In the past two years, Manifest MedEx (MX), now the largest nonprofit health data exchange in California, has rapidly grown after being formed as the result of a merger between San Francisco-based California Integrated Data Exchange (Cal INDEX) and the San Bernardino-based Inland Empire Health Information Exchange (IEHIE) back in 2017.
With offices in Northern and Southern California, the HIE facilitates the secure exchange of 11 million patient claims records and 5 million patient clinical records, and is on a mission to connect healthcare in California.
At the time of Manifest MedEx’s launch in 2017, and as reported by Healthcare Innovation Editor-in-Chief Mark Hagland, the merger combined the 11.7 million claims records from Cal INDEX founding members Blue Shield of California and Anthem Blue Cross with the 5 million clinical patient records of IEHIE and its 150 participating partners.
At the same time, it was announced that Claudia Williams, former White House technology senior advisor, was tapped to lead the new organization as CEO. At the time of the announcement, Mark Savage, chairman of the Cal INDEX Board of Directors and director of health information technology policy and programs for the National Partnership for Women & Families, said of Williams: “Claudia is the ideal candidate to lead this new entity. She is a strategic and transformational leader with national experience managing and scaling health information exchanges. With Claudia, California’s statewide HIE gets the rare combination of breadth and depth.”
The HIE has grown, and the network now has participation from more than 200 healthcare organizations, including more than 80 California hospitals, and five of the largest health plans in the state—including Blue Shield of California and Anthem Blue Cross of California. Just in the past year, Manifest MedEx has added San Diego-based Scripps Health, Stanford Health Care and AHMC Healthcare, a network of seven affiliated hospitals in the greater San Gabriel Valley, to its network, as well as Heritage California and Hill Physicians, two of the largest medical groups in the state.
In an interview with Healthcare Innovation Managing Editor Rajiv Leventhal back in March 2018, 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,” Jaeger said.
In another recent development, the California Department of Health Care Services secured $45 million in federal funding and $5 million in state funding to invest in HIEs throughout the state and the funding will be used to help onboard providers to California information exchanges.
Recently, Williams spoke with Healthcare Innovation Associate Editor Heather Landi about the HIE’s growth in the past two years, the organization’s strategy to provide value to network participants and the path forward for HIEs.
How would characterize the growth and progress of the HIE in the past two years?
We’ve seen incredible progress on several fronts; the first is delivering valuable products and services to our participants that will help them succeed in value-based care. Over the past year we have transitioned to a new modular technology platform, integrating best of breed components from InterSystems, NextGate, Audacious Inquiry and others. We are delivering three value-added services—one is real-time notification alerts (MX Notify); second, the longitudinal health record of patients (MX Access), and in Q1 2019 we will include not just clinical data but also claims data; and third, this quarter we will be rolling out an analytics platform (MX Analyze) that will provide a tool to risk stratify patients and identify care gaps. That delivery of robust, scalable products on a solid technology base has also led to real success in growing our network. We’ve added Stanford, Scripps, Heritage, and AHMC. Those systems are leaning heavily into new forms of care and population health, and I think getting a robust stream of data, reflecting clinical as well as claims data, is incredibly appealing to them.
Claudia Williams
As a result, the network is driving measurable results reducing readmissions and ER usage. As one example, we are working with a large ACO in the Inland Empire, and they have posted measurable changes in seven-day visits after discharge, readmissions reductions, and ED visits, using our HIE services. This is an example of MX products supporting a concrete, effective workflow that succeeds in reducing ED, reducing readmissions and getting patients into care more quickly once they get back in their homes.
In building out your organization’s value proposition, what is Manifest MedEx’s strategy?
We are keeping our attention very trained on the health systems, medical groups and plans that are building out new value-based models because there is a lot of demand for information sharing in those models. Within that, we’ve evolved to focus on who the most intense users of HIEs are going to be, and in our view, it’s the senior VP of population health. On a more daily basis, it’s the care managers, care coordinators and discharge planners who are trying to build connective tissue between their clinical entity and others that are caring for that same patient. I think the average clinician in practice finds value in what we do, but it’s really in those intersections, where a group of people are trying to be accountable for that patient population where we see the deepest and most valuable use.
In March 2018, Blue Shield of California announced it would require network providers to participate in the Manifest MedEx network. What levers do you see health plans using to expand health information sharing?
I’ll cite an example in the Inland Empire, we work closely with Inland Empire Health Plan, which is a leading California health plan and the biggest Medi-Cal health plan in that area. As they look at the key challenges that they are having internally, which includes reducing readmissions, increasing care coordination, increasing their HEDIS scores, as well as doing things like improving the prior authorization experience for both patients and providers, they realize that the data that MedEx is providing is incredible and crucial to that. And, we all recognize that it’s a lift to connect to an HIE, it takes time and energy of your technology team, and your project management team, and they have many tech priorities that they are trying to juggle at once. What Inland Empire Health Plan did was they said, our pay for performance program for hospitals, we’re going to portion a piece of that to incentivizing hospitals to connect to MedEx. [Editor’s note: Inland Empire Health Plan pledged $6 million in incentives to regional hospitals that participate with MedEx and use its services in 2018.] There are actual data sharing requirements built into that incentive program, and as each hospital hooks up their system with ours and sends various types of data and results, such as ADT alerts (admit, discharge, transfer), they are eligible for a substantial financial incentive to do that. We found that helps to move the project up the list. And that’s my hope for the approach the state will take in its $50 million effort, which is really to recognize the effort and time taken, especially by hospitals, and make sure that there is money on the table for them to connect to HIEs.
I’m excited by the kind of collaboration and partnerships we’re seeing, bringing together not just the clinical side of things, the providers, but also the health plans. We’re seeing those partnerships really gaining steam across the country for successful HIEs. And for me, it’s not just a question of what health plans can get from an HIE, but frankly what they’ll also give. In our case, they are providing substantial financial support and also claims data. Many HIEs have struggled with bringing in ambulatory data into the network, because it’s very time consuming and expensive to work with every single provider. So, when we have claims data that provides information—what were all the visits the patient had, what were all the hospital encounters the patient had, what medications are they on, what’s the full list of diagnoses for that patient—that provides a critical complement to the hospital clinical data that HIEs can get. The health plans being at the table, contributing financially and also contributing in terms of data, is going to be a real marker of our success and other HIEs’ success moving forward.
What makes California a unique market when it comes to HIE and interoperability efforts?
I actually think that we’re behind. It’s not surprising, given the size and the complexity of this market, but we estimate about half of all hospitals in the state participate in HIE efforts, and that compares to Maryland, where every single hospital, except the NIH clinical center, is a participant in their state effort, CRISP (the Chesapeake Regional Information System for our Patients, a regional HIE). I’m excited that the funding from the state will really set up a process and an expectation that every single hospital should come on board in 2019. Whether it’s with us or another HIE effort.
Let’s shift to policy and strategy, as you previously served as White House technology senior advisor. What does your previous experience bring to your current role at Manifest MedEx?
We really laid the policy track and the expectation track for technology to deliver on its promise of better care at lower cost. The work that I did that really dug into EHR (electronic health record) adoption, HIE programs across the country, funding, policy expectations, were the precursor tracks that were laid for our success in California.
I think one specific way my background really helped me is that I led the $500 million grant program that was aiming to accelerate HIE efforts in every single state and territory across the country. I had a front row seat to see what works and what doesn’t work. And what I saw that works is a very keen focus on delivering value to participants, and that comes from both the richness and breadth of the data network, and it also comes from a very keen eye on who should be using the services and to do what.
Also, what we’re seeing across the country is that it’s expensive and it takes a lot of expertise to effectively run the infrastructure that I’m talking about, and make it be as dependable and high quality as we all want. We’re seeing a trend towards merging of HIEs or one infrastructure supporting many communities. Maryland is one example, as that organization is now supporting HIE efforts in West Virginia, and D.C. and Virginia. I think to do this right, you need quite a sizeable, robust organization. The model we use is to share a common infrastructure across many communities but have local health information organizations, local HIOs that rally the local community, represent local needs and support participants in that community. We have three of those organizations in three communities across the state.
What are your thoughts on federal policy efforts, such as TEFCA (ONC’s Trusted Exchange Framework and Common Agreement), to spur information exchange?
We’re seeing that the federal government can play a massive role in accelerating the adoption and use of health information exchange, and TEFCA is one way to do that. But recently, CMS (the Centers for Medicare & Medicaid Services) released an RFI (request for information) asking for comment and recommendations on what could be done to accelerate information sharing, and we joined together with 50 organizations to submit comments suggesting that every hospital in the nation should be required to let community providers know when a patient leaves their doors. This is a well prescribed and well executed use case across the country; this basic idea that a primary care provider would be alerted, in real time, when their patient is seen and is discharged. There are HIEs and technology companies that can support this effort for every hospital in the nation. We recommended that become a part of Medicare, basically a requirement of participation in the Medicare program. We don’t’ know what will happen; we expect regulations on that matter. We had a great meeting with (CMS Administrator) Seema Verma, she has been making comments suggesting that is an area of interest for her, so we’d like to see efforts that are well prescribed and well adopted just become the expectation for how we deliver good care.
Looking ahead, what will the leadership team at Manifest MedEx be focused on?
I think it’s time that California come into the digital age by accelerating participation in HIEs across the state. I’d like to see MX play a lead role in making sure every hospital and health system is hooked up to us or another HIE. We have a 50 percent gap, so we have a lot of progress to make but I think with the mandate coming from value-based care, the additional funding that will be available through the state and federal government, as well as the kinds of robust, scalable services that we’re offering and that are really in high demand, I think we’ll get there over the next year to 18 months.
