By Ross Martin, MD, MHA, FAMIA & Brian Dwyer

Last month, we had the opportunity to attend the 2025 NCQA Health Innovation Summit in San Diego, California, where the conversations focused on improving healthcare quality, equity, and outcomes through innovation. The theme this year was “Reflect, Connect, Inspire,” which felt appropriate. The event brought together a mix of policymakers, payers, providers, technologists, and quality experts who are all trying to make healthcare better — even when the system doesn’t make it easy.

Here are a few things that stood out to us.

Medicare Advantage: Progress and Pressure

Medicare Advantage (MA) continues to outperform fee-for-service in many areas, but it’s hitting some turbulence. Changes like the Version 28 risk model have created uncertainty. Some plans are exiting markets, and others are pulling back on preventive programs to manage costs. It’s clear that the industry needs to find better ways to align incentives so that plans can stay committed to long-term health outcomes instead of short-term financial survival.

Artificial Intelligence: Great Promise, Big Prerequisites

AI was everywhere, but not in the “AI can fix everything” way we’ve seen at other events. The focus here was more practical: AI can only be as good as the data that feeds it. One presenter summed it up perfectly: “If your spacecraft were 75 percent perfect, would you launch?” That line stuck with us.

Healthcare data still isn’t where it needs to be. We heard about how HL7® FHIR® and Clinical Quality Language (CQL) are starting to help by connecting fragmented data sources to support digital quality measures. The progress is encouraging, but there’s still a lot of foundational work ahead around data quality, governance, and standardization. If you want trustworthy AI, you need trustworthy data.

Culture and Leadership: The Courage to Tell the Truth

One of the most refreshing parts of the summit came from Dr. Sachin Jain of SCAN Health Plan, who talked about what he calls “courageous challenging.” His message was that improvement can’t happen in organizations where everyone feels pressured to stay positive all the time. “Toxic positivity,” as he put it, prevents honest conversations about what isn’t working.

That resonated deeply with us. If an organization isn’t willing to face challenges with blunt honesty and an objective, non-emotional lens, it’s nearly impossible to make meaningful progress. Real improvement requires courage, candor, and a culture that welcomes feedback, not fears it. Our long-term client experience shows that the organizations that engage with Point-of-Care Partners are nearly always at this stage of recognizing their need for honest, unvarnished perspective.

A Thoughtful Leadership Transition

We also appreciated the closing conversation between Margaret (Peggy) O’Kane, NCQA’s founder, and her successor, Dr. Vivek Garg. Peggy has been a steady hand in quality measurement for decades, and her approach to succession planning reflected the same thoughtful leadership she’s shown throughout her career. It reminded us that progress in healthcare, and in leadership, often happens not through disruption but through deliberate, consistent effort.

Data Fragmentation and the Long Game

A particularly powerful session featured Dr. David Kendrick, who showed how scattered individual health records are across states and systems. His presentation made clear that without a reliable way to aggregate data across the continuum, true “whole-person care” will remain out of reach. His long-term vision of using standards-based exchange, health data utilities / health information exchanges, and longitudinal records feels like the right north star for where we need to go as an industry.

Across sessions, one theme kept surfacing: progress takes collaboration, patience, and persistence. Whether we were talking about AI, value-based care, or quality measurement, the answer was never “buy more technology.” It was about connecting people, data, and purpose.

Turning Insights into Action

At POCP, we work with clients all the time who are trying to navigate these same challenges. We help organizations not only build a strategic plan but also execute it, factoring in more than just technology. The people part of the equation is just as important.

Ready for a courageous conversation? Whether your organization is trying to shift its culture to make space for new technologies and workflows or is tackling foundational data quality and governance work to make AI and automation possible, we can help you chart a path forward that’s practical, collaborative, and sustainable. Contact us to set up an exploratory discussion. Even if we can’t help you directly, we might be able to point you in the right direction.