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Case Study

An MCO Success Story: Centralizing 250 Data Sources to Improve HEDIS and Care Management

By September 1, 2025No Comments

Background

Medicaid health plans face increasing pressure to improve healthcare quality and outcomes while managing costs. In this case study, we examine a Medicaid managed care organization (MCO) that recognized the need for a centralized clinical data repository to enhance their quality reporting and care management capabilities.

Challenge

The MCO struggled with fragmented clinical data spread across approximately 250 different sources. This fragmentation made it difficult to:

  1. Compile accurate and comprehensive HEDIS reports
  2. Access critical vaccination and diagnosis information
  3. Standardize lab and vaccination data from various providers
  4. Derive meaningful insights from raw clinical data

These challenges hindered the MCO’s ability to improve quality scores and effectively manage patient care.

Solution

To address these issues, the MCO decided to implement a Clinical Data Warehouse (CDW) as a centralized repository for all clinical data. The CDW would:

  • Integrate CCDA (Consolidated Clinical Document Architecture) data from all sources
  • Incorporate ORU (Observational Result) and VXU (Immunization) data
  • Normalize and standardize codes derived from raw inputs
  • Serve as the single source of truth for clinical data

Implementation

The implementation process involved several key steps:

  1. Data source identification: The team identified and cataloged approximately 250 clinical data sources.
  2. Integration architecture: They designed a system to ingest and process CCDA, ORU, and VXU data formats.
  3. Data normalization: The team developed algorithms to standardize codes and terminology across all data sources.
  4. Quality assurance: Rigorous testing was performed to ensure data accuracy and completeness.
  5. HEDIS integration: The CDW was connected to the HEDIS reporting system to enable the inclusion of clinical data in quality measures.

Results:

The implementation of the Clinical Data Warehouse yielded significant improvements:

:

1

Consolidated data access

The CDW became the single source of truth for clinical data, eliminating the need to query multiple systems.
2

Enhanced HEDIS reporting

The inclusion of comprehensive vaccination and diagnosis information led to more accurate quality scores.
3

Improved data quality

Normalized and standardized codes provided a clearer picture of patient health and care gaps.
4

Efficient care management

Access to consolidated clinical data enabled more effective patient care coordination.
5

Better decision support

The standardized data allowed for more accurate analytics and insights to drive quality improvement initiatives.

Conclusion:

The implementation of the Clinical Data Warehouse transformed the MCO’s ability to manage and utilize clinical data effectively. By consolidating and standardizing data from multiple sources, the organization significantly improved its HEDIS reporting capabilities and overall quality scores. This case study demonstrates the value of a centralized clinical data repository in enhancing healthcare quality and outcomes for Medicaid health plans.