HEDIS Quality Measure Improvement Case Study | Data Ideology
For a regional health plan, real care wasn’t showing up in the data.
The issue wasn’t clinical—it was operational blind spots that kept prenatal and postpartum care from being counted.
The Challenge
A regional health plan was underperforming on two key HEDIS quality measures—Prenatal and Postpartum Care (PPC)—despite delivering meaningful care to members. The issue wasn’t clinical. It was operational.
Care data from Obstetrical Needs Assessment Forms (ONAF) wasn’t flowing into reporting systems used for HEDIS submissions. Without complete visibility, compliance teams couldn’t accurately reflect delivered care—putting performance incentives, quality scores, and member outcomes at risk.
"We knew the care was happening. The data just wasn’t getting counted."
Clinical Compliance Lead
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“We wanted to improve our scores, but we needed to understand where real care was being overlooked by our systems.”
- Clinical Compliance Lead
We traced the path of prenatal and postpartum care data—and found where it was breaking down.
What they needed was visibility across systems to make delivered care count in reporting.
Current-State Discovery
Uncovered critical visibility gaps in how prenatal and postpartum care data was captured and reported.
We collaborated closely with compliance, quality, and IT teams to understand how data was recorded, transferred, and ultimately reflected (or not) in HEDIS reporting.
  • Conducted stakeholder interviews across clinical and technical roles to map pain points in care documentation workflows
  • Traced Obstetrical Needs Assessment Form (ONAF) data across disconnected systems
  • Identified failure points in data standardization and integration
  • Benchmarked reporting completeness to quantify the scale of missing care
“Our goal in discovery was to capture the real-world challenges—straight from executives and analysts—so the roadmap would be grounded in reality, not assumptions.”
Mike Sargo, Data Ideology
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Future-State Architecture & Business Case
We designed a focused, scalable approach that integrated care data into the systems that mattered—without disrupting frontline workflows.
Delivered a targeted integration framework built on platforms the client already trusted.
  • Standardized ONAF data into a structure compatible with EMR and HEDIS logic
  • Used Oracle and Informatica pipelines to embed that data into the existing HEDIS reporting engine
  • Validated that previously missed encounters were now flowing through to final submissions
  • Built a repeatable integration model that could extend to other NCQA measures
“This wasn’t about changing how care was delivered. It was about connecting the dots across the systems we already had.”
Technical Delivery Lead
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Roadmap & Execution Planning
This initiative turned invisible care into measurable outcomes—protecting incentives and elevating compliance readiness.
Transformed data blind spots into strategic gains through repeatable workflows.
  • Achieved up to 36% year-over-year improvement in postpartum care numerator rates
  • Increased prenatal care numerator rates by 16%, depending on line of business
  • Built a scalable integration framework now being extended to other measures, including Smoking Cessation Counseling
  • Empowered the organization to accurately reflect delivered care, close compliance gaps, and unlock performance-based revenue
“We knew we didn’t need more programs—we needed to report the care we were already delivering."
VP of Quality
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Nearly half of healthcare leaders say their patient data is stored in fragmented, siloed systems—hindering comprehensive reporting and decision-making. Healthcare Information and Management Systems Society
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Clear Outcomes That Enabled Accurate, Incentive-Protecting Reporting at Scale
The engagement delivered measurable results—transforming missed care into reported care, and restoring confidence in quality performance.
Captured and standardized critical ONAF data—integrated previously siloed care into regulatory reporting
Validated compliance with NCQA measure requirementsensured accurate representation of prenatal and postpartum care
Increased HEDIS numerator rates—36% for postpartum and 16% for prenatal care, depending on line of business
Delivered a repeatable integration framework—positioned the organization to expand into additional measures
Protected performance-based incentives—ensured the organization was rewarded for the care already being delivered
What Made This Different
Many firms focus on data ingestion. Few solve for performance visibility in healthcare.
  • We made it seamless. Standardized disconnected care data without disrupting clinical workflows.
  • We stayed platform-aligned. Leveraged the client’s existing tech stack (Oracle and Informatica) to avoid additional overhead.
  • We proved the value. Tied integration to measurable HEDIS gains—enabling faster compliance wins and future extensibility.
  • We created momentum. Equipped the client with a scalable model to close gaps across multiple NCQA measures.
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