A VIBRANT AND HEALTHY FUTURE FOR CALIFORNIA
Advancing California’s Digital Health Data Safety Net
A Message From Our CEO
In 2023 Manifest MedEx (MX) turned seven years old, was designated by the state of California as one of only nine Qualified Health Information Organizations (QHIOs) under the California Data Exchange Framework , and supported the secure and appropriate exchange of more than 38 million longitudinal health records across the great state of California. Simultaneously, we completely pivoted the way we host and manage data; improved our Fast Healthcare Interoperability Resources® (FHIR®) technology capabilities; and implemented a modern, digital approach to enabling individuals to access their own longitudinal records. I am both proud and humbled by the progress we’ve made to deliver on our mission, and I am so glad you have also been part of our journey.
Today, the MX network provides a more complete picture of a person’s health and needs, making it easier to deliver care and support that is smart, compassionate, and effective, while doing our part to protect the privacy and security of Californians’ sensitive health data.
Being contacted in the right language, with an accurate history of your prescriptions, with the latest details about your stay in a hospital, with understanding of your housing and transportation situation, with the right pronouns, at the right time when you need help…this is what every Californian deserves and is essential for the vibrant and healthy future we envision for California.
As you’ll see in this inaugural annual report, we’re making progress toward that vision. Manifest MedEx grew significantly in 2023 — with double-digit growth in 56 out of 58 counties in California and by more than 8.5% across the entire network. We’ve been working closely with the state on supporting Medi-Cal transformation programs, piloting new consent management initiatives, and helping hundreds of organizations successfully participate in the California Data Exchange Framework. We deliver more than 50,000 hospital event notifications to California care teams every day, letting them get a head start on patient follow-up appointments , medication reconciliation and education, and coordinating other social supports they need to get healthy and stay healthy.
This is an exciting time for health in California. We’re seeing the power of an emerging health data safety net in action to advance California’s innovative health and wellness priorities. Connected, secure, compassionate, and effective — I know this is the future we all want for health and wellness in California, and I’m honored that we get to be a part of it at Manifest MedEx.
Thank you for being part of this vision and our journey to achieve it!
Erica Galvez Chief Executive Officer Manifest MedEx
“Manifest MedEx has long been committed to advancing interoperability and health data sharing across California in service to patients and their care teams; to enabling and supporting the high-quality health data infrastructure our state needs; and to ensuring all Californians get the care they need. We want to make sure no one falls through the cracks.”
– Jarrod McNaughton,
Board Chair of Manifest MedEx and Chief Executive Officer of Inland Empire Health Plan
Who We Are
Manifest MedEx (MX) has worked to securely and reliably exchange health data across California since 2017. As the largest nonprofit health data network in California, we are an integral part of the state’s health data infrastructure, combining and delivering crucial health information for 38 million individuals across every county.
MX is taking bold steps toward health transformation, working with partners on the local and state level to advance health equity, support public health initiatives, and achieve Medi-Cal goals.
“Our mission is to provide every healthcare organization in California with the information they need to improve care, enhance health, and lower costs.”
Manifest MedEx Team at Annual Spring Retreat
How Far We’ve Come
2011 Inland Empire Health Information Exchange (IEHIE) is formed as a collaboration between Riverside County Medical Association (RCMA), Inland Empire Health Plan (IEHP), and HASCRiverside 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 patients across 150 network partners.
2018 The network launches MX Notify (ADT notifications) and brings on prominent participants including Hill Physicians Group and Stanford Health Care.
2019 Manifest MedEx earns HITRUST CSF® certification and launches MX Access (longitudinal records) and MX Analyze (population health management tools). Now reaches 17 million Californians with HealthNet, AHMC Healthcare, and funding from California Emergency Services Authority (EMSA).
2020 Supporting urgent public health needs during the COVID pandemic, MX announces sharing health records for 23 million people, more than half the population of California, 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 NCQA designation for validated data streams.
2022 Erica Galvez is named CEO of Manifest MedEx as the network grows to 32 million individuals 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 Qualified Health Information Organization (QHIO) in the CalHHS Data Exchange Framework (DxF). Tests a universal consent approach through the DHCS Authorization to Share Confidential Medi-Cal Information (ASCMI) Pilot with San Joaquin County, Health Plan of San Joaquin, and Health Net. Also, builds more capabilities to exchange social data and expanded demographics like sexual orientation and gender identity (SOGI) data from self-reported sources, 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 With records for 38 million individuals and 2,200 healthcare organization participants, the MX network begins sharing real-time information for DxF participants and launches the California ADT Network — a no-cost, electronic ADT notification exchange.
Data and Impact Across California
After six years of growing and scaling our network and capabilities, Manifest MedEx hit new major milestones in our breadth and depth of network participation in 2023. We’re thrilled to celebrate these accomplishments in building health data infrastructure and advancing health information sharing in California. Looking ahead, MX’s reach as the largest nonprofit health information exchange in the state means that together, we can do so much to advance health equity, support public health programs, and ensure every Californian gets the whole person care they need.
38 Million Unique Records
• In 2023, Manifest MedEx expanded the number of individuals with a health record in our network, aggregated since 2017, by 8.5% to 38 million.
• Approximately 82% of our records include critical clinical data.*
• We had records for more than 30.7 million individuals with last known addresses in California.**
Approximately 18.3 million of those records were active in 2023, with clinical activity or other engagement with a network participant collected during the year.
• We increased the number of portal users by 30% and had 127% more patients subscribed in MX Notify, helping improve patient outcomes across the state.
from only health plan eligibility files or with claims data Records with clinical data
*Data from at least one encounter, lab, medication, problem, condition, procedure, vaccination, or discharge summary sourced from a non-health plan. **The 7.3 million difference in records between total aggregated since 2017 (38 million) and records for Californians in 2023 (30.7 million) is due to factors such as outmigration (approximately 700,000
death (approximately 300,000
year), and out-of-state visitors who sought care from a network participant.
71.6 Million CCDAs Per Year
Manifest MedEx provided an average of almost 6 million CCDAs per month in response to queries for clinical data.
This includes data that we send through our participation in the national networks, such as eHealth Exchange and Carequality, in response to queries from healthcare organizations that are not on our network.
CCDAs Delivered to Organizations Outside of MX Network in 2023*
Organization CCDAs Delivered
Kaiser Permanente (Northern and Southern California) 22,164,093
Sutter Health 5,664,262
University of California San Francisco 2,425,774
Cedars-Sinai Health System
MemorialCare Health System 1,123,990
*After June 2023
“The ease of obtaining records all in one place saves a significant amount of time and helps provide better care for our patients.”
– Jannette Ruz, Transitional Care Coordinator, Central Neighborhood Health Foundation
16 health plans participating in 2023
1.6 Million ADTs Per Month
We also delivered an average of 1.6 million hospital admission, discharge, and transfer notifications each month in 2023 — providing powerful real-time information needed to coordinate care postdischarge.
54,798 Clinical Records Viewed Per Month
Clinical records in the Manifest MedEx network were viewed more than 600,000 times in 2023.
249 New Organizations Joined Manifest MedEx
MX saw especially strong growth among ambulatory care providers in 2023 with 242 new ambulatory participant organizations — vitally important for reaching the care delivery front lines and a segment that has struggled with connecting to HIEs in the past. Manifest MedEx also welcomed two California hospitals and five health plans, bringing our total to 131 hospitals and 16 health plans on our network in 2023.
“By partnering with MX and utilizing our breadth of member data, we are able to identify members in real time who are at risk of an inpatient stay or readmission, which allows us to take proactive, actionable steps to maximize care coordination and delivery, while at the same time providing the member with a quality experience.”
– Mark Reynolds, Chief Operating Officer, Anthem Blue
Cross
MX Ambulatory Provider Participant Growth 2017 - 2023
Number of participating ambulatory sites Number of ambulatory sites sending CCDAs
Number of ambulatory sites sending lab data
MX Hospital Participant Growth 2017 - 2023
Expanding a Digital Health Data Safety Net Across California
Healthcare is local and mobile as people seek care when commuting or traveling. Manifest MedEx serves as a partner in every county throughout California, working on the ground with communities across the state to succeed in data-driven initiatives like California Advancing and Innovating Medi-Cal (CalAIM).
We increased the number of individual records on our network by more than 10% in 56 out of 58 counties.
“As we build a healthy California for all across our vast and complex state, let us ensure digital equity for all providers by advancing a health data safety net that extends beyond traditional healthcare to support whole person health and wellness.”
– Erica Galvez, CEO, Manifest MedEx
Percent Increase in Individual Records on MX Network in 2023 by County Based on Last Known Address
Data to Serve Every County in California
The MX network had an active health record for more than 18 million Californians in 2023 alone, demonstrating the opportunity for a digital health data safety net that bridges large urban centers and rural communities alike.
Active Records on MX Network in 2023 as a Percent of County Population*
Growth in Top 10 Largest California Counties
Here are a few highlights of our growth in the 10 largest counties in California, totaling more than 22 million records in 2023.
Increase in Records According to Last Known Addresses on MX Network by County From 2022 to 2023
*Based on 2022 Census estimate, accessed in Jan 2024.
Building Medi-Cal Health Data Infrastructure
California has been embarking on an ambitious new set of priorities to better deliver coordinated care to Medicaid (Medi-Cal) beneficiaries and build powerful, connected health data systems to support whole-person care. Manifest MedEx has been an early collaborator with the plans and providers implementing the CalAIM program, bringing in new organizations that support Enhanced Care Management (ECM) and Community Supports (CS) to the network; alerting Medi-Cal providers with ADT notifications; providing longitudinal records with race, ethnicity, and preferred language (REaL) data that support culturally appropriate and trauma informed care; and piloting innovative new data delivery programs.
Highlights:
• CalAIM is “a broad transformation of Medi-Cal to create a more coordinated, person-centered, and equitable health system that works for all Californians.”1
• In 2023, Manifest MedEx brought on three new Medi-Cal health plans — Alameda Alliance for Health, Community Health Plan of Imperial Valley, and CenCal — joining 10 existing Medi-Cal plans on our network, including Aetna, Anthem Blue Cross of California, Blue Shield of California Promise, Gold Coast Health Plan, HealthNet, Inland Empire Health Plan, and Health Plan of San Joaquin.
• We were selected as one of three participants in DHCS ASCMI Pilot, helping to shape future programs and facilitate the exchange of data needed to successfully implement programs such as ECM and CS, which require obtaining members’ consent for sharing sensitive data.
• We invested resources to develop capabilities that enable MX to bridge the data sharing gap between clinical care delivery, human or social services, and public health that meet privacy, state, and federal regulations.
1https://www.dhcs.ca.gov/CalAIM/Pages/CalAIM.aspx
“We first joined Manifest MedEx in 2018 to access real-time health data to support whole person care before, during, and after a hospital visit as part of the Health Homes Program, which has now transitioned to the Enhanced Care Management and Community Supports program under CalAIM, of which Riverside Family Physicians is a provider. Gaining access to real-time ADT notifications has allowed our organization to efficiently improve our post-discharge processes and ensure our patients get the care they need.”
– Tarek Mahdi, MD, President, Riverside Family Physicians
Participant Spotlight:
Aria Community Health Center
Aria Community Health Center (ACHC) is a federally qualified health center (FQHC) and ECM provider serving Fresno, Kings, and Tulare counties.
ACHC leverages the information in MX Access to improve patient engagement, a core service component of ECM. Because care managers and providers have access to longitudinal patient records, they can have sensitive and compassionate conversations, foster trust, and improve patient engagement. They also use MX Access to find up-to-date patient demographic and contact information, which helps them more successfully engage patients and provide more culturally and linguistically appropriate care.
ACHC runs a mobile clinic to serve rural populations where patients may not have access to a primary care provider or reliable transportation. At these clinics, community health workers use information from MX Access to identify patients who are eligible for ECM and provide education on their benefits. As case managers continue to build those relationships and trust within rural communities, these interpersonal interactions have improved health outcomes and closed care gaps for an underserved and under-resourced population.
“Utilizing MX Access allows our case managers to provide the best possible care with the utmost sensitivity to the patient. It allows them to view their records, which helps them educate, and provide one-on-one assistance to those eligible for ECM. This improves their health outcomes and builds long-term trust with the patients.”
– Cynthia Diaz, Program Manager of Enhanced Care Management, Aria Health Care Center
Becoming a Designated QHIO to Advance California’s Data Exchange Framework
Manifest MedEx was designated one of just nine Qualified Health Information Organizations (QHIOs) by the state for the CalHHS Data Exchange Framework (DxF) in 2023. As a QHIO, we demonstrated our ability to meet DxF requirements and help California providers, hospitals, skilled nursing facilities, counties, health plans, and other organizations participate in the DxF as required by law passed in 2021.
Becoming a QHIO required Manifest MedEx to demonstrate capabilities such as:
• Sharing clinical data in national and federally adopted standards, including the United States Core Data for Interoperability (USCDI) v2, with data classes and elements related to social determinants of health (SDOH) and sexual orientation and gender identity (SOGI).
• Improving and streamlining Individual Access Services (IAS) so that individuals can better participate in their own care and ensure the accuracy of their information.
• Successfully meeting the requirements of HITRUST CSF certification, demonstrating the highest levels of security in the healthcare industry. Manifest MedEx has consistently earned HITRUST CSF certification since 2019.
We look forward to continuing to support all DxF participants, regardless of their location, technical capabilities, or resources so that we can truly advance data sharing to ensure seamless, coordinated care for all Californians.
Andrew Bindman, MD, Executive Vice President and Chief Medical Officer, Kaiser Permanente; Sandra Hernández, MD, President and Chief Executive Officer, California Health Care Foundation; Assemblymember Jim Wood, 2nd Assembly District, State of California at the 2023 Annual DxF Summit.
Highlights:
• Manifest MedEx serves on the Implementation Advisory Committee and the Policies and Procedures Subcommittee to help guide the development and implementation of the DxF.
• More than 450 participants from the MX network signed the Data Sharing Agreement (DSA) to participate in the DxF.
• Additionally, more than 100 organizations that selected MX as their QHIO to meet their DxF requirements received QHIO Onboarding Grant Funding. MX also supports 38 organizations that were awarded Technical Assistance (TA) grants*.
• As an early adopter and strong advocate of the DxF, MX held five educational webinars with more than 700 attendees and co-hosted the 2023 Annual DxF Summit with CDII, California Health Care Foundation, and Connecting for Better Health to discuss ways to accelerate cross-entity collaboration through the DxF.
• As of May 2024, more DSA Signatories have selected Manifest MedEx to meet their DSA requirements than any other intermediary, vendor, or network.
*Rounds 1 and 2 were awarded in 2023. Round 3 grants were delayed and awarded in 2024.
“Under the DxF, MX has the security, platform, and tools that work in parallel to help us achieve outcomes. For example, if someone on our case management team wants to know when a member was admitted into the ER, they receive notifications within 5-10 minutes of when that person enters the ED. When the person is discharged, we have the full ADT, CCDA, and discharge summaries that are populated and pushed over in real time in our EHR system for our providers. This creates a full ecosystem that our providers enjoy, as well as our case management team.”
– Justin Ashe, Vice President of Information Technology, Choice Physicians Network
Supporting California’s Public Health Priorities
The California Department of Public Health (CDPH) solicited competitive bids and awarded Manifest MedEx an up to five-year contract to build a health data solution for high-volume, normalized reportable lab data across the state.
We successfully implemented this new data system for CDPH’s Surveillance and Public Health Information Reporting and Exchange (SaPHIRE), helping to advance public health in the state and ensure crucial lab information is delivered in a timely and reliable manner.
Highlights:
• Manifest MedEx migrated electronic lab results and data feeds from more than 400 labs and other entities that submit results to CDPH in 2022 and continued to connect labs across the state in 2023.
• Today more than 1,500 labs participate in electronic lab reporting through SaPHIRE, and MX receives 1.4 million reportable lab results per month.
• In addition to electronic lab reporting, MX now provides electronic case reporting (eCR) to CDPH, providing more than 65,000 CCDAs per month to help support public health efforts.
“We are honored to provide SaPHIRE infrastructure to CDPH and elated to have completed this massive migration of lab data feeds from across the state. We look forward to continuing to improve lab data quality and supporting CDPH’s initiatives to create a healthier California.”
– Jason Buckner, Chief Information Officer, Manifest MedEx
Tomás Aragón, MD, State Public Health Officer and Director, California Department of Public Health; Emily Chung, Public Health Director, County of Santa Cruz Health Services Agency; Wayne Enanoria, Chief Science Officer, Santa Clara County Public Health Department; Eric Sergienko, MD, County Health Officer, Mariposa County Health and Human Services Agency and President-Elect, California Conference of Local Health Officers at the 2023 Annual California DxF Summit.
“To maintain oversight of such a large county, utilizing real-time ADT notifications and accessing patient information are pivotal in ensuring no patient is lost on our radar.”
- Shadi Barfjani, MD, MSc, Senior Deputy Director, San Joaquin County Public Health Services
Investing in Technology to Expand Secure Data Sharing
and Protect Privacy
Manifest MedEx is committed to providing exceptional value and the best experience for our customers. We made a series of investments and enhancements to our tools and products in 2023 to help participants meet their DxF requirements, streamline performance, improve reporting quality, save participant time, and provide a better user experience.
Highlights:
• Manifest MedEx added 500,000 clinical care summaries from Kaiser Permanente California, CommonSpirit Health, Sutter Health, UC Health
System, MemorialCare, Cedars-Sinai, and other California health systems to our network through our treatment-driven exchange with national networks like eHealth Exchange and Carequality.
• We invested in enhancements to MX Notify and MX Access, like supporting USCDI v2 data, which includes SDOH and SOGI data, and enhanced our FHIR capabilities to deliver data faster.
• Manifest MedEx also earned NCQA Data Aggregator Validation Designation again, marking the fourth consecutive year that health plans and providers can rely on validated data from Manifest MedEx as supplemental data for HEDIS® quality reporting.
Manifest MedEx
Data integrated through direct connection
Data integrated through other sources
• DxF QHIO
• 16 Health Plans
• 130+ Hospitals
• 2,100+ Ambulatory Providers
• 38 Million Individual Records
• TEFCA Qualified Health Information NetworkTM (QHINTM)
• 5 federal agencies
• 64 regional or state HIEs
• 75 percent of all U.S. hospitals eHealth Exchange
Manifest MedEx: A California Health Data Network with National Connectivity
MX 2023 Financial Statement
Manifest MedEx is a nonprofit 501(c)(3) and is tax exempt. MX invested more than $12M in program expenses in 2023 to enhance its core platform infrastructure to better serve network participants, help them meet their DxF requirements, as well as meet MX’s QHIO DxF requirements.
2023 Total Revenue
2023 Total Expenses
2023 Total Revenue and Other Support: $51.1 Million
• Grant and Contribution Revenue: $34.4 million
• Health Information Exchange Services Revenue: $16.6 million
• Interest Income: $126,000
2023 Total Expenses: $50.8 Million
• Program Expenses*: $40.2 million
• Management and General Expenses**: $10.6 million
*Costs related to providing MX’s programs or services in accordance with its mission of developing a statewide, next-generation HIE. These costs include, among other items, third-party software-as-a-service fees (“SaaS Fees”), implementation expenses, hosting fees, and internal labor and contracting costs associated with maintaining and developing the HIE.
**Management and general expenses are costs related to administering the day-to-day activities of MX. These expenses do not directly relate to the purpose for which the Company exists and typically include costs for activities such as privacy/security management and governance.
Looking Ahead
We believe health equity for Californians depends on digital equity for providers to seamlessly connect clinical care delivery with social supports and public health. Manifest MedEx is committed to improving our products and services, expanding our capabilities, and advancing a statewide health data safety net that serves California stakeholders in alignment with our state’s ambitious goals for health equity, public health, and Medi-Cal outcomes.
Here is what is guiding our work in the months ahead:
Serving Public Health and Advancing Health Equity with Social Data
Public health data modernization is critical to ensuring no one falls through the cracks and that California is ready for the next pandemic or public health emergency. We remain focused on supporting counties to ensure meaningful connectivity at the regional level — connectivity that includes non-traditional data exchange partners like schools and jails that are essential to helping those most in need.
Making it Easier (and Free!) to Securely Send and Receive ADTs
Manifest MedEx recently launched the California ADT Network, a first-of-its-kind, no-cost, electronic acute and post-acute event notification exchange to substantially scale the exchange of ADTs across DSA Signatories. We look forward to continuing to expand the network to get ADTs to the right care teams.
Faster and More Useful Data
We are investing in ways to accelerate data exchange and data quality to make data we provide more insightful and actionable for our participants. Look for Manifest MedEx to expand our FHIR® capabilities, bring in more complete social data, pilot various approaches to increase matching rates and data quality, and integrate new technologies to protect the privacy of sensitive health data.
Expand Participation in National Networks
Through our partnership with eHealth Exchange, a designated Trusted Exchange Framework and Common Agreement (TEFCA) QHIN, Manifest MedEx intends to participate in TEFCA and offer our participants the ability to participate in TEFCA and meet their data sharing requirements.
As health data exchange continues to evolve, we remain committed to building the health data infrastructure and health data safety net needed to support our participants, those outside our network, and California more broadly. Together, we can enable the 21st century digital health ecosystem we all deserve.
