Healthcare Data Transformation Validation for a Leading US Health Plan

Healthcare Data Transformation Validation for a Leading US Health Plan

Project Description

We are leading the strategy and execution of the Data Quality Assurance for this significant program with close to 7 million users. Driven by the National Council for Quality Assurance (NCQA), the Healthcare Effectiveness Data and Information Set (HEDIS) is one of healthcare’s most widely used performance improvement tools, with more than 200 million people enrolled in plans that report HEDIS results in the US Center for Medicare and Medicaid Services (CMS). 

Scope, Size & Complexity

The client aimed at modernizing its data repository from hundreds of SQL server environments to a single Database in Azure PaaS, including Value Based Payment Provider integrations. The Program aimed at Leveraging the Azure platform features to improve performance, scalability, extensibility, and maintainability of the data repository, including additional Risk and Encounter data elements to perform Risk Analysis, targeting, and monitoring Encounter submissions. 


Our Automated Data Validation Engine was implemented to capture gaps at every layer of Data Processing. This Validation Engine helped identify errors upfront in the process, thus significantly reducing rework and improving overall data quality. The Engine has helped process half a trillion plus records in the first year and reduced the HEDIS reporting duration from 15 days to 5 days, along with a 60% reduction in support ticket volume as the Engine allowed for a monthly pre-validation before submitting to business for end-user validation.

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