California Health Data Utility Manifest MedEx’s Increasing Role in Public Health
During a WEDI 2025 Spring Conference panel session, Erica Galvez, CEO of Manifest MedEx (MX), highlighted several ways the health data utility (HDU) is partnering with state and local public health agencies in California to improve population health.
Galvez was speaking on a panel with two other leaders of the HDU movement: John Kansky, president and CEO of the Indiana Health Information Exchange, and Melissa Kotrys, CEO of Contexture, the health data organization for Colorado and Arizona. All three are members of the Consortium for State and Regional Interoperability (CSRI), along with CRISP, CyncHealth, and the New York eHealth Collaborative. CSRI defines the health data utility (HDU) as a single organization or a jointly governed cooperative of a small number of organizations, ideally operated by a not-for-profit organization with multi-stakeholder governance, that seeks to meet the comprehensive health data and health data analytics needs of both the public and private sectors within a state.
In California, MX is a statewide health data utility connected to 19 health plans, over 140 hospitals, approximately 3,000 providers, with 40 million people in the master person index.
Saying that she sees population health as a foundational characteristic of health data utilities, Galvez began her WEDI presentation by talking about an example involving statewide electronic lab reporting and case reporting. In 2022 MX began supporting the California Department of Public Health (CDPH) with the infrastructure required to enable statewide electronic lab reporting.
“That year, when we won the contract with CDPH for that infrastructure, we migrated data feeds from more than 400 labs onto a solution called SaPHIRE (Surveillance and Public Health Information Reporting and Exchange),” Galvez explained. “And as we took lab results in from those 400-plus labs, we began processing those. What MX does that's really valuable for public health in this case is we match those lab results up. They're often duplicated, so we match them to a unique identity, de-duplicate those labs, normalize and uplift that data, and then we pass those on to CDPH, so that they can make sense of of what's happening in our ecosystem.”
Today, the number of labs sending results through that solution has more than quadrupled. “We process more than one and a half million reportable lab results every month for CDPH,” she said. “About a year and a half ago they added electronic case reporting to that scope of work, which today results in about a million CCDAs, or those longitudinal care summaries, coming through our system for electronic case reporting.”
Working with county public health departments
At a more local level, MX has worked with several counties such as San Bernardino County in Southern California, to address congenital syphilis. “That is a condition that I know you're probably thinking is largely irrelevant in these modern times. But between 2014 and 2018, much to the surprise of many of us, there was a 267% increase in syphilis cases in San Bernardino County alone,” Galvez said. At the same time, there was a 500% increase in cases among females between the ages of 15 and 44 years. That boom in syphilis rates, resulted in a 675% increase in congenital syphilis cases.
Congenital syphilis is an entirely preventable condition, she noted. It does require the appropriate treatment and intervention during pregnancy and delivery, so knowing where a person is during that journey becomes really important for preventing passing of syphilis from mom to baby.
In San Bernardino County, this challenge was compounded by a number of general factors and characteristics of the ecosystem there. Nearly half of the households in that county speak a language other than English as their primary language, and the median household income across the county lags both the state and the nation, which results in a wide range of barriers to accessing care.
“To address this challenge, which I will admit at the time, seemed a little bit insurmountable, just given the rise in cases, MX partnered with San Bernardino County Department of Public Health and essentially put a program in place to monitor pregnant individuals with syphilis,” she said. “That is a reportable condition, so public health knows what that population looks like of folks who were exposed to syphilis. We monitored the care delivery system for those individuals and notified the public health case managers in San Bernardino County when those folks showed up at a hospital.”
What that enabled was real-time intervention and treatment to prevent the transmission of syphilis to babies. “Between 2020, and 2021, that collaboration resulted in an 18% decrease in congenital syphilis cases,” Galvez added, “which we we think is a big win, and San Bernardino County thinks is a big win also.”
Another example grew out of the pandemic. During the pandemic, there was a concerted push across the state of California to get the most vulnerable individuals vaccinated against COVID given limited vaccine supplies at the time.
Identifying and prioritizing that population for outreach and vaccination was really tricky, Galvez said, and the state laid out a set of characteristics and co-morbidities — things like use of oxygen. MX then partnered with the Health Plan of San Joaquin to try to understand the incidence of those characteristics across their population to help them prioritize their membership. MX included several data elements in a report that helped the health plan reach this most vulnerable population and then conduct culturally competent outreach to them.
“COVID mortality risk is something we had to calculate based on state guidance, details about existing vaccines — everything from the manufacturer of the vaccine to dosages and dates — the number of co-morbid conditions,” she explained. “Again, based on on the state's analysis of the correlation between high risk of poor outcomes from COVID and chronic conditions, we pulled this information from multiple sources.
The impact of that work is that vaccination rates significantly increased from March 2021 to July 2022 across a whole host of population categories, she noted.
“I don't know any other organization, aside from an HIE or an HDU that could do this in partnership with a health plan and the state,” she said, “because we had to pull data from the vaccine registry, from the clinical care delivery system, from the health plan’s claims, and bring that all together, accurately match that to an individual identity, then run some analytics on it and produce a report that can be sorted and shared with a third partner organization to conduct outreach.”
Health equity work
The last example she gave was of another collaboration with the California Department of Public Health that was focused on understanding to what extent information from a health data utility could supplement and inform work that the department was doing around health equity.
“We did this work looking at a random case file of TB cases — both TB infections and latent TB infection, and then a random file of COVID,” she said. “We matched those case files in our system and then produced output back to the state so that they could analyze: what does the Manifest MedEx data system have in it that the public health system does not have? What information does it have about these individuals?”
Both MX and the California Department of Public Health did analyses of the data. “We had significantly more data, in many cases, on important factors like race and ethnicity, and primary language in our system,” Galvez said. “We were also able to identify trends in things like health delivery system utilization, and how that correlated with race or ethnicity, how that may have correlated with primary language.
“I think the take-home on this is we're all better together,” she said. “There is significant opportunity in the public health space for improvements and real impact when public health collaborates with health data utilities.”
