L.A. Care Using FHIR to Send Claims, Encounter, and Clinical Data to LANES QHIO

Los Angeles-based L.A. Care Health Plan, the nation’s largest publicly operated health plan, is the first managed care plan in California to use FHIR to connect with the Los Angeles Network for Enhanced Services (LANES), its Qualified Health Information Organization (QHIO) under the state’s Data Exchange Framework (DxF).

This data-sharing approach is aligned with national efforts such as the Trusted Exchange Framework and Common Agreement (TEFCA), established by the Office of the National Coordinator for Health Information Technology (ONC).

Another payer, Elevance Health, began using FHIR-based exchange to connect with Manifest MedEx (its QHIO), including sharing claims in FHIR format for the DxF,  in December 2024.

Through this initiative, healthcare providers and social service agencies across the state now have real-time, secure access to L.A. Care member data—including adjudicated claims, encounter records, and clinical information. L.A. CARE said the advancement supports better care coordination, closes gaps in medical history, and improves health outcomes, particularly for underserved communities.

“L.A. Care continues to pave the way for health information technology adoption across the state,” said Martha Santana-Chin, CEO of L.A. Care Health Plan, in a statement. “This technological advancement bridges gaps in medical history, treatment plans, and social services support, ensuring that providers have the information needed to deliver timely, informed care.”

“By receiving claims and encounter data from L.A. Care in the FHIR standard, we’re expanding our ability to support value-based care and whole-person care,” said Ali Modaressi, CEO of LANES, in a statement. “Claims data adds a critical dimension when combined with clinical, mental health, and social determinants of health data, allowing us to deliver deeper insights, close care gaps, and help providers manage population health more effectively.”

“By strengthening data-sharing capabilities and expanding provider access to critical member information, this initiative helps close long-standing gaps in care and drives better health outcomes across Los Angeles County and beyond,” added Santana-Chin. “This achievement reaffirms L.A. Care’s commitment to health equity, ensuring that underserved communities receive the support they need.”