Building on Flume

What are the steps to launching a health plan?

Go from idea to fully-fledged health plan.
STEP 01

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?
STEP 02

Partner Selection

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. 
STEP 03

Plan Construction

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.
STEP 04

Actuarial Validation

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.
STEP 05

Systems Integration

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.
STEP 06

Launch

Congratulations! ID cards are out, members are enrolled, and claims are being processed.
STEP 07

Iterate

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.

The 12 Levers of Health Plan Design

Learn the best-in-class tactics that every modern plan needs to include.

Read Blog Post