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Health data utilities – nonprofit information exchange organizations governed by multiple stakeholders – are helping drive efficiencies for state Medicaid programs. Rather than having to get necessary data insights from many different sources, HDUs aim to make all relevant data available in one place.
At the upcoming 2026 HIMSS Global Health Conference & Exposition, a scheduled panel discussion will focus on how HDUs are helping advance Medicaid and public health use cases.
The session, "Boosting Medicaid Efficiency Through Health Information Exchange Integration," will explore opportunities to bring different types of data together, such as medical information and social determinants of health.
"We'll talk about quality improvement and using data from a health utility to support quality improvement initiatives and electronic clinical quality measures," Melissa Kotrys, CEO of the Contexture HIE, who will speak on the panel, told Healthcare IT News.
Diving into HDU use cases
Health information exchanges serve a growing health data exchange and patient risk profiling functions. Nationwide, they are looking to the HDU model to better unify health data and support communities, patients and health plan members as new healthcare sector regulations – such as Medicaid work requirements –emerge.
HDUs have become a critical resource for state Medicaid agencies that need to streamline complex processes, such as determining medical frailty exemptions for upcoming work requirements and accelerating disability eligibility.
"We're really looking at the future of bringing different data sets together to be able to do different types of analysis," Kotrys explained.
With some HIEs transforming to state HDUs, they offer a range of services, such as clinical data exchange, electronic health record integrations, public health services including reporting certification, claims exchange, and research and academic services.
Arizona and Colorado have been integrating, aggregating and analyzing multiple health data sources, implementing several use cases that support the state Medicaid agencies, according to Kotrys.
Joining her for a panel discussion to address how HIEs can use claims and quality improvement data and other analytics to serve unique and innovative use cases are Anthony Flot, CIO at the Arizona Healthcare Cost Containment System, and Chris Underwood, a senior consultant with the Colorado Department of Healthcare Policy and Financing, who previously served at the state's Medicaid agency.
"Some of the Medicaid use cases that will be discussed include data dashboards that use claims data to really show information on inpatient utilization, emergency department utilization, telehealth and more," Kotrys said.
SDOH, Medicaid work exemptions
Panelists will also focus on social determinants of health (SDOH) by discussing how closed-loop referral systems can connect individuals with social services to improve their health and wellness.
Some use cases have supported various types of healthcare providers – from tribal facilities to inpatient psychiatric care units – to overcome SDOH.
"I think some of the innovative areas where we have had some success, but we could build on it for new use cases, are things like bed capacity tracking across behavioral health and crisis facilities," Kotrys said.
Attendees will also hear insights on the evolving healthcare landscape.
Medicaid work requirements that begin in 2027 specify at least 80 hours of work or volunteering per month to maintain coverage, but those rules will be subject to varying definitions of the medical frailty exception.
"Whatever the definition is, the clinical data likely resides at the HIE," she noted.
State agencies will need to implement processes for identifying medically frail individuals who could be exempt from work requirements. HIEs and HDUs could play a role, streamlining the process and ensuring that individuals who should be exempt from Medicaid work requirements are identified early on.
They have supported Medicaid agencies with disability and eligibility determinations and been "able to significantly accelerate and make that process more timely, more efficient, save state resources and get people qualified for services more quickly because we have all the medical information in one place," Kotrys said.
The panel session "Boosting Medicaid Efficiency Through Health Information Exchange Integration" is scheduled for Thursday, March 12, from 11 a.m.-12 p.m., in Palazzo I/Level 5 at the Venetian at HIMSS26 in Las Vegas.
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.
