Outreach moved no members to preferred providers.
A health plan tied its vendors’ outreach to the claims that followed. The outreach had moved no one.
Challenge
The questions
- 01Did vendor outreach move members to preferred providers?
- 02Where did each member go for care after the outreach?
- 03How much vendor spend went to outreach that changed nothing?
Several point solution vendors were contracted to steer members to preferred, cost-effective providers.
Each vendor reported high engagement on its own dashboard. No one had tied that activity to what members did next.
Making that link meant joining outreach records to claims across several systems. It was possible, and rarely a priority.
Solution
Flume resolved member identity across 270 vendor files, 4 data domains, and more than 14 schemas.
It then followed each outreach event forward. It checked whether the member’s next claim went to the intended provider or somewhere else.
Impact
$9.6M
Misdirected vendor spend, annualized
Four times the $2.4M measured in a single quarter, for a subset of members.
0%
Of outreach that moved a member to a preferred provider
Claims showed members kept seeing higher-cost providers.
<4 weeks
To a confirmed answer
With an embedded Flume team and governed production access already in place.
- Outreach moved away from the point solution vendors.
- Vendor reporting now measures outcomes in claims, not activity.
- Leadership had judged the program by dashboards of activity. The claims showed the gap, and the program changed course.
Start with the question your team keeps waiting on.
See how ContextBase answers it on your own claims, eligibility, and contract data.