Overview
Health plan IT and operations leaders face a host of challenges with data integration. You’re responsible for making sure various systems and solutions for the modern health plan are configured for efficient data exchange. And you can’t allow data integration solutions to eat up budget and staff time that can best be applied toward higher-value projects.
The women’s health ecosystem is - finally - expanding, with greater choice in solutions that cater to every stage of life. Employers recognize the importance of providing these benefits for attracting and retaining strong talent, while payers recognize the need for better, more personalized care. But greater demand for a variety of women’s health solutions leads to greater administrative burden. Flume understands these challenges. Our platform is built to help ensure seamless and efficient data integration for payers and third-party administrators (TPAs) connecting with dozens of solution providers - including all types of women’s health benefits.
Enabling women’s health
The trend toward more and smaller employers self-funding their health benefits is forcing health plans to improve efficiency and flexibility. It’s imperative that plans streamline their data integrations to satisfy administrative services only (ASO) groups that can bring upwards of 50 vendors and point solutions for benefits. Payers and TPAs must go beyond traditional health benefits to satisfy clients wanting to step up their game in attracting and retaining talent.
In particular, health plans need to account for growing demand for such benefits as:
- Family planning and fertility treatments
- Maternal health, including doula support, nutrition, lactation support, and physical therapy
- Access to care that may be legally restricted in some states
- Menopause care
- Advanced primary care
- A full range of behavioral health services
Administrative and technical barriers often hinder the return-on-investment of specific women’s health solutions, given the integration work required to exchange basic data like eligibility or claims. Many health plans resort to providing a general-purpose women’s health solution or identify one solution that caters to a plurality of members – thus compromising the richness of a benefits plan. Some health plans are choosing to go with networks, curated marketplaces, or partnered carve-out solutions, which creates a different layer of data complexity.
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.
For example, Flume recently built an integration for a large women’s healthcare network solution for employers, completing the integration in three days - easily in time for an April 1 go-live date. The customer had projected a six- to eight-week implementation.
Key features
- Custom Business Objects: Our newest feature offers the ability to instantly connect a women’s health solution to specific employer groups, populations (e.g., women of certain age cohorts), or products with just a few clicks; non-technical users can easily add and delete groups, lines of business, health plans and products within the platform
- Enables data exchange of various data types: eligibility, medical claims, pharmacy claims, copay accumulator, provider directory, prior authorization and pre-certifications, encounter, engagement data and more
- Canonical structure (not point-to-point) for automated, secure bidirectional data exchange
- Ability to apply validation logic and send only incremental records or essential data only, further enhancing data privacy protections
Expected outcomes
For health plan CIOs, CTOs or COOs, Flume can deliver significantly lower marginal integration costs and greater speed and simplicity for women’s health benefits. And you can manage integrations within your existing charter as an IT leader, leading to budget protection for strategic priorities.
