Improving HEDIS Outcomes with Case Management Integration - Data Ideology

CASE STUDY

Improving HEDIS Outcomes with Case Management Integration

Healthcare

Enterprise

Data Strategy

KEY OUTCOME

Key Outcome: The client saw up to a 13% increase in medication reconciliation rates and a 3–5% improvement in follow-up tracking.

How did Data Ideology solve this organization’s challenge?

CHALLENGE SUMMARY

The client was struggling to capture key patient follow-ups after Emergency Department (ED) and inpatient visits, which directly impacted performance on HEDIS measures. In particular, engagements related to medication reconciliation and timely follow-ups for high-risk conditions were either incomplete or untracked. As a result, their scores for Transitions of Care (TRC) and Follow-Up After ED Visit for High-Risk Conditions (FMC) were below target.

SOLUTION SUMMARY

Data Ideology partnered with the client to integrate critical case management data into their existing data workflows. This data was transformed and mapped into the client’s EMR-compatible format using Informatica ETL tools. Once structured appropriately, it was made available within the client’s HEDIS engine, enabling automated inclusion in measure calculations and improving reporting completeness.

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Deep Dive

THE CHALLENGE

  1. Case management activities were recorded outside of the core EMR system, limiting their visibility in HEDIS calculations.
  2. Medication reconciliation encounters were inconsistently captured, leading to underreporting.
  3. Follow-up visits after ED and inpatient discharges lacked standardized tracking mechanisms.
  4. Existing infrastructure did not support automated ingestion and transformation of disparate case management data.
  5. The client lacked a business case to justify scaling the integration of case management workflows across additional programs or providers.

THE RESULTS

  1. Achieved an immediate 3–5% increase in numerator rates for timely follow-up measures.
  2. Delivered up to a 13% improvement in medication reconciliation engagement tracking.
  3. Built a compelling business case for expanding the use of case management data to close care gaps.
  4. Improved the accuracy and completeness of HEDIS submissions, positively impacting incentive programs.
  5. Laid the groundwork for broader interoperability and performance analytics through integrated data pipelines.

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