Blue Shield of California to Make HIE Participation Mandatory in its Contracts

San Francisco-based Cal Index was founded in 2014 as a nonprofit health information exchange through seed funding from Blue Shield of California and Anthem Blue Cross. After slow initial uptake and several leadership changes, Cal Index merged last year with the San Bernardino-based Inland Empire HIE to become Manifest MedEx. Now Blue Shield of California has announced that beginning this year it will require providers in its contracts to participate in Manifest MedEx.

Blue Shield is telling its accountable care organization providers they must sign a participation agreement with Manifest MedEx by Aug. 31, 2018, and other network providers must do so as a part of their next contract renewal.

“Manifest MedEx delivers the information that helps hospitals, medical groups and ACOs do the hard work of improving care coordination, reducing inefficiencies, addressing gaps in care and enhancing the patient experience,” said Claudia Williams, CEO of Manifest MedEx, in a prepared statement. “Manifest MedEx gets you the information you need, in the formats you need, when you need it. We break down silos, so California providers can focus on what they do best: improving health care, not assembling data.”

Manifest MedEx said it facilitates the secure exchange of 11 million patient claims records and 5 million patient clinical records for over 200 participating partners.

In a recent interview with Healthcare Informatics Managing Editor Rajiv Leventhal, Chris Jaeger, M.D., vice president of accountable care innovation and clinical transformation at Blue Shield of California, called Manifest MedEx a key foundational effort leading to value-based care.

 “Creating an infrastructure that can be this HIE 2.0, if you will, [could be] the foundation for value-based care that can support population health efforts and drill down to the personal level as patients migrate through their life. That’s critically important,” he said.

Jaeger noted, however, that HIE merger hasn’t yet impacted the Northern California region as it has the southern part of the state, but he feels that under the lead of Claudia Williams, the former White House technology senior advisor, the new organization will be in good shape. “I don’t mean to speak for [Williams], but Cal Index, under its old leadership, was challenged with getting a large number of providers to sign on. The value proposition was a good one on paper, but perhaps too broad from an implementation perspective,” he said.

Speaking to the needs of the region more broadly, Jaeger said that Kaiser, if it were to join Manifest MedEx and share its data, would create new value at the individual level for people moving in and out of Kaiser’s system. And from a de-identified data perspective and research perspective, “you’d be able to better study and understand what types of health interventions might create value versus the ones that won’t. That might help spread the adoption of things inside Kaiser to outside of [Kaiser], and vice versa,” he added.