovascular disease who are trying to improve their quality of life and reduce the risk of recurrent cardiovascular disease events. What I’ve noticed in my practice over the last 20 years is that people are coming in with higher risk, more complexity and a greater burden of interrelated clinical conditions. We’re seeing more people who have obesity, many of whom also have uncontrolled diabetes, chronic kidney disease, or both additional comorbidities. Usually, patients with diabetes and chronic kidney disease also have hypertension and some dyslipidemia (an abnormal level of fats in the blood), and it’s this interrelated cluster of risk factors that we’re seeing over and over again.

The clusters of risk factors I saw in my clinical practice overlapped with my research on the growing impact of obesity on multiple downstream systemic challenges, including the development of diabetes and chronic kidney disease, with resultant increased risk for cardiovascular disease—and that is what we’re talking about with CKM syndrome.

How did the name CKM Syndrome come about?

The main reason behind the naming of CKM Syndrome is the interrelatedness, or connectivity, among cardiovascular, metabolic and kidney conditions. Many patients feel like they’re just having bad luck, wondering “Why are all these things happening to me at the same time?” without recognizing that their health conditions are interrelated.

The other reason for the name is that there’s a reliable and predictable trajectory that leads to the development of this kind of complex presentation. It typically starts with excess and dysfunctional adipose tissue (body fat), progressing to the emergence of chronic kidney disease and metabolic conditions like diabetes, hypertension and dyslipidemia, leading to the development of subclinical cardiovascular changes and eventual clinical cardiovascular disease. The consequence of progression along this spectrum is a greater risk for premature mortality, most often due to cardiovascular disease.

As a cardiologist, I often see people at a point when these interrelated factors have not been addressed for many years and now they have cardiovascular disease that is difficult to manage because of its severity and the multiple coexisting comorbidities. But I also recognize the opportunity to identify and address the risk much earlier in the process and, hopefully, avoid getting to these really severe and complex stages.

What challenges do people with CKM Syndrome experience when trying to access healthcare?

First, there’s quite a bit of under-recognition. Many of the risk factors aren’t recognized by patients or clinicians, and even if they are recognized, they may not be addressed due to other things that seem more pressing. If a patient has multiple interrelated conditions and is trying to see multiple clinicians from different specialties, it can be hard to navigate. If there is conflicting advice, they are trying to figure out who to listen to. It doesn’t help that clinicians tend to operate in our own silos. The kidney doctor will be focused on protecting the kidneys, the heart doctor will be focusing on what’s good for the heart and the endocrine doctor will focus on what is best for the endocrine system. CKM Syndrome doesn’t respect our subspecialty silos. We need to move beyond that and understand that these conditions are interrelated and make sure that risks are addressed holistically and in a timely fashion.

How can we empower patients to prevent or manage CKM Syndrome?

We need to help people understand that there’s a predictable trajectory that occurs with these interrelated conditions and that these issues are readily addressable, particularly in the earlier stages. The CKM staging concept is really important. It helps patients to identify where they are along the spectrum and learn what they can do to preserve health for as long as possible. There’s no doubt that a healthy lifestyle is at the core of preventing and managing CKM Syndrome. But a healthy lifestyle is not just about behavioral choices—it is about the multi-level social drivers of health that impact a person’s lifestyle. We need to recognize the barriers patients may encounter and do what we can to make it easier for them to make the healthy approach their default approach.

What was your experience participating in NCQA’s CKM Syndrome convenings?

It was a really thoughtful group of individuals that represented a lot of different perspectives, including some people who were coming into this with fresh eyes. I appreciated the shared sense of urgency. There is widespread agreement that this is a shared challenge across disciplines, driving risk for patients and driving worsening mortality trajectories in the population. It’s something we all need to work together to help solve. The framework outlined in the white paper is a great step forward.

What were some of your key takeaways from the expert panel?

One of the really important things we talked about was using measurement as a platform for enhancing CKM Syndrome care. We need to think about cross-cutting measures that incorporate multiple disciplines and focus on recognizing risk in earlier stages, as well as some patient-facing measures that can guide us toward more integrated care. I also enjoyed the discussions about innovations in our approach to activating and supporting clinicians and patients through EMR-based strategies, other health technologies and the use of artificial intelligence.

What would be the most impactful change we could make to have a positive impact on CKM Syndrome care and outcomes?

It’s hard to pick just one. If people had more of an awareness of what CKM syndrome is, then it would be a great starting point for conversations with their clinicians. If clinicians focused more on holistically recognizing and addressing CKM risk—and if that CKM risk profile could be shared across all specialties—then we would all be looking at the same snapshot and we could talk to our patients in the same language. For example, the American Heart Association recently developed a new online risk calculator for cardiovascular diseases, which integrates and quantifies the clinical impact of CKM risk factors, that has been very impactful.

I also believe care coordination is very important for CKM syndrome. If we had a CKM care coordinator working with patients to address lifestyle changes and social determinants of health and coordinating care across all of the specialties, that would be a tremendous help. In the NCQA convening, we also talked about emerging EMR-based and AI-enabled approaches that could support care coordination when we don’t have enough people to play that role.

Basically, we need to make this complexity a little bit more accessible for both patients and clinicians and help us all speak the same language in a way that makes our care more patient-centered and less siloed. Also, identifying and addressing CKM risk earlier will lead to the best clinical outcomes for patients.

Learn More

• Download our white paper, Cardiovascular-Kidney Metabolic Syndrome: Improving Quality of Care and Accountability.
• Get more CKM Syndrome resources from the American Heart Association.
• Learn more about the American Heart Association PREVENT™ risk calculator.

The post Dr. Chiadi Ndumele: “CKM Syndrome Doesn’t Respect Our Subspecialty Silos” appeared first on NCQA.