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Learn about NCQA’s shift to digital quality reporting and how Optum can help your organization stay ahead.
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[On-screen Text – Rethinking Quality in the Digital Frontier, Presented by: Shariff Baseer, VP of Product Optum, Fern McCree, Director, Digital Quality Informatics, NCQA] [On-screen Text – RISE logo displayed on each slide] [A webinar, PowerPoint slides with talking points and details, and thumbnail videos of webinar participants on the side of the screen] BAILEY FIELDS: Hello, everyone. Welcome. We'll give everyone just a few seconds to join in, before we officially get started. See the numbers coming in. Yes. Hello, hello. Welcome. We're going to go ahead and get started. So hello, everyone again. Welcome, and thank you for joining today's webinar sponsored by Optum. Today, you're going to be hearing on rethinking quality in the digital frontier. Before I turn it over to the presenters to get started, I do just want to go over a few housekeeping items. [On-screen Text – Webinar participation tips: - All participant lines are muted. To protect your privacy, you will see your name and the presenters’ names in the participant box. - To submit a question to the presenters any time during the event 1. In the Event window > Panels dropdown list > Select Q&A 2. Type your question in the Q&A box 3. Click Send] So you are going to notice that all your cameras and mics are off, and they will be for the duration of the webinar. But please, please, please, if you have any questions at all, put those in the Q&A box down at the bottom of your screen. The presenters will be happy to answer those. If there's any that they're unable to get to during the presentation today, they will follow up with you directly after the webinar. I also want to flag that you will be receiving a copy of today's recording as well as the slide deck from RISE the following day. Without further ado, I'm going to turn it over to Shariff to get it started. [Thumbnail pictures of Shariff Baseer and Fern McCree] [On-screen Text – Today’s presenters - Shariff Baseer, VP of Product, Optum - Fern McCree, Director, Digital Quality Informatics, NCQA] SHARIFF BASEER: Thank you, Bailey. Hi all. My name is Muthiulla Shariff Baseer. I'm excited to be here. Just a short introduction about myself. I lead the product team here at Optum, which encompasses of quality and member engagement. Been here, working on risk adjustment and quality solutions, for over a decade. Excited to be a part of this digital journey with NCQA and for all of our customers. Really excited to be here. With that said, I do want to also introduce Fern, from NCQA, who has graciously agreed to partner with us for this webinar. Over to you, Fern. 1 FERN MCCREE: Great. Thanks, Shariff. My name is Fern McCree, Director of Digital Quality Informatics at NCQA. I've actually been at NCQA for about 10 years now, and my work focuses on development and maintenance of quality measures, and more specifically, our transformation to digital quality measures, and also how do we best pull in and leverage more structured clinical data in our measures and be able to meet a various set of different use cases. I thank RISE and Optum for hosting and collaborating with us at NCQA for this very important discussion. I’m really looking forward to this conversation. SHARIFF BASEER: Absolutely. Thank you, Fern. So without further ado, we would like to start off with our first poll of the day. Health plan [On-screen Text – How would you describe your organization? - - - - - - Industry analyst Provider Provider-Sponsored health plan Vendor Other] I know we have quite a few participants on. Would love to know how would you describe your organization you're a part of? I'll give it another 10 seconds. [PAUSE] Awesome. So I do recognize that we have a great mix of health plans, providers, vendors and other specific partners on here with us. First and foremost, appreciate you guys spending time and attending this webinar and just being a part of this. Hopefully all of us will walk away with a greater understanding of what to expect from the digital transition and digital quality aspects and great bit of knowledge here. So with that said, I do want to tee up the next conversation in terms of what are the current problems you're facing in this current space we are in and why digital quality now and like what's the focus of it? So Fern, getting into more of what is digital quality and why digital quality, could you speak to this a little bit? [On-screen Text – Why digital quality? - Quality has been fragmented and burdensome - - - Emerging standards and regulations are enabling a digital transformation Quality will be better aligned with care delivery and a learning health system Will lead to reduced burden and costs, improved alignment, more relevant measures and improved care and outcomes] FERN MCCREE: Absolutely. And that's the key question and why this conversation is important is digital quality or quality, why digital quality is important is because quality, we know has been fragmented and burdensome across systems. And we're seeing how emerging standards and regulations are helping to enable digital transformation, such as the 24th Century Cures Act, or FHIR, or USCDI, just to name a few. And so with digital, quality can become more aligned and better aligned with care delivery, as well as a learning health system, and will help reduce burden and cost, again, improving 2 alignment, and getting to better measures or more relevant measures that can support improved care as well as focusing on outcomes. And so that's why this is a very important discussion. SHARIFF BASEER: I think from the lens in which we're looking at it, and especially looking at it from a product lens standpoint, the fact that we are focused more on transformational strategy and looking at the digital forefront of this rather than, hey, it's regulations and what NCQA is really trying to drive is beyond the regulatory attributes and into more of that care outcomes and actual improved care is truly fabulous to see that we're a part of this journey and we're in this journey right now. In terms of market readiness and like what is the take on why act on it now? Industry feedback [On-screen Text – Why now? Need for changes indicated by the market - o The market is asking for reduced measure burden, a more effective learning health system, and more support for value-based care - - Maturity of standards o The industry has taken steps to adopt interoperability standards as regulatory forces drive investment, and quality is the top use case Payment arrangements o The financial shift from fee-for-service to [text blocked by video inserts]] FERN MCCREE: That’s important. This is a very pivotal moment in health care transformation, as we all know. NCQA and our framing of this shift is strategic and timely. And so there are different forces that are converging right now and really driving the digital quality evolution, which is making this the right time for change, if you will. Some of those key forces, first, we're listening to the industry. The market is asking for more efficiencies and reduced burden, and also more effective support for a learning health system, one where quality can be aligned across the health care system and support a range of different use cases. Also, the maturity of data standards, as I referred to earlier, this has evolved substantially over time in the last few years, and we think we're at a point, where based on both the maturity of the standards and policy decisions, that those aligning can really support this transformation. And then lastly, continued trends in payment arrangements towards value-based care and also a desire from organizations that want to continue their journey from fee-for-service to more value-based incentive models, is also really putting pressure on the quality enterprise to evolve and meet those needs. So I'll say, really in short, the industry wants smarter, simpler, and more useful ways to better measure care. And now we have not only the tools, but also the motivations and incentives to really make that happen. SHARIFF BASEER: I truly appreciate how NCQA has actually looked at this from a forefront of value-based care and trying to say, hey, here's how we can play a part in this value-based care journey, where everyone is trying to evolve and move towards that outcomes-based measurement. It's fantastic to see that. Can you talk a little bit about in terms of just NCQA's transition on this forefront? 3 [On-screen Text – Digital quality benefits - Lower cost, burden, variability: Paper to software o Measures content can be developed and distributed smoothly to reduce interpretation, development and maintenance needed today. - - Support full learning health system use cases: New architecture o Measures content that can be configurable and used in different workstreams for different use cases, including quality improvement, population management and analytics. Better value-based care support: Better measurement system o Quality measures must move beyond signals or gates [text blocked by video inserts]] FERN MCCREE: Absolutely. So again, we are understanding from the insights from the market and communicating with our customers and getting feedback from our customers. It really signaled three key areas where NCQA can support and where we are supporting currently. So first, the market wants simpler, more affordable ways to be able to manage quality measures. So we are addressing this by shifting from paper-based processes to digital tools. So the digital content services is a software platform that is used to distribute digital measure content, and so digital content services, as well as digital HEDIS measures, help to reduce interpretation, development, and maintenance costs. And we'll get more into that a little later, I'm sure. And then also being able to support more use cases. Quality measures need to work across different teams and different use cases and purposes. So from care management, care improvement, quality improvement, population health and analytics, for example. And so we're building measures that are more flexible, that can be more configurable to support these different workflows. And thirdly, creating better measures, again, for value-based care. So quality measures today are signals or quality gates, but they don't meet the evolving value-based care needs. And so, NCQA is developing, working to develop more relevant measures and more measures that are more connected and consistent. And these measures will work better across different care settings, as well as different accountability models, helping payers and providers be able to focus more on improving outcomes. SHARIFF BASEER: Absolutely, and I should really take a moment to highlight the partnership with NCQA, which Optum has had. Obviously, we partner with you guys to do traditional certification. We are beta vendor partners with you guys, so we are very well-versed with the paper to software. And being a part of the early adopter program for the digital content services and now continuing that digital content partnership has truly helped us evolve. I can tell you that it truly matters and it makes a huge difference in terms of how NCQA is looking at it, to our actual products and services, which we have to offer. We are able to truly see this delineation and differentiation between digital quality versus traditional. So that's fantastic. Can you share a little bit in terms of timelines? What can we expect, when? [On-screen Text – Transformation from traditional to digital HEDIS® - Traditional HEDIS, Since the 1990s o Claims data 4 o Chart chasing/hybrid reporting o Non-standard local. Health data environments o Traditional “paper-based” technical spec o Retrospective and focused on reporting VS. - Digital HEDIS, By 2030 o Claims, HER and other sources o Automation and interoperability/ECDS o Migration to FHIR based data sources o Digital quality measures o Prospective and focused on quality improvement *HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)] FERN MCCREE: Thanks, Sariff. We definitely appreciate the partnership as well. So, yes, so as we move towards this future state, NCQA has set a goal to transition to a fully digital HEDIS measurement system. And we've set a goal by 2030, year 2030. And at which point we would be distributing our measure content fully, in a fully digital way. And so what does that actually mean? So that means going from traditional HEDIS to digital HEDIS. That means going from claims data to using EHR and other sources in addition to claims data, so a more comprehensive set of data sources. Going from chart chasing and hybrid reporting to automation and interoperability and ECS reporting, which I know we're going to be able to dive into a little bit later as well. Going from needing to adjust to local health data environments to migrating to FHIR-based data sources that can create more standardization across systems. It means going from traditional paper-based technical specifications that need interpretation to NCQAdelivered digital quality measures. And then lastly, it means going from retrospective quality measurement to focusing on prospective quality improvement. [On-screen Text – NCQA’s digital transition phased approach - Phase 1, Digital Introduction, Measure Year 2023 o Current Early Adaptors o Subset of measures o Reference CQL Engine through Digital Content Services for measure processing - - Phase 2, Digitally Enabled Measure Years 2024-2026 (We are here) o Admin components of measures fully digital o Digital measures (dQMs) delivered through Digital Content Services o Addition of Pre-Certified & Digital Certification o Ability to use digital measures for health Reporting o Can use any supported CQL engine for processing Phase 3, Fully Digital, Measure Years TBD o All measures fully digital o Hybrid measures retired and replaced with measures using full population data collection o Option to maintain traditional development and certification 5 - Phase 4, Digital Only, Measure Year 2023 o Sunset traditional HEDIS® Volume 2 paper specs o Sunset traditional Measure Certification] So I do want to just double click on that a little bit more, just on how we're going to go about that because we can't flip a switch and all of a sudden everything is digital. So I want to speak to that a little bit more, in terms of NCQA's pathway. We've created, as you can see on the slide here, we've created different phases to support organizations through this transformation. So within the HEDIS ecosystem, there is more than the measures. And our phased approach supports all of these different components and the different operations of the HEDIS lifecycle that have to evolve as we do this transition. And so we're currently in phase two, where all administrative components of measures as well as the ECDS measures are available in a digital format. We've also released guidelines for organizations that are ready to start using dQMs for health plan reporting. And we're also focusing on, in this phase, providing resources to support the transition. And so I want to note, it is important to just remember, as we've outlined these different phases, that each organization will be at a different phase and maybe have different timelines, depending on their specific environment. That's why we've sort of laid out this timeline, in these different phases, to support that. SHARIFF BASEER: And I should definitely say, when we first heard about this digital transition roadmap and this view came about from NCQS webinar, I still remember it. Very, very anxiously sitting in that meeting saying, hey, are we really prepared? And now, sitting here on September 2025, I can confidently say that so far so good. We're in phase two. FERN MCCREE: It's good to hear. SHARIFF BASEER: Especially with everything, how this has all evolved across the board, it's been fantastic. And I think this is a real good tee up to our next poll question, in terms of how prepared are you for the digital transition? [On-screen Text – How prepared are you for the digital transition on a scale of 1-5? 1. Not prepared at all – is the digital transition 2. Not prepared 3. Neutral 4. Actively pursuing the transition 5. Plan in action – ready to go live!] We would love to understand more from the audience today to essentially gauge where everyone is at in terms of their digital transition journey. [PAUSE] Give it 10 more seconds and then we can share the results. Fantastic. As you guys can see, a lot of the folks on the webinar today are actively pursuing the transition, which is great to know. The fact that NCQA has enabled us to actually have digital measures made available live to them and the fact that everyone has access to digital data and the CQL engine itself, 6 essentially, is fantastic to hear. And we are on the right track. We are where we wanted to be in phase two of the journey we are in when it comes to digital. [On-screen Text – Optum perspective on digital quality - Digital data orchestration o Aggregating and normalizing data from EMRs, claims, labs and thirdparty sources to meet NCQA validation standards o Building FHIR/HL7-compliant systems for robust data exchange - - - Smooth digital engine o Parallel reporting and testing run between traditional reporting and digital results for identifying discrepancies and benchmark performance Prospective supplemental data collection o Support shifting from hybrid medical record reviews to current-year gap closure, and standardize an electronic source for ECDS use o Reduce administrative burden and cost by leveraging AI/NLP capabilities for clinical abstraction o Enhancing quality performance while reducing administrative burden for both health plans and providers Comprehensive o [text blocked by video inserts]] As we get into this digital space, I do want to spend a little bit of time in encapsulating everything, what Fern just discussed right now when it comes to digital quality and acknowledge a few areas where we've been spending a lot of time on. When it comes to Optum's digital quality journey, we've kind of divvied it up similar to how NCQA has as well, to look at what can we do to help the industry in terms of digital data orchestration. Obviously, we have a lot of EMR aggregators, we have a lot of EMR connections, and the access to EMR data is in abundance. Trying to have the ability to orchestrate this data, acquire this data, and building that FHIR HL7 compliant systems to be able to orchestrate and exchange data is a key big bet which we are taking from a digital quality standpoint. The second aspect of this is when we talk about the NCQA’s reference CQL engine, when we talk about a CQL engine and moving away from our traditional reporting and traditional measure engines. Having the ability to recalibrate results and ensure that there is some sort of parallelism and some sort of way to compare and contrast the two and come out with an understanding of what to expect, and come up with opportunities and improvement areas, and doing that now, in 2025, rather than in 2030, when the sunset has already taken place and we don't have a reference point, is going to be hard. So what we're really looking to do is that smooth digital transition while we have access to the traditional measures, while we have access to the engines, and we can recalibrate year-over-year comparisons and all of these things with what we do. One of the big shifts, and I know this is our next topic to discuss, is ECDS reporting. While we focus on the digital frontier and digital forefront, we also are moving away from something which has been a cornerstone of the quality business, which is hybrid measurement and hybrid reporting. So while we are looking in all of these aspects, the shift towards perspective and focused initiatives on perspective quality improvement initiatives and quality performance is becoming key. So that's essentially how we're 7 looking at it. And at the same time, we've also recognized that these cannot be individualized services. We have to look at this digital quality transition as a more comprehensive, more holistic journey, where everyone has to adapt to it starting from the get-go of do we even have access to digital data, to are we focused on it from a prospective standpoint, and are we utilizing the CQL software the way it needs to be? So this is how we, as Optum, are essentially looking at our digital quality journey. Again, would love to share more with the use of AI within our products and services and where we are going. With that said, I do want to tee off another poll question to identify what's the familiarity of ECDS? [On-screen Text – How familiar are you with ECDS on a scale of 1-5? 1. What is ECDS? 2. Not too familiar 3. I know the term, but not entirely sure how this [text blocked by video inserts] 4. Somewhat familiar 5. Very familiar] Do you guys have a great understanding of ECDS reporting and what that means to your organization? [PAUSE] I'm going to give 10 more seconds. I do see a lot of, at least 50% or more, 60% of our audience is somewhat familiar or very familiar with ECDS, which is fantastic. This, I feel, is an opportunity for all of us to get at 100% by the end of this portion of our webinar, because we are going to spend a little bit of time talking about ECDS and where our quality world is headed towards. So over to you, Fern, to provide your expert opinion on ECDS and what this means to us. [On-screen Text – Leveraging electronic clinical data for quality measurement - The digital transformation includes the tradition to ECDS reporting method to encourage the use of real-time clinical data and improve the accuracy and timeliness of quality reporting. - - Over time, hybrid measures will phase out to reduce the need for manual and reviews and emphasize interoperability between healthcare systems and providers. Electronic Clinical Data Systems (ECDS) is an HEDIS reporting method that encourages the use and exchange of structured electronic health data.] [Image with “Health Plan Reporting” in the center, with four categories surrounding it: PHR/HER, Case Management, Clinical Registers/HIE, Admin/Enrollment] FERN MCCREE: Great. And thank you, everyone, for responding to that poll. It's helpful to kind of see there's a spectrum of experience with ECDS, from those that might just be getting to know the concept, to those that are pretty familiar with the measures. And, Shariff, I really like how you framed it as this is a journey and it's also multifaceted. And one of those first steps to getting to digital quality measures is first getting access to the data, getting access to the data in a structured field and structured format is really the first step or one of the first steps to being able to consume digital content. And so the digital transformation, NCQA's digital transformation does include the transition to ECS 8 reporting, the ECS reporting method to encourage the use of real time clinical data and encourage and improve accuracy and timeliness for quality reporting. So as noted, over time, we're going to be phasing out of hybrid measures as we shift to ECDS reporting, to reduce the need for manual chart reviews, which we know can be burdensome, and also emphasize interoperability across systems. And the Electronic Clinical Data Systems reporting method, or also known as, for short, ECDS, was developed about 10 years ago to address this need to leverage clinical data, because claims data could be limited in what insights it can provide. So it really required a new reporting method that could encourage and incentivize the use and exchange of structured electronic health data, so from EHRs, registries, and other sources, and enable the advancement of measures that can focus on health outcomes. SHARIFF BASEER: Absolutely. And Fern, I go back to the time when I started off with quality, and when obviously CDS has been around longer than the digital transition itself, and I had to essentially Google this to understand what's the difference between hybrid versus admin versus ECDS. And I know that now it's becoming even more of a discussion topic. So I would love to hear from the experts themselves in terms of how do we understand these differences between admin, hybrid, and ECDS? [On-screen Text – Understand the difference in the reporting methods in HEDIS - Administrative (Administrative + supplemental) o Population: Full eligible population o Data sources: Supplemental data can’t be used for the denominator o Data format: Allows the use of data in nonstandard formats and layouts o Data sharing: No data-sharing mandate - - Hybrid (Administrative + supplemental + medical record review o Population: Systematic sample o Data sources: Supplemental data can’t be used for the denominator o Data format: Allows the use of data in nonstandard formats and layouts o Data sharing: No data-sharing mandate ECDS (Administrative, EHRs, HIEs, registries, case management) o Population: Full eligible population o Data sources: All relevant data sources can be used for any part of the measure o Data format: Promotes the use of data stored in structured electronic formats that use standard layouts o Data sharing: Bidirectional data exchange, Data must be available to the care team upon request] FERN MCCREE: Absolutely. And we definitely want to be able to describe what do we mean when we refer to the ECDS method? So when we are talking about ECDS, this is a specific set of not just measures, but these are a specific set of guidelines for HEDIS reporting that have some differences. There are some similarities, but there's some key differences from the traditional methods. So I'm referring to the administrative method and the hybrid method. So here on this table, we are highlighting some of those key differences between the three methods and particularly what kind of makes ECDS 9 achieve those objectives that I just mentioned. So I'll kind of just walk through some of these differences, from top to bottom. So first, starting with the measure population, I think this is probably the biggest difference when we're talking about the difference between hybrid and ECDS, particularly. So the hybrid method is calculated based on a systematic sample of members, while the administrative and ECDS methods are calculated based on the full member population. So, of course, the hybrid method, you're doing medical chart extraction to pull in that clinical information. Of course, it's kind of burdensome to do that for your full member population and so that's why it's calculated based on a sample. But for ECDS, the full member population is key because that leads to more comprehensive and real-time insights. So then we can talk about the data sources. One other difference to point out is the use of clinical data sources in terms of the guidelines. So for the traditional methods, so both the administrative and hybrid methods, plans can use administrative data and they can supplement their numerator counts and their exclusion information with information or data from other non-administrative data. So that's referring to the EHR registry and other sources. We call that supplemental data. So you can supplement your numerator and exclusion information with supplemental data. But that supplemental data cannot be used to define your denominator population. For the ECS method, this framework is really to allow non-administrative data, that could be called supplemental, it allows those data sources to be used for any part of the measure specification. So you can use it for your numerator exclusions and also your denominator. So this is meant to be able to incorporate more data to get greater insight and on-care for your target population. I'll move on to the data format. So, the administrative and hybrid methods, they allow data to be used or data use to be used that might be in non-standard formats and layouts, while ECDS is intended to promote the use of data that's stored in structured electronic formats that are using standard layouts. And this, lastly, is data sharing. So the ECDS guidelines do require that data be available or made available to the care team upon request. And this is to enable bi-directional exchange of information, not just sharing of information for quality reporting. So no such requirement exists for the traditional method. [On-screen Text – Planned timeline to sunset hybrid reporting method. Goal: Hybrid measure specification and reporting method removed from HEDIS by MY 2029] [Table showing the timeline of “Remaining hybrid measures” by year: MY 2025, MY 2026, MY 2027, MY 2028] Even further on that point, when we're thinking about ECDS and how it may differ from the other reporting methods, I want to share that we're focusing on the hybrid to ECDS transition as you think about those differences, because we understand that some organizations may rely on clinical information that might be found in manual chart abstraction for reporting. So we want to be very careful with that transition away from the hybrid method. So we've outlined this timeline to remove the hybrid method from HEDIS by measurement year 2029. And as you can see, this is a multi-year timeline, and we also have different pathways for the measures. So, different years in which hybrid is going to be removed, but then also there's different directions or different ways in which that's going to happen. So, some measures like the lead screening and children measure, which 10 just recently became ECDS only, that one just went directly to ECDS. We'll have some measures that actually go to admin only, so we'll remove the hybrid method, but it'll still be reported using the administrative reporting method. And then we have some measures, sort of near the end of this list here, where we're going to be developing new ECDS versions of the measure, introducing those into HEDIS first, before we remove the hybrid measure later. So there'll be like a transition period, for about two or so years, where both versions of the measures are reported at the same time. And this is actually something we've done for other transitions in the past. So this is sort of to help organizations with that, prepare for that transition away from relying on the hybrid methodology. And we'll continue to communicate these updates along the way as we proceed through the timeline. [On-screen Text – Measures that use HEDIS ECDS reporting method, Measurement year 2026 - - - - - Behavioral health o Depression Screening and Follow-up for Adolescents and Adults o Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults o Depression Remission or Response for Adolescents and Adults o Unhealthy Alcohol Use Screening and Follow-Up o Prenatal Depression Screening and Follow-Up o Follow-up Care for Children Prescribed ADHD Medication o Metabolic Monitoring For Children and Adolescents on Antipsychotics o Tobacco Use Screening and Cessation Intervention Preventative screening o Breast Cancer Screening o Colorectal Cancer Screening o Cervical Cancer Screening o Documented BI-RADS Assessment Mammogram o Follow-up After Abnormal Mammogram Assessment o Lead Screening in Children Health equity o Social Needs Screening and Intervention Immunization o Prenatal Immunization Status o Adult Immunization Status o Childhood Immunization Status o Immunization for Adolescents Management of chronic conditions o Blood Pressure Control for [text blocked by video inserts] o Follow-Up After Acute Care [text blocked by video inserts] for Asthma o Statin Therapy for Patients [text blocked by video inserts] o Statin Therapy for Patients with Cardiovascular Disease o Blood Pressure Control for Patients with Diabetes] 11 And I'll note, so there's many different things that we factored in as we thought through this timeline. And again, this is something we're continuing to evaluate. But one of those key considerations that we considered is the existing ECDS measures. So as I mentioned, we introduced ECDS in, I think it was 2015, to be exact. Started with just a few measures, now we're at 25 measures that are now available for ECS reporting. And so we have taken those learnings from these measures along the way from these previous ECS transitions to help frame the hybrid transition. So here we're just showing the full list of measures today, as of measurement year 2026, so the most recent publication that was released in August, that are now available for ECDS. So you have some measures that are completely new concepts, so we developed them from the beginning, within this framework. And then we have some concepts that we actually, that were traditional measures that we have transitioned to the ECDS method or are in the process of doing that. So you can see they cover a range of different clinical domains and content areas now, and also different populations that are covered. We definitely have taken these measures to help guide our overall transition as we think about the entire HEDIS measure set. SHARIFF BASEER: This is fantastic, Fern. One of the things I do want to call out, for somebody who basically has to look at our strategy at the measure level and essentially come up with an approach to improve that care at that individual measure level, the strategy in terms of where we introduce ECDS along with the traditional measures, where we move them to ECDS only. And the introduction of these new measures as well, with these additional data sources and just the fact that we have upped the amount of data sources to tap onto right now and we are not restricted or caged to just say, hey, unless it's this, you can't really do much. I'll tell you this. It's tremendously helpful on our side to be able to essentially say, bring in more innovation, bring in more ideas to the table to improve the care we provide to the members that truly make a difference in the member’s life. I think this is what is moving the needle more than anything else. And to that point, I do want to see if you could share a little bit in terms of how this introduction of this clinical sources and the data is influencing a variety of different measures in different ways. Obviously, there are a few measures which only use one aspect of this, but there are others where clinical data is highly reliant on. Primarily claims-based [On-screen Text – Use and reliance on clinical data varies across ECDS measures - o Breast Cancer Screening o Follow-Up After Acute Care Visits for Asthma - - Relies heavily on clinical data o Blood Pressure Control for Patients With Hypertension o Adult Immunization Status Only uses clinical [text blocked by video inserts] o Depression Screening o Tobacco Use Screening an Cessation Intervention] FERN MCCREE: No, this is a great segue. I think one thing that we love to clarify when it comes to ECS reporting is not only do they cover different range of clinical domains 12 and content areas, but we've been evaluating and trying to understand feasibility. And as we pull in more of these clinical data sources, what does that mean for being able to implement the measures? And it is not the same across the measures. So one of the key factors to understand how to best implement these measures and pull in these sources is understanding how much the measures rely on clinical data. So the use and reliance on clinical data sources does vary across the measures. So we do see a spectrum of data use. This slide is really visualizing that. So you have some measures that are still primarily claims-based. What I mean by that is you can use clinical data for them, but they are well represented using the administrative data that's available, that's readily accessible to health plans to use. We just put a few examples under each of these buckets to give you some insight of kind of what we're referring to. And then you have some measures, in the middle bucket, that there's claims codes to represent those concepts, but plans still rely heavily on clinical data. And that could be for a few different reasons. One could be that the available codes that do exist are just not being used. That could lead to measures that have a large contribution from these other sources or where there's a reliance on medical record review, for example. And then lastly, this last category are measures that are exclusively using clinical data for some of the concepts. So this is common when we're looking at behavioral health measures or behavioral health screening measures that have a result for a PHQ-9 score or something like that, where you're not going to find that in a claim. And so you have to really rely on, completely on other sources to be able to report. So it really just depends on the measure, but also how much of that data is being used. Also, how much of it is actually structured. So that's also a key. So that's why it's really important to understand it at the measure level. SHARIFF BASEER: It’ll be really good for us to spend a little bit of time and just going through the trends and the data available to you guys because of the fact that we've had ECDS turned on for some time. Would love for you to just walk through these reporting trends. [On-screen Text – ECDS reporting trends *For more reporting results, visit the ECDS webpage: ncqa.org/ecds. Special Report: Reporting Results for Measures Leveraging Electronic Clinical Data for HEDIS®] [Bar graphs: - - - ECDS reporting across health plans is increasing, across all product lines Increased use of nonclaims data sources Better performance with clinical data] FERN MCCREE: Absolutely. This is the fun part, is being able to look at the data for us and understanding what we're seeing in the reporting. So we've been evaluating the ECS reporting over the years, the annual reporting, to just get a better understanding of implementation. So I'll just share some key observations. One is we're looking at just the adoption in general. So reporting is increasing. More plans are reporting ECDS measures each year. So we start to the left, is the figure I'm referring to. We're just showing a subset of measures, but you can see based on that bar chart, looking at the blue bar, which represents the most recent year of data available, we're seeing an increase in submissions 13 for those measures. There's a few different factors for that, becoming exclusively ECDS or moving to public reporting as we look at the broader range of measures, but we are seeing more participation. And that's really key. That's the first step is being able to really try the measures out and report them, to kind of identify those opportunities for improvement. And then we'll move to the second data point we want to highlight, which is there's an increase in other sources of data beyond claims that are being used. So we're actually able to, we've been able to see the different contributions of those four different categories of data sources, claims, EHR, case management, and HIE registry data, we've been able to see kind of how much does that contribute to each of the measure elements. So, for example, how much does it contribute to the numerator? This figure in the middle is showing for the colorectal cancer screening numerator, we're seeing that there's actually been more use of non-claims data over time. So that's represented by that gray box getting larger across the measurement years from 2020 to 2023. We're seeing more contribution from those sources. Again, this varies across measures. And then this is an important data point because we've seen and generally we've seen better performance when other sources are being able to be used. You can see here on the third bar chart to the right that we're looking at the three cancer screening measures that are available for ECS reporting. And there's actually a slight increase. So these are actually measures that are well represented by claims. So not the biggest difference, but there's still a little bit of a difference in performance when plans are using those other sources, incorporating those other sources. And we've seen bigger differences across other concepts. So just really interesting, and we're continuing to evaluate this. I'll note, and we'll provide a link to you, we have more data to share, so that's actually available on our ECS webpage, where we actually have a special report that dives into more detail around some of these reporting insights. [On-screen Text – Hybrid reporting trends - Hybrid lift is the influence of manual medical review on the performance rates - - Hybrid lift varies across measures but has decreased over time. *For more reporting results, visit the ECDS webpage: ncqa.org/ecds. Special Report: Reporting Results for Measures Leveraging Electronic Clinical Data for HEDIS®] [Chart showing: Controlling high blood pressure (CBP)] So that's kind of the ECDS reporting trend. And Shariff, so I want to talk about the hybrid reporting trends. I know folks are really interested in what does this mean as we move away from the hybrid method into ECDS. And a lot of those measures I showed you haven't yet, we haven't yet actually collected any measure, any data related to ECDS because they're not available for ECDS yet. We’ve been looking at the hybrid data and specifically what's called the hybrid lift. So the hybrid lift is defined as that difference in performance when including medical record review versus not. So this actually provides a really good, just an indication, proxy of how much plans are actually relying on manual chart review for reporting, which can give some insight to what the potential impact may be once the hybrid method is removed. We've actually seen that the hybrid lift across those measures, so we did a review of this, of all eight measures, is generally decreasing. 14 It's decreasing over time, showing that plans are using more structured data. They're reducing less on medical record review over time. Here we're showing the controlling high blood pressure measure, which has seen about a seven percentage point decrease in that lift over the last three years. So just an interesting data point we're trying to just use as we better understand the impact of moving away from relying on chart review. [On-screen Text – Summary: ECDS reporting - ECDS is a set of guidelines for HEDIS reporting that enable improved use and exchange of electronical clinical data sources. - - - NCQA is phasing out the hybrid method to reduce the need for manual data reviews and emphasize interoperability between healthcare systems and providers. Dependency on medical record [text blocked by video inserts] is decreasing while use of structured clinical data is increasing] The ECDS reporting method continues to evolve to support a broader range of customers and use cases beyond plan reporting] So again, we will provide the links. We do have more data to share that's available on the ECDS webpage, also around the hybrid reporting as well. I know that was a lot, so I wanted to just summarize the ECDS, what we've talked about with the ECDS topic here and the strategy. So again, ECDS is a set of guidelines for HEDIS reporting to better enable the exchange of structured clinical data. We're phasing out the hybrid method to reduce the need for manual data reviews and really emphasize interoperability and data exchange. We're seeing, as noted before, we're seeing a smaller reliance on chart review over time, and that's a great signal that we're happy to track in seeing more use of structured data. And also, just overall, the ECDS method is a bridge, and it continues to evolve and continues to really expand to support a broader range of customers in use cases beyond health plan reporting. SHARIFF BASEER: Absolutely. Thanks a lot for this, Fern. And one thing what I also want to call out, going back to our first slide, like why now and where is the differentiation and how are we trying to get embedded within this journey of moving more towards outcomes-based, value-based care journey. I'll tell you this. In the current phase we are in and with what ECDS brings to the table, more than anything it's the proactive aspect of this. Basically having the ability to decouple or de-link the hybrid dependency on medical record review, having the ability to look at it in a prospective lens, and utilizing multiple data sources truly, truly helps us bridge that gap. You termed it correctly when you closed this out in terms of a summary. ECDS has truly been that bridge between the two to get us on this journey while we are trying to navigate through our understanding of FHIR and understanding of what this means as we move in. [On-screen Text – Optum perspective on ECDS - Client viewpoint and challenges on transition from hybrid reporting - Optum Offers Continuity of Care Document (CCD) as a service that sources CCD-A documents as supplemental data sources 15 - Optum is expanding options for [text blocked by video inserts]cycle data collection as a supplemental data source o AI-assisted abstraction] One of the things what we've really started to do and when we looked at it from an Optum standpoint is, what are the transition challenges which the customers are facing? We obviously have quite a bit of our current customers who are probably also on the webinar today. We've restarted and we were like, hey, how can we help? We are recognizing the trend that we are needing to be more proactive, more prospective, more towards the CCDS reporting trend. And I do want to also call out, like when we move away from hybrid, what we do not want to neglect is the impact in terms of budget and financials, if we don't actually have a plan of action in place. So we are not only saying, hey, we have a plan for you to move away from hybrid, but we also are trying to see how we can do this in the most cost effective and the most impactful manner. And that's essentially where the CCD as a service or leveraging CCDs as a data point, a data source for our current existing customers is becoming one of our key pivots, which we are having to do since 2024. And we've been pretty successful in introducing this and decoupling that hybrid lift and using that as one of the CCD channels. Obviously, we wanted to ensure that our supplemental sources and the structured data sources are going up, but we also wanted to pivot our focus towards what about the unstructured data? What about data which we have access to, which is beyond our traditional data sources. And this is the place where we are like what place to start off with is the access to CCDA documents itself. And to the same point, while we're moving into ECDS reporting and focus more on that for full population reporting, one of the things what we also wanted to see is how can innovation play a big part in it and how can we essentially introduce AIassisted abstraction capabilities to one, create more efficiencies, two, evolve the product to use AI to basically be more effective, precise, and accurate in terms of what we're trying to capture and do the auto cycle data collection, like be more prospective, proactive. That's the only way we can, essentially, be ready for the CCDS transition and shift. Obviously, it really helps with how NCQA has teed it up with doing this in a very phased manner, giving health plans and the members and the providers and everyone within the health care ecosystem that time to get phased out of hybrid. But again, we’ve been talking to everyone in the industry and in the market, and we're like, we got to do this now. Although there is this reliance on hybrid, we need to start moving away from that hybrid dependency as we prepare up for 2029. So at least this is exactly what we've been up to in terms of ECDS reporting from an Optum standpoint. One of the key challenges, I know, as we are talking about the digital topic is, what is our readiness for FHIR? [On-screen Text – Do you have a plan for FHIR data transformation? 1. Yes 2. No] So I do want to create another poll, and this is going to be a yes or no answer to this. Talking about FHIR data transformation, I know we've spoken a lot on ECDS, but let's talk CQL and FHIR next. [PAUSE] I know it's essentially an introduction of digital 16 quality, talking about ECDS, where a lot of the audience is familiar with. And now we're basically getting into that expert level phase of digital quality. So it will be very interesting to see the poll results. Thank you for everyone who participated in it. We do recognize that 55% of the people who voted at the moment are on the no side. It's okay, we're early in this journey. This is a transition journey and it is a phased journey, so that is fantastic to actually see. But hopefully, again, as we've teed up already, we want to spend a little bit of time talking about CQL and FHIR. And the key topic we want to kick us off with is what are dQMs? We’ve heard a lot about digital quality measures. Fern touched on it a couple of times. Let's spend a little bit of time with our expert in our panel today, Fern. How would you best describe dQMs? [On-screen Text – What are Digital Quality Measures (dQMs)? - Digital quality measures… o Rely on standards-based data exchange format (Fast Healthcare Interoperability Resources or FHIR) o Are written in a machine-interpretable language (e.g., Clinical Quality Language or CQL) o Incorporate data concepts/terms (e.g. value sets) required to calculate the measure o HEDIS dQMs are currently available through NCQA’s Digital Content Services.] [Graphics with words corresponding to each: two gears fitting together: Easier deployment of [text blocked by video inserts] in health IT systems] a dartboard with an arrow on the bullseye: Reduce interpretation, recoding, human error an icon of a finger pushing a button: Standardized to ease use of health care organizations] FERN MCCREE: Great. No, thank you everyone for responding to the poll. And again, I also agree it's definitely okay for those that haven't yet started your FHIR transformation. I promise we're not going to get too technical. Hopefully what we're talking about here is getting your little spinning of where you are and what you can do to continue or build that out. And so digital measures. So we're kind of switching gears here. Digital measures are a version of just traditional measures that rely on a data that's in a standard format. So digital quality measures are aligned with the FHIR standard. They're also written in a machine interpretable language, so clinical quality language is the syntax. And they incorporate standard data and concepts that are required to calculate the measure. And dQMs are valuable because they take away the need for organizations who are executing HEDIS measures to the need to have to interpret the value to specification and encode them themselves. And so the dQM is available. It's already made available to include that measure logic and ready to be executed. HEDIS dQMs are currently available through NCQA's digital content services, which is a cloud-based delivery mechanism where we provide or offer accessibility to HEDIS digital measures. I won't be going into too much detail about that today, but we'll provide you lots of links so you can learn more about 17 DCS or digital content services. But, really, the digital measures are a key foundation of the digital content services platform. SHARIFF BASEER: This is fantastic. When I heard digital quality measures, it's truly what it says. It's essentially digitally enabled data exchange, digitally enabled analytics or the measure logic itself and how the measures are calculated. And the results are also digitally enabled. So it's like the whole package of it. And, obviously, we've touched on digital quality measures within Optum and it's been a fantastic journey. One thing which I do want to also speak about a little bit, and Fern would love to get your thoughts in terms of like, how do you best describe this conjunction between FHIR and CQL? Like for a layman to understand, hey, CQL, is it similar to what's already known in the industry and how is FHIR leaning into it? [On-screen Text – What is FHIR-CQL? - FHIR: Stands for Fast Healthcare Interoperability Resources, a nextgeneration interoperability standard created by the standards development organization Health Level 7 (HL7). – Data model o FHIR enables systems to “speak the same language”, make data exchange faster, more consistent and interoperable - CQL: Clinical Quality Language (CQL) is a high-level, domain-specific language focused on clinical quality and targeted at measure and decision support artifact authors. – Syntax o CQL standardizes how measures are calculated.] FERN MCCREE: Right. So FHIR CQL, the two main components of a dQM is FHIR, which stands for Fast Healthcare Interoperability Resources, and CQL, Clinical Quality Language. And so FHIR, that is an HL7 standard for exchanging health care data electronically. It groups health information into modular resources that can be shared across different systems. And it allows for EHRs, payers, and health plans and providers and other systems to be able to essentially speak the same language. So, making data exchange more quicker and accessible and consistent as well as interoperable. And then CQL, Clinical Quality Language, that is the syntax, that is the human readable, computer interpretable language for expressing the measure, the quality measures or the logic for the quality measures, as well as for clinical decision support. It describes how to calculate the measure, who is in the denominator, who qualifies for the numerator. So it also ensures that quality measure requirements are precise, they're shareable, and then they're also standardized so that different organizations are calculating the right results consistently, with reduced burden in doing so. SHARIFF BASEER: And for me it's like when I look at CQL and FHIR together, the gray area is gone. We’re moving away from the grays of interpretation and questions. It's more standardized. It's a piece of code when it comes to CQL, which is standardized measure calculation logic within it. And then FHIR, as we all know, has been the Holy Grail when it comes to organizations trying to adopt to something which is more holistic across the health care ecosystem itself. And the fact that we're on this journey together, trying to align to that FHIR HL7 format and utilizing CQL is just fantastic. One of the 18 other questions I know, I keep having to talk about and clarify to folks outside of the quality world is how can we best describe the shift between ECDS, which is where we spent a lot of our time just talking through, and dQMs. What’s that journey looking like? What's that marriage and how do you see them fitting together in the future? [On-screen Text – Summarizing key distinctions between ECDS and dQMs - ECDS: Reporting method, What data can be used/where can data be pulled? o Structured data - dQMs: Measure format, How should the data be represented in code? o Standardized data] FERN MCCREE: This is definitely a key point. These concepts are similar, but they're not the same. I can just sort of distinguish them. So ECDS, again, that's a reporting method that is used to provide guidance on where do you pull the data and how it can be used for quality reporting for HEDIS. It focuses on getting information to be structured, incorporating data that's more structured and moving away from chart review, while being more inclusive of data sources. And then dQMs, that is a measure format. How should the data be represented in code using these existing standards that we incorporate in our dQMs? So it really focuses on how can data be standardized as well. They kind of work together because data, as you know, can be structured, but it still could be challenging to exchange that data if systems aren't able to talk to each other. So dQMs really provide that opportunity to standardize that because they require data to be in a structured field, to be able to also be mapped to FHIR. So that’s really how they work together, but they also have sort of different roles in the digital transformation. If we talk about the larger digital transition, I want to speak to, given that, sort of given these different goals of these concepts, how do we bring them together? I would say currently, we are in a transition phase where dQMs are available. So I know we have a slide that kind of shows the different, the transition phase and moving to fully digital, as you know. [On-screen Text – Digital quality transition roadmap - Transition phase, Now through 2029 o Ongoing dQM evaluation and parallel testing o Nondigital (paper) measures are still available o Ongoing transition to ECDS/hybrid sunset - Fully digital, Approximately 2030 o No more nondigital (paper) measures o No more hybrid measures] We're in at the end of that transition phase, where we have digital measures that are available across the administrative and ECDS versions of those measures are available. And we're also implementing parallel testing to give organizations an opportunity to validate the accuracy of digital measures as you prepare. So we can definitely follow up with you if you want to learn more about parallel testing. And then during this time, we'll still have non-dQMs available, and we'll continue to transition away from the hybrid method. Again, we've set the goal for 2030 to be fully digital. And at that point, we'll no 19 longer have the non-digital or paper versions of measures. And then we would also be transitioned fully from the hybrid method. [On-screen Text – Summary: ECDS and the digital quality transition - dQMs use standard formats (FHIR and CQL) to automate quality measure calculations from electronic data. - - ECDS guides how to gather and report data from sources like EHRs and health information exchanges o dQMs focus on how measures are calculated o ECDS focuses on where the data comes from and how it’s reported NCQA aims to make HEDIS fully digital by 2023. ECDS helps move away from [text blocked by video inserts] chart reviews and towards automated reporting.] Together, dQMs and ECDS make quality measurement faster, more accurate and standardized] And then I just wanted to summarize, I know we're short on time, so I won't go through these specifically, but again, we hope this is helpful to understand the differences between ECS and dQMs, as well as how they work together to get data to be structured, as well as standardized to reach that goal of really making quality measurement faster and more accurate. [On-screen Text – Optum perspective on FHIR/CQL - Clients are in various stages of FHIR transition o Some already have FHIR data; some are just starting o Collecting all data elements required by HEDIS Core is complex - - - - FHIR data at Optum o Converting from traditional sources and other FHIR layouts to HEDIS Core o Sourcing FHIR data from EMRs for clients NCQA Digital Content Services Early Adopter Program starting in 2024 Optum digital engine to run native CQL under development Multiple validations in place: o Digital vs. traditional parallel testing o Digital vs. NCQA reference engine] SHARIFF BASEER: I think the last sentence which you're sharing in here, regarding more faster, more accurate, that's on point. And as a part of a group which truly appreciates partnering with NCQA and the collaboration we share on a day-to-day basis, not just during a webinar or whatever, I can share that it is receptible. It is something which is a goal which is real, and we're here with you guys to partner together to get there. One of the things, what's really relevant to this conversation, is we recognize and acknowledge that, the FHIR transition, we have clients which are on a variety of stages. When we talk to our current customers to say, hey, we have access to FHIR data. We don't have access to FHIR data. We have all of these data elements, but then getting it into that HEDIS score is complex and can you help. We, from an Optum standpoint, have been really, really focused on how can we get data from FHIR layouts or acquire data and 20 FHIR layouts and convert that to HEDIS score? Because obviously when we are talking about CQL engine and the use of these measures, we still need to have FHIR data itself formatted and HEDIS score itself. So a lot of this is happening. Like Fern was mentioning, the validations of being in this transition phase from 2025 through that 2029, it is very important to have those multi-point validations to be in place when it comes to the digital versus traditional, digital versus the NCQA reference engine. And gladly, the fact that we've been partnering with NCQA and the digital content services and having a scaled engine internally for us to essentially customize, tweak, enhance, embed within the needs of our customers really enables us to have that multi-point validation in place. This has been fantastic so far and I'm looking forward to more of the same as we move towards the next phases of this digital journey. Fern, last question for you. In terms of preparedness for the future, can you describe this checklist for us, on what health plans can essentially take away from today's session? [On-screen Text – preparing for the future - Evaluate HEDIS MY 2026 ECDS updates - - - - - Participate in optional ECDS reporting Evaluate hybrid lift Evaluate data availability and system connections to support ECDS [text blocked by video inserts] going forward Develop clinical strategy towards FHIR Participate in parallel reporting [text blocked by video inserts] access readiness for digital HEDIS] FERN MCCREE: Absolutely. And I'll try to go quickly. I think the key thing, definitely looking at some of our updates for year 2026, we've released a number of new measures available for ECDS, as you saw. So looking at what measures have transitioned, I think is definitely key. Participating in optional reporting where possible. So some measures have that dual reporting options where you can do that comparison for your own operations, evaluating hybrid lift as well. But I think a key thing is evaluating the measures and data availability and system connections at the measure element level, even at the measure, well, measure level and particularly the measure element level, because the standards need to be assessed really at that specific level to really understand opportunities for improvement. And then also, no matter where you are, really figuring out your clinical data strategy towards FHIR. So now that could be figuring out how to map your data that's in its current format to FHIR. But, of course, how do you get to a point where you're incorporating the FHIR standard within your clinical workflow so that it can be that data is just flowing and it's more easily accessible for quality reporting as well as quality improvement. And then lastly, being able to participate in parallel reporting can also help you assess your readiness to moving to digital HEDIS. And then we just have a few resources. And we'll send you these slides. I know we're going to go a little quickly, but so you can get the links to all of these different resources. [On-screen Text – NCQA resources, Upcoming NCQA events] 21 [QR codes for HEDIS Electronic Clinical Data Systems (ECDS) Reporting, Digital Quality Transition Hub, Webinar: Life of a code for Digital Quality Measurement, NQA Health Innovation Summit] These are events. There's an event tomorrow that we certainly encourage you to attend. It's a webinar, as well as our Health Innovation Summit that's coming up in October, from October 12th to the 15th. And definitely please check out the Digital Quality Transition Hub is where you can dive deeper into many of these concepts we just talked about and also reach out to us at NCQA. [On-screen Text – NCQA Health Innovation Summit, Visit Optum at Booth 431. Join. Us for our innovation theater session: Lessons Learned on the Road to Digital Quality Reporting, Monday, October 13 12:05-12:25 p.m.] SHARIFF BASEER: Thank you, Fern. With that said, we at Optum are also well represented in the health innovation summit. Very excited to see you guys there. We do have our innovation theater sessions as well as the booth. Also, do visit us at booth 431. Would love to engage in conversations with you guys in person. I know we didn't get quite a bit of time on the Q&A, but all of these Q&A questions which are coming in, we definitely would want to spend some time to talk through an answer. And if we don't get to your question today, then we'll definitely reach out to you offline and speak to it. Do we have time for one question, Bailey? [On-screen Text – Q&A] BAILEY FIELDS: Yeah, absolutely. SHARIFF BASEER: Awesome. Let me see. Fern, one of the questions which we've been speaking about, I think, is has NCQA been working with EMR vendors and companies to implement HEDIS ECDS legal measures? FERN MCCREE: Yes, we have been working with different vendors in different capacities through our digital content services tool, but also through testing, as well as other engagements to better understand implementation and also better understand how they're incorporating these different standards into measures. And that's also been helpful for us to understand the feasible timeline and pathways that we've set. I definitely encourage you to check out the digital hub to learn more about collaboration with vendors. SHARIFF BASEER: And I think there's another question around how will plans review measure specs if they are not available in paper form? FERN MCCREE: No, that's a great question. I'm happy to clarify that you will still be able to access, there'll still be a human readable version of the specification as we move to being able to be exclusively delivering measures in a digital format. There certainly 22 will be a narrative that can be interpreted and used and are reviewed by those that may not be digital or technical, so that you can understand the requirements of the measure. SHARIFF BASEER: Absolutely. And I know, if there are any other questions, feel free to reach out to us. I just do want to say thank you for everyone who participated today. Bailey, over to you. [On-screen Text – Thank you. Learn more at optum.com/quality *While we have selected our speakers based on their general knowledge and experience with the subject matter of the program, neither RISE nor the speakers are providing legal or compliance advice to you or your organization. You should consult your organization’s legal or compliance advisor(s) regarding your unique circumstances. Any examples discussed in the program are hypothetical only. The presence of vendors or speakers at RISE events does not constitute an endorsement of the vendor or speaker or their views, products or services.] BAILEY FIELDS: Thank you both so much for a great presentation today. And like Shariff said, we want to thank you all for attending today's webinar. And thank you so much to Optum for sponsoring today's webinar.