CASE STUDY

Learn how Advanced Patient Matching Transformed Quality and Efficiency for California’s Largest HIE

HIEs face intense pressure to provide highly reliable patient data to their participants and public health agencies in real time. Manifest MedEx’s use of advanced patient matching technology ensures access to complete and trusted patient data, elevating its efforts to support connected care. It’s an approach that positioned Manifest MedEx to become one of just four organizations in the country to receive data aggregator validation status from the National Committee for Quality Assurance (NCQA). 

Challenge

Manifest MedEx is the largest health information exchange (HIE) in California and the most robust health data network in the state, sharing data for more than 27 million residents. Each year, the HIE receives clinical and claims data for individuals from over 120 hospitals, hundreds of provider practices, and 9 health plans.

In 2017, Manifest MedEx was created from the merger of California Integrated Data Exchange (Cal INDEX) and Inland Empire Health Information Exchange (IEHIE). The newly formed organization had an enterprise master patient index (EMPI) solution in place to help verify the accuracy of members’ demographic data. But managing the solution was complex work. While the EMPI Manifest MedEx had in place used probabilistic and deterministic matching to detect duplicate medical records—a common problem for healthcare organizations—the EMPI flagged hundreds of thousands of records as “potential duplicates.” Each instance required Manifest MedEx team members to manually review and resolve records. Additionally, creating customized rules for the EMPI demanded a lot of time and effort from Manifest MedEx’s IT team. Leaders desired an EMPI with standardized logic that they could depend on to increase match rates with significantly less need for manual intervention.

When Manifest MedEx decided to move to a cloud-based operating model, leaders saw an opportunity to choose a cloud-native solution for patient identity matching that would strengthen security, efficiency, and accuracy.

Solution

As the largest health data network in California, it’s no small task to keep our system operating efficiently. Verato’s solution empowers our HIE to deliver accurate, up-to-date health information to participants in real time so they can do the hard work of improving patient care.

DAVID Kates, CHIEF TECHNOLOGY OFFICER, MANIFEST MEDEX

Manifest MedEx partnered with Verato to help eliminate duplicate member records and boost match rates. Efforts to strengthen match rates are critical, given that safety and quality of care as well as care management depend on the ability to uniquely identify patients and associate clinical and claims data with the correct individual. Research by The Pew Charitable Trusts shows that among hospitals alone, patient match rates between hospitals can be as low as 50%. Sometimes, these occurrences are due to errors made while inputting patient demographic information, such as the patient’s name, birth date, or address. Sometimes, they occur because patients’ information changes over time. The high rate of duplicates points to the need for a more advanced approach.

Manifest MedEx implemented Verato Auto-StewardTM, a cloud-based service that paired with the HIE’s existing EMPI to automatically detect and resolve duplicate medical records. Over time, Manifest MedEx further simplified its approach by adopting Verato’s SaaS-based EMPI, Verato Universal® MPI, which uses Referential MatchingSM to achieve substantially higher accuracy in patient identity resolution.

“It’s exciting to see Verato’s patient matching technology in action,” says David Kates, Chief Technology Officer, Manifest MedEx. “Our HIE is incredibly large, with numerous data sources and 27 million covered lives, and in an era of increased mergers and acquisitions, it’s not uncommon for two healthcare organizations to use the same numbering scheme for patient records. Having a robust, highly accurate EMPI ensures we match patients with the right records in that data stream. It also enables staff to focus on higher-value work rather than managing and maintaining this system. Simplifying our approach also meant having a HITRUST-certified solution. Verato’s solution gives us a high degree of confidence in the security and stability of our EMPI.”

Results

More Complete and Connected Health Records

Manifest Medex accelerates time-to-value for health plans by maintaining a master record consisting of all available member data to fuel quality improvement and reporting, risk adjustment, care coordination, and utilization management. Records are immediately updated whenever new member information is available and shared with health plan participants following stringent security and privacy controls.

Manifest MedEx has also enabled these plans to:

  • Reduce “chart cases” for HEDIS by 54%
  • Decrease outbound calls to hospitals by 15% to 20%
  • Receive real-time alerts when members are seen in the emergency department or are admitted or discharged from hospitals
  • Identify at-risk members to support outreach that improves health outcomes Manifest MedEx provides health plans with NCQA DAV validated standard supplemental data for HEDIS reporting – without the need for additional validation by health plans. The HIE’s success in matching the right data to the right members in real time was key in earning NCQA validation status. This enhances the efficiency of quality reporting for providers and health plans.

Manifest MedEx provides health plans with NCQA DAV validated standard supplemental data for HEDIS reporting – without the need for additional validation by health plans. The HIE’s success in matching the right data to the right members in real time was key in earning NCQA validation status. This enhances the efficiency of quality reporting for providers and health plans.  

Enhanced Collaboration for Public Health

When the COVID-19 pandemic emerged, it intensified pressure on health information exchanges to provide highly reliable, real-time data to their participants and public health agencies. Manifest MedEx’s use of advanced patient matching technology ensures access to complete and trusted patient data, improving COVID-19 tracking capabilities and health outcomes. During the pandemic, Manifest MedEx was able to:  

  • Leverage predictive analytics to identify high-risk members and respond with proactive outreach 
  • Alert providers when their patients test positive for COVID-19
  • Track and forecast hospital bed capacity to keep a pulse on availability
  • Support test ordering and scheduling with state and county clinics
  • Bolster contact tracing efforts by matching test results with patient contact information

Manifest MedEx also partnered with five HIEs spanning six additional states to develop dashboards that provide a real-time view of test results by county, age, gender, race, and ethnicity.  It’s an initiative that has enabled these not-for-profit organizations to deliver critical and timely data and services that strengthen the public health response during the pandemic.

As Manifest MedEx continues to grow, our advanced patient matching solution enables our HIE to quickly resolve duplicate records that are created when we connect to new data sources. We’re grateful to Verato for providing the tools that help us provide trusted member data where and when it is needed, including during a crisis.

Jason Buckner, Technology Chief Operating Officer, Manifest MedEx