HEDIS Compliance Case Study - Standardizing Demographic Data- Data Ideology
When health equity reporting became mandatory, their data wasn’t ready.
Multiple demographic formats and inconsistent logic created compliance risks and blocked accurate HEDIS submissions.
The Challenge
A national health plan faced a new mandate: all HEDIS measure reporting now required stratification by CDC Race and Ethnicity Codes (CDCREC). Their internal demographic data, however, came from multiple sources—each with its own format and logic. None of it was compliant, and submission deadlines were fast approaching.
This presented both a compliance risk and a significant barrier to accurate population-level reporting.
"We weren’t confident in the data—especially when it mattered most for health equity reporting."
Clinical Compliance Lead
Insights
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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 began by identifying the root cause of inconsistent demographic reporting—and charting a path to standardization.
Current-State Discovery
Uncovered the fragmentation across race and ethnicity data sources and the lack of a unified logic.
We partnered closely with stakeholders across data governance, quality, and analytics to define requirements, assess available data, and establish a compliance-driven framework.
  • Cataloged all race and ethnicity data sources across lines of business
  • Assessed completeness, consistency, and reliability of each source
  • Identified conflicts in source logic and lack of prioritization across systems
  • Benchmarked alignment to CDC-recognized standards
“We had the data—we just didn’t have a standard. That’s where the risk lived.”
Director of Quality Reporting
Insight
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Future-State Architecture & Business Case
We delivered a structured, repeatable integration model designed specifically for regulatory compliance.
Standardized and prioritized race and ethnicity data using a scalable ETL approach aligned to CDC standards.
  • Defined ranking logic for source reliability and priority
  • Created mapping logic to convert internal values to CDC-recognized codes
  • Assigned the highest quality source per member for accurate and consistent population
  • Used Informatica ETL to load the standardized data into membership and HEDIS reporting tables
“Once the logic was in place, compliance became a process—not a panic.”
Enterprise Data Lead
Insight
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Roadmap & Execution Planning
The engagement enabled accurate health equity reporting—without adding burden to business or clinical teams.
Enabled compliance at scale, with a framework that can evolve alongside future regulatory demands.
  • Successfully met CDCREC-based HEDIS reporting requirements within the required cycle
  • Improved accuracy and completeness of race and ethnicity data across the enterprise
  • Established scalable integration workflows for future ingest from CCDs, external EHRs, and vendor feeds
  • Strengthened trust in analytics tied to effectiveness-of-care and health equity
“For the first time, we knew our reporting matched the populations we serve."
Chief Compliance Officer
Insight
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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
Healthcare Information and Management Systems Society
Clear Outcomes That Enabled Accurate, Incentive-Protecting Reporting at Scale
The engagement delivered critical infrastructure to support both compliance and strategic insights.
Standardized demographic data—using CDC-recognized mappings
Prioritized high-quality sources for each member—ensuring consistency and traceability
Automated integration using Informatica—reducing manual intervention and reporting risk
Enabled population-level analytics—on care effectiveness and equity
Positioned the organization to expand data intake—from new clinical and vendor sources
What Made This Different
Many firms focus on data cleanup. Few build compliance-aligned infrastructure.
  • We aligned to standards. CDC-recognized mappings ensured regulatory readiness
  • We made it scalable. Logic was reusable and extensible to new data domains
  • We worked within existing tech. Built the solution using Oracle and Informatica—no new tools required
  • We made it future-proof. Designed to evolve with NCQA requirements and vendor growth
Talk with our experts about your Data Strategy.