CONNECTING THE DOTS FOR HEALTHIER COMMUNITIES
How California’s Digital Transformation Is Bridging Gaps in Care and Services
A Message From Our CEO
As I reflect on 2024, it is remarkable how much progress MX has achieved in advancing health data exchange across California through new partnerships with key stakeholders, the expansion of our network, and a relentless focus on improving value to our participants. Together, we built upon the momentum from 2023 and continued to work toward creating healthier outcomes across communities in every county — all while respecting individual privacy rights and meeting evolving state and federal regulations.
In 2024, Manifest MedEx increased the number of unique records on our network by 13% to 43.3 million. We worked with more than 3,000 participating organizations and closely collaborated with local and state leaders to advance ambitious health data transformation goals. We launched the California ADT Network, a no-cost electronic ADT notification exchange; invested in improving data quality; and advanced our interoperability capabilities through FHIR®, ensuring the right information is delivered at the right time — securely and as permitted — to make the biggest impact for individuals, communities, and their health outcomes.
As the national policy landscape shifts in 2025, I am grateful for the strong year we built with Manifest MedEx in 2024 — enabling us to continue in our commitment to supporting California’s health data infrastructure; building the digital health data safety net that our families, friends, and communities deserve; and innovating new ways to include social care organizations, streamline costs, and reduce burden for our health workforce. We will continue working to provide exponential value to our participants to support them in a challenging funding environment, one in which the rapid evolution of generative artificial intelligence will bring new possibilities for organizations like Manifest MedEx as a resource for clinicians, health plans, and public health alike.
As you’ll see in this annual report, Manifest MedEx made significant progress on many fronts during our seventh year of operations. We have ambitious goals for the year ahead (and beyond) and will continue shaping what is possible for health and human services information exchange in California and across the U.S. with our partners.
Thank you for being a part of this Manifest MedEx journey with us!
Erica Galvez Chief Executive Officer Manifest MedEx
“The robust and timely exchange of health and social data that Manifest MedEx enables has never been more important as it helps to ensure our communities receive the care they need when they need it.”
–Jarrod McNaughton, Board Chair, Manifest MedEx and Chief Executive Officer, Inland Empire Health Plan
Who We Are
Manifest MedEx (MX) is the largest nonprof it health data network in California. Since 2017, we have served as an integral part of the state’s health data infrastructure, combining and delivering crucial health information (clinical and claims data) for 43.3 million people.
MX is taking bold steps toward health transformation, working with partners at the local and state levels to advance health equity, support public health initiatives, and achieve Medi-Cal goals.
“Finding
ways to navigate the complexity of a diverse state, expanded data exchange partners, and much broader datasets that must include sensitive information, while safeguarding privacy and reinforcing continuous security, is a challenge worth taking up. Not every state is as large and complex as California, but they all share many of the same challenges and opportunities when it comes to policy leadership and health data progress.”
– Erica Galvez, Healthcare Innovation, December 2024
Milestones to Date
2011 Inland Empire Health Information Exchange (IEHIE) is formed as a collaboration between Riverside County Medical Association (RCMA), Inland Empire Health Plan (IEHP), and HASC-Riverside and San Bernardino Counties (Hospital Association of Southern California) to facilitate health information exchange.
2014 Anthem Blue Cross and Blue Shield of California partner to launch Cal INDEX, a groundbreaking health data-sharing initiative.
2017 Cal INDEX merges with IEHIE to form Manifest MedEx, with records for more than 11 million across 150 network partners.
2018 The network launches MX Notify (admissions, discharge, and transfer notifications [ADTs]) and brings on prominent participants including Hill Physicians Group and Stanford Health Care.
2019 Manifest MedEx earns HITRUST CSF® Certification; launches MX Access (longitudinal records) and MX Analyze (population health management tools); and now reaches 17 million records with HealthNet, AHMC Healthcare, and California Emergency Services Authority (EMSA) as participants.
2020 Supporting urgent public health needs during the COVID pandemic, MX announces sharing health records for 23 million people through the network of more than 600 participating hospitals, health plans, and provider organizations.
2021 MX becomes a Qualified Health Information Organization (QHIO) under the Cal-HOP program to help Medi-Cal providers connect to health information exchanges (HIEs), publishes a major report on the impact of the COVID pandemic on healthcare utilization in California, and earns the National Committee for Quality Assurance (NCQA) designation for validated data streams.
2022 Erica Galvez is named CEO of Manifest MedEx as the network grows to 32 million unique records across more than 125 hospitals, 12 health plans, and 1,500 ambulatory providers. MX is awarded a contract with the California Department of Public Health (CDPH) to implement the System for the Surveillance and Public Health Information Reporting and Exchange (SaPHIRE) for electronic lab reporting.
2023 Manifest MedEx is designated a QHIO in the CalHHS Data Exchange Framework (DxF). MX tests a universal consent approach through the Department of Health Care Services (DHCS) Authorization to Share Confidential Medi-Cal Information (ASCMI) pilot, builds more capabilities to exchange social data and sexual orientation and gender identity (SOGI) data, expands SaPHIRE to include electronic case reporting, and partners with CDPH on a pilot to analyze the potential of HIE data to improve health equity.
2024 Now delivering for more than 43 million records and 3,000 health organization participants, the MX network begins sharing real-time information for DxF participants, launches the California ADT Network, and becomes among the first HIEs in the country to join the Trusted Exchange Framework and Common AgreementTM (TEFCATM).
Data and Impact Across California and Beyond
Building on a foundation of years of infrastructure development, 2024 was a period of both strong network growth and data expansion in many ways. Manifest MedEx helped to advance secure, permitted data exchange for a broader range of providers, expanded data connectivity to trusted organizations outside our network, and increased the data we deliver to include SOGI information. Altogether, the year’s progress set up a more insightful, more connected health data landscape for the communities we serve.
2024 MX Progress Highlights
• Added 4.8 million new longitudinal records — Manifest MedEx reached a new milestone of 43.3 million unique records in 2024, with 35.4 million representing individuals with a last known address in California. Among that state-based population, 22.6 million records were active in 2024, meaning the record included clinical activity or other engagement with the MX network within the past two years.*
*Defined as records with a healthcare interaction from a participant of the MX network, DxF, or national
health plan, IPA, or ACO from 1/1/23–12/31/24.
or eligible
“It has been an excellent resource for gathering information and research on members, allowing for a better understanding of their situation and healthcare needs.”
– Collected from MX user surveys, 2024
• Delivered important data — In 2024, we delivered more than 120 million Consolidated Clinical Document Architecture documents (CCDAs). This document standard provides a consistent and accurate structure for clinical data sharing, including medication lists, images, and reports. Manifest MedEx also sent approximately 2 million ADTs every month, informing providers and care teams that an individual is moving across a care setting. Each time an ADT is generated, the providers “subscribed” and caring for that person can learn more about their health concerns and needs in real time, supporting seamless care and improved health outcomes.
120,306,447
TOTAL CCDAS SENT IN 2024
2,012,559
AVERAGE MONTHLY ADTS SENT (from July–December 2024)
• Added adolescent immunization data — We launched an adolescent immunization feed from the California Immunization Registry (CAIR), which provides physicians, clinicians, and care managers with consistent and more comprehensive information, helping them ensure their young patients are up to date with immunizations.
• Integrated social data — We began the journey to integrate social data from community-based organizations (CBOs) into our platform to enable non-clinical social support providers, such as community health workers, to electronically share data with broader care teams through Manifest MedEx. This work followed specifications set by Gravity Project, a national public collaborative
that develops consensus-based data standards to improve usability and sharing of information on social drivers of health (SDOH).
• Supported SOGI data — Manifest MedEx started collecting and delivering SOGI data through standardization of this content in USCDIv2. LGBTQI+ individuals often face inequitable treatment, including challenges with healthcare access and quality. While there has been growing recognition over the past decade that SOGI are key drivers of health, there has been a notable lack of health-related data for LGBTQI+ populations. According to the AJMC: “Routine, consistent, and high-quality SOGI data collection are indispensable for our work in health services research.”
By the end of 2024, MX’s system contained SOGI information for almost 9% of our active statebased population of 22.6 million Californians, and we continue to work with providers, especially community health centers, and their EHRs to bring in this critical information to our network.
• Increased use of MX Access — A measure of value of data from Manifest MedEx, we saw the number of clinical records viewed in MX Access increase by 9,000 per month in 2024. That’s a jump in activity of almost 260% since 2020.
• Added 677 new participants to the network — Among our new participants, MX was pleased to welcome three new health plans/lines of business, increasing our total participating health plans to 17. We also added three new independent physician associations (IPAs)/accountable care organizations (ACOs), nine hospitals, and more than 140 new practices across 500 locations in California. In addition to traditional providers, we expanded our capabilities to enable a broader range of providers to participate in the Manifest MedEx network.
Average Number of Clinical Records Viewed in MX Access Per Month 2020-2024 (rounded to the nearest 1000)
Number of Participants on MX Network 2020–2024
17 health plans participating in 2024
• Expanded reach with California counties — We continued to grow California’s digital health data safety net not only in the larger counties such as Los Angeles and Alameda, but also in smaller, rural counties where getting access to healthcare and health information can be more difficult but is just as important.
Active MX Records in 2024 as a Percent of County 2020 Census Population*
*Defined as records with a healthcare interaction from a participant of the MX network, DxF, or national networks, or eligible information from an MX participating health plan, IPA, or ACO from 1/1/23–12/31/24.
Top
10 Counties with Greatest Increase in Number of Active Records* on MX Network
•Defined as records with a healthcare interaction from a participant of the MX network, DxF, or national networks, or eligible information from an MX participating health plan, IPA, or ACO over a two-year time frame.
• Supported care delivery outside of our network As a participant of eHealth Exchange, the country’s oldest and largest nonprofit national network, Manifest MedEx helps provide more complete health data to participants of national networks for treatment purposes. This is important not only for California-based organizations that are not part of the MX network, but also for individuals who travel or move in and out of our state. By delivering this health data, MX helps providers improve clinical decision-making and enhance patient outcomes across the country. With the passage of Assembly Bill 352 in California, which restricts the exchange of reproductive health and gender-affirming care information, especially outside of California, the content that MX shares in response to queries over the national networks continues to evolve significantly.
330 Million Patient Discovery, Query for Documents, and Retrieve Document Transactions to Manifest MedEx through eHealth Exchange in 2024
MX Delivery of 78 Million CCDAs in CA in Response to Retrieve
Document Queries in 2024
Enabling California’s Early Data Exchange Framework Success
Manifest MedEx was approved as a Qualified Health Information Organization (QHIO) in 2023 to support the California Data Exchange Framework (DxF) and the state’s ambitious plans for health and social data sharing. By the end of 2024, 510 organizations had selected Manifest MedEx as their QHIO for the exchange of CCDAs, and 466 had selected Manifest MedEx as their QHIO for the exchange of ADTs. We are pleased to support these organizations’ participation in the DxF, helping them meet their data sharing requirements and participate in the broader data sharing ecosystem in California.
Number of Organizations Using Manifest MedEx for Selected Methods (as of May of each year)
Additionally, of the 105 organizations that named Manifest MedEx as their QHIO for QHIO Onboarding Grant funding in 2023, 98% met their Milestone 1 requirements, and 15% met their Milestone 2 requirements (deadline in 2026) by the end of 2024. Congratulations to these grantees for their dedication in advancing data exchange!
“We previously partnered with another company, but they didn’t have the governance that we wanted to have as well as the HITRUST certification. Also, we felt MX would be a partner here, especially in the California landscape, where we have our own unique challenges.”
– Justin Ashe, Vice President of Information Technology, Choice Physicians Network on selecting MX as their QHIO
MX Innovations Advancing the DxF
1. California ADT Network
The CA ADT Network is a no-cost, electronic hospital event notification exchange launched in January 2024 by Manifest MedEx to help organizations deliver ADT data. In alignment with DxF guidelines, the Network is assisting in substantially scaling the secure and appropriate sharing of ADT alerts across the state.
“Providers have been asking for this type of real-time health data for decades to help physicians provide better and more efficient care for their patients,” said William Barcellona, Executive Vice President of Government Affairs for America’s Physician Groups. “This is a great opportunity for California to advance health data sharing to benefit all patients and communities.”
80 Hospitals enrolled in the network at the end of 2024, and 47.5M ADTs were delivered from these hospital participants last year.
2. Individual Access Services (IAS)
We believe that health and social data belongs to the individual and that everyone should have easy and timely electronic access to their health records to support their own health and well-being.
In 2024, Manifest MedEx partnered with Selfiie, a first-in-class, secure patient identity verification and electronic records access service, to provide a simple and secure way for people to download a copy of the health data we have received on them from providers, hospitals, health plans, and other healthcare organizations that share information for permitted purposes.
As a QHIO, MX spearheaded connectivity with regional nonprof it QHIOs to share data for treatment of individuals when they are admitted to the hospital. As a result, MX delivered 1.2 million CCDAs to DxF participants on our network in 2024 that they would not have otherwise had. In 2025, we will build on these efforts by evaluating data quality of both the CCDAs and ADTs we receive from DxF participants to ensure MX participants are getting meaningful information.
As this state program continued to evolve in 2024, Manifest MedEx also maintained a presence in ongoing conversations to support the DxF implementation by serving on three committees:
Implementation Advisory Committee (IAC)
Felix Su Director of Policy
Data Sharing Agreement & Policies & Procedures
Jason Buckner Chief Information Officer
2024 Standards Committee
Tim Polsinelli Senior Director of Health Informatics
Driving Medi-Cal Transformation
CalAIM (California Advancing and Innovating Medi-Cal) is a multiyear initiative aimed at improving the health outcomes of the state’s Medicaid beneficiaries. Focused on a more coordinated, person-centered approach to healthcare, emphasizing whole-person care and addressing social drivers of health, the initiative aims to reduce complexity, increase flexibility, and improve quality outcomes within the Medi-Cal system.
In 2024, Manifest MedEx was an integral part of the state’s CalAIM health data infrastructure, combining and delivering crucial health information to help support the Medi-Cal data ecosystem.
CalAIM highlights in 2024:
• Added new Medi-Cal plans — In 2023, Manifest MedEx was already working on CalAIM with Aetna, Anthem, Blue Shield of California Promise Health Plan, Gold Coast Health Plan, Health Net, Inland Empire Health Plan, and Health Plan of San Joaquin. In 2024, we connected Alameda Alliance for Health, Community Health Plan of Imperial Valley, CenCal, and Kern Family Health Care to our network to help support their Medi-Cal members.
• Listened to CalAIM participant needs — Manifest MedEx added Enhanced Care Management (ECM) eligibility data for more health plans to our longitudinal health records platform, MX Access, allowing users to see if an individual is currently or was previously eligible for ECM services and their assigned ECM provider’s National Provider Identifier (NPI). This helps care teams identify ECM-eligible members and get them to the appropriate points of contact for ECM enrollment to receive better coordinated care and support services. Manifest MedEx currently shares ECM eligibility information in MX Access from Health Plan of San Joaquin, Health Net, and Inland Empire Health Plan to support care coordination.
• Expanded SDOH data — To help address health disparities and factors that drive poor health outcomes outside the traditional care delivery system, healthcare organizations need reliable data to better understand the populations they serve. Manifest MedEx’s Health Equity and Social Drivers of Health (SDOH) Report delivers actionable insights by providing individual-level demographic data — including race, ethnicity, and language — as well as key SDOH data such as Z codes and metrics from Public Health Alliance of Southern California’s Healthy Place Index to help organizations coordinate timely interventions for vulnerable patient populations.
As of June 2025, 18% of our active longitudinal records (4M out of 22M Californian records in the past two years) contained information about SDOH.
“There are times individuals are hard to reach. Having the most up to date info is beneficial for care management and helps the person
get engaged or reengaged
if
follow-up.
they’ve been lost to
And once you start interfacing with that member, there’s a whole host of medical issues that can be shared back to help the entire care team support them.”
– Brian Buller, Sr. Director of Provider Relations and Compliance, Independent Living Systems, an ECM and Community Supports provider serving 32 counties
Connecting County Agencies and MCPs to Support the Justice-Involved Population
Health Plan of San Joaquin (HPSJ) kicked of f a multiyear effort with HealthNet to exchange data with up to 60 county agencies, including two correctional facilities in San Joaquin and Stanislaus counties. This effort is mandated by the Department of Healthcare Services (DHCS) in an All Plan Letter (APL) requiring managed care plans (MCPs) to execute Memorandums of Understanding (MOUs) with local government and educational agencies in the counties they serve. A requirement of the MOUs is to exchange data between MCPs and local agencies to coordinate referrals and care.
Manifest MedEx created and operates a custom technical solution enabling the appropriate and secure exchange of data between these parties. Among other capabilities, the solution facilitates delivery of prerelease care plans from correctional facilities to Justice-Involved ECM providers.
In the next phase of work, Manifest MedEx will expand to correctional facilities and juvenile probation departments in El Dorado and partner with other agencies to onboard to this solution as their MOUs are executed with the MCPs in their respective counties.
POPULATION HEALTH ANALYTICS
REPORTING
Did you know...?
To support Individuals at Risk for Avoidable Hospital or ED Utilization under the ECM program, MX’s Chronic Condition Report can help health plans identify highrisk members with one or more chronic conditions and utilization trends, including the date of the most recent emergency department (ED) and inpatient (IP) visits, and the number of ED and IP visits within the last six days and 29 days, respectively. This can inform appropriate education, intervention, and case management to reduce costs and prevent more serious conditions from arising.
Collaborating with Public Health
The California Department of Public Health’s Surveillance and Public Health Information Reporting and Exchange (SaPHIRE) is a secure, statewide health data system designed to integrate lab data and enhance disease surveillance efforts. In 2022, MX was awarded a fiveyear contract with CDPH to create and operate SaPHIRE solution, integrating data from more than 400 labs into the system.
CDPH expanded their SaPHIRE contract with MX in July 2023 to include electronic case reporting (eCR) for the state.
SaPHIRE in 2024 at a Glance
1,600+ LABS
1.6 million REPORTABLE LAB RESULTS PER MONTH
1 million CCDAS PER MONTH FOR PUBLIC HEALTH REPORTING
To help counties and public health efforts, Manifest MedEx also added two EMS agencies and six fire agencies to the network in 2024, increasing the total number of emergency medical services connected to MX to 23 across the state. We also added Tuolumne county to the network, bringing the total number of participating counties to 11.
“The South San Joaquin County Fire Authority is proud to be the first public safety agency to connect to the California Data Exchange Framework by way of Manifest MedEx, California’s largest health information exchange and a QHIO. The prospect of accessing health information on scene during an incident would exponentially impact patient care in a positive way, helping with treatment decisions and learning after an incident, to understand how those treatments affected the patient.”
– Capt. Kevin Meineke of the South San Joaquin County Fire Authority
Can Existing Health Information Exchanges Be Leveraged
To Modernize Public Health Surveillance?
In 2024, we compiled reporting for a white paper based on a pilot we completed with CDPH to explore the extent to which data from a health information exchange can be used to advance health equity given the richness of its demographics data.
For this pilot, CDPH provided two rosters from its communicable disease data system:
• Approximately 250,000 patients reported with TB disease (2016–2022) or latent TB infection (LTBI) (2019–2022) statewide
• A statewide random sample of one million patients with COVID-19 (diagnosed 2020–2022)
Manifest MedEx matched the case files with longitudinal health records and securely returned a subset of health information (e.g., demographic data, clinical condition data, utilization data) for the matching cases to CDPH.
While CDPH continues to evaluate the value of the enriched data received from Manifest MedEx, some preliminary findings from the pilot include:
• MX identified Race, Ethnicity and Language (REaL) data for more than 50% of the individuals in the TB/LTBI and COVID-19 case files before opt-outs were removed.
• With the REaL data from Manifest MedEx: CDPH identified increases in completeness of data for matched individuals in the TB/LTBI case file as follows:
– Race/ethnicity data fields from 45% to 94%
– Language data fields from 0% to 65%
• CDPH identified increases in completeness of data in matched individuals in the COVID-19 case file as follows:
– Race/ethnicity data fields from 74% to 87%
– Language data fields from 28% to 67%
Read the full white paper on our website!
WHITE PAPER
Technological Innovation and Investment
Manifest MedEx continued to be a voice of leadership on health data sharing, innovation, and technology in 2024. With a goal of providing better, faster, and more actionable health and social data to the community, the team led several initiatives during the year.
• We participated in NCQA’s Digital Content Services Early Adopter Program to advance digitized quality measurement initiatives and help shape NCQA’s framework and approach to enable the practical and flexible use of digital quality measures across the full spectrum of value-based care use cases, including quality reporting for health plans.
• MX successfully piloted inbound and outbound integration with a large health plan to both receive and supply data via FHIR® for operations use cases and to exchange DxF claims data.
• Manifest MedEx upgraded our FHIR-based data analytics and reporting platform, MX Analyze, with more robust analytics capabilities, customizable
reports, and data services to help population health managers easily understand and manage the utilization and quality of care for attributed patients informed by data from across the MX network.
• The National Institutes of Health (NIH) All of Us program selected Manifest MedEx as one of three pilot sites to test individually authorized data sharing for its database of 840,000 participants who voluntarily provide their data for research. We successfully developed the capability to support the Access Consent Policy (ACP) workflow through eHealth Exchange. This workflow is commonly used for authorization-driven use cases outside of Treatment, Payment, and Operations — in this case, for research purposes.
• MX met the requirements of HITRUST CSF® certification for the sixth consecutive year. This demonstrates the highest levels of security in the healthcare industry and places our nonprofit among the elite few HIOs that have maintained this certification.
MX 2024 Financial Statement
Manifest MedEx is a nonprofit 501(c)(3) and is tax-exempt. Since 2017, our organization has steadily and sustainably grown to deliver health data in California and beyond for 43.3 million individuals and thousands of community health organizations.
2024 Total Revenue 2024 Total Expenses
2024 Total Revenue — $48,920,794
• Grant and contribution revenue $27,890,537
• Health information exchange services revenue $19,587,556
• Professional services revenue $971,670
• Interest income $471,031
2024 Total Expenses — $44,133,741
• Program expenses $31,849,240
• Management and general expenses $12,284,501
Looking Ahead
Manifest MedEx is already working hard in 2025 to accelerate value to our participants and better serve our state by continuing to invest in technology and innovation, including generative AI (genAI), expanding our network, and delivering more actionable and higher quality data. Our goals for the year ahead include:
• Building stronger connections with the communities we serve — We understand that healthcare is local, and the real change happens when we can connect stakeholders within their own communities to meet their unique needs. As we expand our team with new Regional Executive Directors, we’re committed to fostering meaningful relationships to enable accurate, real-time data exchange that meets the specific needs within your regional health data ecosystem.
• Updating MX Notify to streamline workflows — These upgrades include a new streamlined user interface; improved filtering, searching, and export capabilities; and smarter email notifications to ensure users are seeing the most up-to-date and useful information.
• Providing whole person data for whole person care — In 2025, you will notice MX collaborations bringing in more permitted social data, such as health-related social needs assessments and information about SDOH to support CalAIM. We’ll also expand behavioral health information as permitted under HIPAA, 42 CFR Part 2 regulations, California-specific regulations, and other applicable law.
• Improving data quality — We are implementing data “uplift” services that allow participants in the MX network to receive normalized data mapped to standard codes in several MX data services for a range of clinical data domains. This will allow participants to more easily consume accurate and streamlined data for their HEDIS® reporting, population health management, and care gap closure to improve health outcomes and performance on quality measures.
• Harnessing new innovations in technology to accelerate value — Generative AI presents opportunities for HIOs to exponentially increase value to network participants and reduce health system costs. Our focus this year includes both shortterm and long-term goals around leveraging genAI to accelerate value for our participants — finding ways to cut through the noise of big data, giving them only the data they need and efficiently.
• Supporting public health to create a healthier California for all — Manifest MedEx is collaborating with regional partners to improve public health through analytics and reporting that support population health management. These aid in the development of targeted public health initiatives and interventions that promote healthier communities.
• Helping California organizations participate in national networks — Manifest MedEx participates in TEFCA through our partnership with eHealth Exchange, and our participants can onboard to this voluntary national framework through our network.
As health and social data exchange continues to advance, we remain committed to delivering value and improving the health and wellness of all communities across our state.
Thank you for being a part of the Manifest MedEx journey to enable a healthy California for all through a more connected health and social data ecosystem!
manifestmedex.org