Payers: It's time to get ready for Interoperability with TEFCA
Steven Schneiderman, Practice Leader, IQVIA Healthcare Solutions
May 20, 2020

As we begin the journey to recovery from the pandemic, we understand that the after-effects of COVID-19 will be with us for a long time.  Not only do we want to address the needs of the recovering COVID-19 patients, but also the effects of resource restrictions on urgent non-COVID-19 conditions, the impact of interrupted care on chronic conditions, and the long-term mental health impacts of the pandemic.

While there is a need to reassess the priorities set at the beginning of the year, the pandemic and its after-effects underscore the need to accelerate the exchange of Electronic Health Information (EHI) and move toward interoperability with the new Trusted Exchange Framework and Common Agreement (TEFCA). 

Payers are large, complex organizations that process thousands of transactions daily across multiple systems. These systems often have their own data schema and unique record keys. Simply look at the practitioner records maintained in a single payer system and it’s easy to understand the challenges involved in keeping this data clean and accurate. Integrating this same set of data to other systems within the walls of the payer organization adds another layer of complexity.

Is it any wonder why the Centers for Medicare & Medicaid Services (CMS) routinely identify high rates of inaccuracy when conducting audits on provider directories at payer organizations? It’s time to assess and address data quality, not just for provider data, but across the payer enterprise. 

The Office of the Coordinator for Health Information Technology’s (ONC) 21st Century Cures Act, finalized in March 2020 and published in May, requires payers to make their provider directory available through the mandated standards-based Patient Access Open application programming interface (API), as defined in Health Level Seven International’s (HL7) Fast Healthcare Interoperability Resources (FHIR) API standards by January 1, 2021. Shortly thereafter, payers need to exchange Electronic Health Information (EHI), as well as accept incoming EHI, as directed by the members. Preparing for this exchange is no small task and requires an evaluation of all stored EHI data, how it is maintained and accessed today to determine what needs to evolve to handle these transactions tomorrow.

The good news is there is still time to develop a plan to address these upcoming regulatory changes. The first step is understanding your data; how it is formatted, where it is stored, and the quality of the data. 

IQVIA has helped payers with data quality and integration for years. Our expert team can assess your readiness for the upcoming changes. If you are not familiar with the Cures Act and Interoperability, I suggest you take a look at this white paper Cures Act: Getting Ready for the Implementation of TEFCA and Healthcare Interoperability Standards.

Ready to speak with a solutions expert to help your organization prepare for the Cures Act? Let’s talk! 

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