Use Cases

Anyone with a vision can launch a health plan that addresses the specific needs of a population

Incumbent ASO Carriers

Existing ASO technology has been excellent for a "one-size-fits-all" plan design, but today it is seriously limiting ASO carriers' ability to grow and offer innovative products.

Flume OS allows carriers to build personalized health plans, make ASO profitable, and scale into new markets easily. Tier networks, upload direct contracts, integrate with point solutions, set dynamic member incentives, and use data to trigger custom actions with the Flume Workflow Engine™.

Direct Primary Care

Direct Primary Care (DPC) is the future of primary care, delivering better engagement, prevention, and downstream cost savings to employers and members alike. But as a bolt-on to larger plans, adoption and growth are limited.

DPCs use Flume OS to design and launch primary-care-centric health plans that patients love and that allow doctors to truly manage care. Building a plan on Flume’s infrastructure means getting to market quickly and designing dynamic incentives such as $0 member responsibility for following a prescribed course of care.

Chronic Disease

Currently seen as bolt-on offerings, traditional health plans have a hard time showing ROI for disease management programs, not to mention driving member engagement. Thus, chronic disease programs struggle to get the attention—and enrollment—they deserve.

Building a plan specifically tailored to a disease population or risk pool allows the plan to amplify their effectiveness and reach, while lowering member and plan costs because the risk is adjusted appropriately.

Demographic

Today's "one-size-fits-all" approach to health plans means there are certain population groups that receive no attention at all. Specific identity and culture groups find it hard to get the coverage and member experience that's right for them.

Use Flume OS to build a plan specifically tailored to meet the unique medical needs of the population you care about most. Decide what gets approval, how the member experience feels, what special add-ons your members need, and then bring that plan to market!

Hospitals & Health Systems

Legacy insurance has become intertwined with patient-doctor relationships. Often, hospital systems that want to do more to innovate for their patients and communities have their hands tied by a system that can’t—or won’t—make it happen.

Launching your own commercial health plan puts you and your patients in direct communication. The data flowing through that plan finally makes the dream of interoperability a reality, and you can use the Flume Workflow Engine™ to build and test key member and business experiences.

Stop Loss "House Plan"

As a risk bearer that relies on brokers to bring in individual groups, it's impossible to get a truly deep understanding of how a plan is designed and might perform.

But owning a plan design with known entities that will run to spec across a wide range of groups opens the door to a truly dialed in underwriting experience. The motto is “build it once, sell multiple times.”

Onsite/Nearsite clinics

The onsite/nearsite model offers higher value and quality care at much lower prices than leaving members to navigate a complex and fragmented healthcare system. The problem is, bolting nearsite clinic operations into an employer’s existing plan limits access to data and budget.

When you’re the payer and the provider, however, you can design the member experience that's best for your market, and communicate directly with patients without having to go through someone else's health plan. Member economics also improve by expanding your business from bolt-on to owning the full plan.

Brokerages

Most major brokerages have spent years developing relationships with vendors and resources for underwriting and designing cost containment plans. But their revenue is still based on broker fees and selling one-size-fits-all plans that have become a commodity.

Launching a branded health plan gives brokerages much deeper connections with clients, and a completely unique product to sell in their markets. It also opens the door to revenue share and risk taking for captives, plus licensing options for smaller local outfits.

Challengers

Administration of innovative self-funded plans is the bottleneck to existing plans today. NPS for major carrier companies is low, while demand for better outcomes and lower prices among employers is surging.

Net new health plans that can build a 10x better member experience and even fractionally lower prices have the opportunity to steal legacy health plans’ lunches—all 278,000,000 of them. Use Flume OS to build a health plan alongside and around your key value props, giving you a market-ready offering in as little as 6 months.

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