Oscar Health Partners With HealthEx to Integrate Members’ Medical Records Into AI Workflows

The integration uses Individual Access Services (IAS) under the Trusted Exchange Framework and Common Agreement (TEFCA) and is designed to bring longitudinal clinical data into Oscar's digital platform and AI-powered workflows.

Oscar Health has announced an enterprise partnership with consumer health data platform HealthEx to enable members to access and connect their medical histories from hospitals, clinics, and laboratories across the United States from the first day of coverage.

The integration uses Individual Access Services (IAS) under the Trusted Exchange Framework and Common Agreement (TEFCA) and is designed to bring longitudinal clinical data into Oscar's digital platform and AI-powered workflows.

Launching ahead of the 2027 Affordable Care Act (ACA) Open Enrollment period, the integration will allow Oscar members to opt in during digital account setup and retrieve their medical records from healthcare providers nationwide.

The partnership addresses a longstanding challenge in health insurance, where plans typically rely on retrospective claims data to understand new members' medical histories. This process can take weeks or months after care is delivered and often leaves insurers without access to clinical information from members' previous providers and health plans.

TEFCA Individual Access Services and Consumer Consent

HealthEx operates as an Individual Access Services provider under TEFCA, enabling individuals to exercise their right under HIPAA to access and direct the sharing of their digital health records.

Unlike traditional payer-to-payer data exchanges, which depend on business-to-business connections between health plans, the IAS model allows medical record requests to originate directly from individuals through consumer consent.

HealthEx combines TEFCA query networks with direct HL7 FHIR endpoint lookups to search across 90% of US clinical care locations. According to the company, 70% to 80% of individuals across its active user base automatically retrieve records from an average of four to five distinct care sites in under five minutes. The approach captures twice as many records as standalone FHIR-directory scrapers.

The integration is opt-in and consumer-permissioned. Connecting medical records does not affect members' underwriting, coverage eligibility, or premium costs. Members can also use the HealthEx Wallet to review shared records and revoke access at any time.

“When someone changes health plans, their health history usually stays behind,” said Priyanka Agarwal, MD, MBA, Co-Founder and CEO of HealthEx. “With HealthEx, Oscar members can choose to connect their records and bring that history with them to their new plan, so their care can be more personalized. Members always stay in control, deciding what records to share and when to stop.”

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