Overview
Managing the flow of healthcare data is becoming more complex, thanks to a host of factors. More vendors and point solutions, greater consumer demand for better access and choice in health-related benefits, continual cost pressures, and changing government regulations and oversight all create significant challenges for IT and operations leaders in healthcare.
Case in point: Medicare Advantage. The MA market was healthy and thriving until recent market dynamics created profitability pressures. As MA plans work to overcome these new hurdles, they’re looking closely at reducing the cost and complexity of their data integrations - a task that the Flume platform is designed to handle with speed and efficiency.
Unique data challenges in MA
MA has enjoyed increasing popularity through the years, thanks in large part to benefits like gym memberships and low cost-sharing and premiums. Most MA plans offer a variety of benefits and programs that require the plans to manage complex data integrations for eligibility, enrollment and claims.
Recent developments are forcing payers to closely examine the cost and complexity of managing their data. These three stand out:
- Decreasing profitability: Amid declining profitability, CVS Health Aetna and Humana are forecasting membership declines for 2025. Some analysts expect MA plans to cut back on the number of extra benefits they offer.
- New CMS reporting requirements: The Centers for Medicare and Medicaid Services has expanded and clarified requirements for plans to report on their use of supplemental benefits, which will increase plans’ member eligibility data exchanges.
- FHIR implementation requirements: Plans must implement the FHIR standard for prior authorization APIs by 2027.
Benefits of using Flume
Flume is the first data integration platform designed specifically for health plan administration. The solution systematizes the complex process involved in establishing connections with a variety of sources and destinations of administrative data that are required for members to use their health benefits, typically resulting in cost savings of 80% to 90% on integration setup and maintenance.
Payers using Flume also save considerable time. For example, working with a customer, Flume recently built integrations for point solutions in a curated bundle that aims to lower medical costs in high-spend areas, such as musculoskeletal and cardiology, in under three weeks. The client had projected at least an eight-week implementation.
Key features
- Canonical structure (not point-to-point) for automated, secure bidirectional data exchange
- Ability to transform data into any standard inbound and outbound
- Ability to apply validation logic and send only incremental records or essential data only, further enhancing data privacy protections
- Custom Business Objects feature offers the ability to instantly connect solutions and vendors to specific plan products, members with specific conditions, or lines of business with just a few clicks; non-technical users can easily add and delete groups, lines of business, health plans and products within the platform
- Works within your existing existing data schema and systems
Expected outcomes
For health plan CIOs, CTOs or COOs, Flume can deliver significantly lower marginal integration costs and greater speed and simplicity for Medicare Advantage. You can achieve multiple goals - meeting regulatory requirements, reducing member friction and providing richer benefits in a competitive MA landscape - with Flume. And you can manage integrations within your existing charter as an IT leader, leading to budget protection for strategic priorities.
