What Will It Take to Actually Build a Quality Healthcare System? NCQA's New CEO Dr. Vivek Garg Has a Plan

Key Podcast Moments

• Dr. Vivek Garg, the new CEO of NCQA, walks through the full two-year pipeline behind every HEDIS measure: evidence review, statistical modeling, feasibility testing, and independent clinical committee sign-off.
• Vivek is candid that the quality data physicians are being judged on is often incomplete, lagged by months, and built from a single EMR system that captures only a fraction of the patient's actual clinical picture.
• Vivek closes with his sharpest line of the interview: the single biggest mistake healthcare quality could make in the next five years is continuing to create measure sprawl instead of driving toward cohesion around outcomes that actually matter.

When Dr. Graham Walker introduced his guest as the second-ever president of NCQA in its 36-year history, he wasn't just setting up credentials. He was framing a question that every physician has felt but rarely gets to ask directly: who actually decides what good medicine looks like, and do they know what it's like to practice it? Dr. Vivek Garg, an internist and primary care physician who has worked at One Medical, Oscar Health, and Humana before taking the helm of the National Committee for Quality Assurance, is uniquely positioned to answer that. He has been on both sides - the clinician being measured and the operator building the measurement infrastructure - and he doesn't pretend the current system is working as well as it should.

The conversation opens with a deceptively simple question: does the United States have a quality healthcare system? Vivek's answer is careful and honest. The US has quality in pockets, driven by geography, resources, insurance coverage, and the underlying health of the population. What it doesn't have is a system. A consistent, reliable framework for delivering on the basics across every zip code and every patient panel. That gap, he argues, is exactly what NCQA was built to address, and exactly where it has more work to do. Graham pushes him on what quality even means in practice, and the exchange reveals one of the episode's central tensions: physicians know quality when they see it, but translating that instinct into a measurable, reproducible standard is where the complexity begins.

Vivek walks through a process that most physicians have never considered: a research gap gets identified, a grant gets commissioned, a scientific team reviews the evidence, prototype measures get tested against real data, and an independent Clinical Performance Measurement Committee reviews the results before anything gets added to HEDIS. The whole cycle takes one to two years. By the time a measure reaches a physician's workflow, it has been through more scrutiny than most clinicians realize. That context doesn't eliminate the frustration of being dinged for a metric that feels disconnected from patient care, but it does change the nature of the conversation. Vivek is clear that the process is open to input and that clinicians who engage with it have more influence than those who simply absorb its outputs.

When Graham raises Goodhart's Law, the idea that when a measure becomes a target, it ceases to be a good measure, Vivek doesn't deflect. He shares a story about a colleague in New York who deliberately avoided using a structured EMR field because she disagreed with how it was captured in her quality score, making her look like an outlier on paper while delivering excellent care in practice. He acknowledges that financial incentives have been overused as a lever for behavior change, and that the data feeding most quality scores is incomplete, often missing out-of-network encounters, specialist notes, and patient-reported information.

The conversation closes on primary care, AI, and what Vivek calls measure sprawl — the tendency to keep adding metrics without asking whether the existing ones are actually driving better outcomes. He is blunt that the US invests roughly 5% of healthcare spending in primary care despite it representing 35% of all clinical visits, and that no amount of measurement will fix that without real resource investment. His closing answer, when Graham asks what the biggest mistake healthcare quality could make in the next five years, is the sharpest line of the episode: stop creating measures and start creating meaning.

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Top Takeaways

Most physicians experience quality metrics as something that happens to them. Requirements that appear. Scores that arrive. Bonuses that fluctuate. This conversation is an invitation to understand the system well enough to engage with it on your own terms. Here are four things every physician should walk away knowing.