Every quality metric shaping your career, your bonus, and your reputation traces back to one nonprofit most physicians have never thought twice about.

In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Dr. Vivek Garg, the new President and CEO of NCQA - the National Committee for Quality Assurance - and only the second leader in the organization's 36-year history.

This episode is unabashedly nerdy. And that's the point.

Because the measures you're chasing, the scores you're being judged on, and the bonuses tied to your performance don't come from nowhere. They come from a deliberate two-year long process of evidence review, statistical validation, and independent clinical committee sign-off. It’s a process most physicians have never seen and don't know they can influence.

Vivek doesn't come to this conversation to defend the status quo. He's blunt that the current system produces incomplete data, punishes independent practices for lacking the infrastructure of large health systems, and has overused financial incentives as a lever for change. He calls value-based care underappreciated and AI overhyped, and then spends the rest of the conversation explaining exactly where both could actually move the needle.

This episode is an honest reckoning with whether we're measuring what actually matters and what it would take to build a system that clinicians trust and patients actually feel.

What You'll Learn

1. Where your HEDIS scores actually come from and the two-year pipeline behind every measure that lands in your workflow
2. Why the data feeding your quality scores is often incomplete, lagged, and missing critical parts of your patient's clinical picture
3. How Goodhart's Law plays out in real clinical practice — and why even well-designed measures can distort the behavior they're trying to assess
4. Why independent and small practices carry the same reporting burden as large health systems with entire quality departments