TEFCA Readiness: What Your Payer is About to Ask You

As a Health IT leader, you've heard the mandate: by January 1, 2025, Qualified Health Information Networks (QHINs) will reshape healthcare data exchange. TEFCA (Trust and Exchange Framework for Care) is coming, and your organization must be ready.

The Clock is Ticking: QHIN Integration Timelines

We're less than a year away from the CMS deadline for establishing QHINs.1 These networks will become the nerve center for data sharing under TEFCA, yet many health systems are still assessing their readiness for this pivotal shift.

Recent news of Oracle Health's designation as a QHIN2 should serve as a wake-up call. It's time to evaluate your connections and compatibility with these networks. Can your organization seamlessly integrate with the QHIN ecosystem?

FHIR Standardization: The New Normal

As we guide clients through this transition, one thing is clear: FHIR (Fast Healthcare Interoperability Resources) is the future. Its flexibility and scalability have made it the CMS-mandated standard for data exchange.3

Our experience implementing FHIR shows it's more than a buzzword: it delivers tangible benefits. On average, our clients have increased data exchange efficiency by 35% through FHIR adoption, saving time and costs associated with manual integration headaches.

Payer Expectations: FHIR Compatibility

Payers are increasingly demanding FHIR-based data exchanges. Their network Adequate Process Requirements (APRs) will prioritize TEFCA compliance, and your organization must be prepared.

If your health system hasn't yet explored FHIR compatibility, now's the time. It's no longer an option but a necessity, especially when negotiating contracts and risk-sharing agreements with payers.

Onshore Outsourcing: A Strategic Shift

As these industry mandates evolve, we're witnessing a noteworthy trend: a shift towards onshore outsourcing. Our clients have realized a 20% average cost savings by tapping into domestic talent pools, avoiding the complexities of offshore engagements.

This strategic move not only reduces costs but also ensures rapid access to essential health IT expertise. It's a refined approach to resource allocation, mitigating geopolitical risks while adapting to the demanding healthcare IT landscape.

Select the Right QHP Vendors

For those selecting Qualified Health Plans (QHPs), the criteria have changed. FHIR compatibility and TEFCA alignment are non-negotiable in vendor evaluations.

Epic and Cerner have already announced their FHIR strategies,4 and other leading vendors are following suit. When evaluating potential partners, ensure they can deliver on the promise of seamless data interoperability, or you may risk being left behind.

Your TEFCA Checklist

TEFCA's impact is imminent, and at Mobtronic, we're here to help you navigate this complex terrain:

• Assess QHIN Connection: Evaluate your organization's ability to integrate with QHINs seamlessly.
• FHIR Roadmapping: Develop a clear strategy for FHIR standardization across your health system.
• Payer Alignment: Engage with payers to understand their TEFCA-related expectations and negotiate FHIR-based data exchange agreements.
• Onshore Talent Strategy: Explore domestic outsourcing options for cost-effective, rapid-response IT expertise.
• Vendor Selection: Prioritize FHIR compatibility and TEFCA alignment in your QHP vendor evaluations.

Inviting Conversation

TEFCA and FHIR are game-changers, and Mobtronic has the expertise to guide your health system toward compliance. If you're tackling these mandates and want a second opinion, let's schedule a conversation. We'll help you assess your position and develop a strategic plan to stay ahead of the curve.

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1. CMS.gov: https://www.cms.gov/newsroom/fact-sheets/tefca-fact-sheet-09082022.html
2. Oracle HealthNews: https://health.oracle.com/press-room/oracle-designated-qualified-health-information-network-tefca
3. HL7.org: https://hl7.org/fhir/
4. EHRIntelligence.com: https://www.ehrintelligence.com/epics-fhir-strategy-drives-interoperability-initiatives-49198.html

If you are working through these decisions right now and want an experienced perspective, let's talk.