TEFCA is not live yet, but the tea leaves point to a partial “Go Live” announcement at ONC’s Annual Meeting on December 14-15, 2023. We’ll see if “Go Live” means two Qualified Health Information Networks (QHINs), or maybe more.
Despite achieving the “Go Live” milestone, these first connections will be limited to queries for treatment purposes. The emphasis on treatment arises from existing networks having the most experience in supporting it. That means it will take more time before TEFCA goes live with other permitted exchange purposes: Payment, Healthcare Operations, Individual Access, Public Health, and Benefit Determination.
Meantime, a robust community of committed interoperability stakeholders is shaping up around TEFCA. For example, Carequality is hosting an individual access early adopter’s program in 2024Q1, which b.well will be participating in. This initiative will be watched closely by regulators and stakeholders within the TEFCA community.
Significant efforts are underway to ensure that information exchange benefits providers, payers, and most importantly, consumers. This mission is championed by the information usability workgroup.
Plus, a new workgroup is getting started to build out a formal privacy and consent framework across TEFCA. The idea is to leverage FHIR resources and profiles to tag and manage data according to a consensus standard set of policies and consent rules. So, if you query for a treatment purpose there will be an audit trail to see that this purpose was used appropriately.
We’re also seeing TEFCA start to move into FHIR facilitated exchange, but around narrowly defined use cases. QHIN Candidates, like eHealth Exchange, incentivize collaboration between payers and providers with initiatives like prior auth APIs, even before regulatory mandates are finalized. This approach aims to deliver value to providers, who bear most of the burden of treatment-based interoperability, and simultaneously bring something of value to payers, so they’ll participate in TEFCA and bring their pocketbooks.
Payers seem to be onboard. Some of the largest payers spoke on a panel about getting organized around payer-to-payer APIs through TEFCA. They are supportive because of the opportunities to improve care transitions post-enrollment and before coverage years begin. We were especially excited that payers understand the need to deliver personalized digital experiences to beneficiaries as soon as they enroll in a new plan and helping them take action to reduce interruptions in their benefits. These are exactly the types of consumer digital experiences where b.well thrives.