Building on Flume
What are the steps to launching a health plan?
Concept Design & Mission
Start by defining the plan concept. What are the key mechanics and capabilities that will better serve your target populations—either clinically, economically, or through other benefits and preferences? What is the unique care model that the health plan is built around?
Identify which partners will perform what jobs in your stack. These include selecting provider network, PBM, disease management vendors, telemedicine providers, etc... Flume OS has native integrations with dozens of trading partners already, and can handle custom integrations.
Turn your plan selections into concrete rules and benefit design, which load into the Flume Workflow Engine™ and develop plan documents including the Summary Plan Document (SPD). This is where member economics, inclusions/exclusions, and incentives are defined.
Work with our stop loss partners to seek actuarial validation on the perceived impact to costs and outcomes. This step can be iterative with plan construction, and ultimately plays into captive pools and stop loss for individual plans. Well-designed plans can achieve substantial rate decrements compared to standard offerings.
Connect systems such as member support CRM, portals, and data warehouses to the Flume OS. For many partners, most integrations happen via our API's, though Flume OS also supports standard EDI and SFTP transactions.
Congratulations! ID cards are out, members are enrolled, and claims are being processed.
The best health plans use data to iterate on design and improve over time. Flume OS gives you the ability to experiment with plan design and measure the impact to cohorts of plan subscribers.