Standardizing Demographic Data for HEDIS Compliance - Data Ideology

CASE STUDY

Standardizing Demographic Data for HEDIS Compliance

Healthcare

Data Stratetgy

Enterprise

KEY OUTCOME

The client achieved regulatory compliance with stratified HEDIS reporting by CDC Race and Ethnicity Codes (CDCREC).

How did Data Ideology solve this organization’s challenge?

CHALLENGE SUMMARY

New HEDIS requirements mandated that health plans stratify measure reporting using standardized CDC Race and Ethnicity Codes (CDCREC). The client had multiple sources of ethnographic data—none of which were aligned to the CDCREC standard. Internal rules for applying and prioritizing race and ethnicity data were inconsistent, leading to fragmented submissions and regulatory risk.

SOLUTION SUMMARY

Data Ideology identified and cataloged all available sources of race and ethnicity data across the client’s systems. These sources were then ranked by reliability and business line, mapped to CDCREC standards, and governed under a new prioritization framework. A single best source of truth was established for each member, and that data was integrated into the membership tables and downstream into HEDIS reporting submissions.

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Deep Dive

THE CHALLENGE

  • Multiple ethnographic data sources with no shared standard.
  • No existing mapping to CDC-recognized codes for race and ethnicity.
  • Inconsistent rules for determining which data source to trust per member.
  • Need to stratify reporting by Line of Business, adding complexity.
  • Risk of non-compliance with newly mandated stratification requirements.

THE RESULTS

  • Enabled HEDIS submissions that comply with CDCREC stratification rules.
  • Improved accuracy of care effectiveness analysis across diverse populations.
  • Created a repeatable template for future integration of additional data sources (e.g., CCDs, external EHRs).
  • Streamlined data governance processes tied to member demographics.
  • Built a scalable model using Oracle and Informatica for ETL and data transformation.

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