Partner Spotlight: Flume Health

 

We have various solution partners.  Yes, I know….shocking.  One of the most complex and most strategic decisions anyone can make is deciding who is a good TPA partner.

Now, a TPA typically refers to the health plan administrator as the entity that writes the check to pay medical claims and the company staffing the member service line to support all the complexity that is healthcare.

You may think of this in terms of “Oh, Aetna runs all aspects of my health insurance”, but in reality, there are really segments that a TPA or Plan Administrator executes.  And often, there are very central themes that distinguish a good TPA versus a Bad TPA, or a Good TPA versus a TPA with a train-wreck of service issues ready to drop any day.

 

 

Naturally, with this kind of decision, we do lots of due diligence to avoid the pitfalls.

 

If you follow our social media at all, you know we have some really deep love for Aither Health and have been migrating our more complex plans to their platform with our “Aither + EHIMRx + OneBeacon” strategy for self-funded clients.

One of our other partners that we’ve been vetting not only internally, but in partnership with some of our peers in the Health Rosetta cohorts has been Flume Health.

Flume Health, as the name implies, is a TPA that administers Health Plans for the Self-Funded or Level-Funded (sometimes call Partially Self-Funded) Employers.

In the most recent interview, we asked all kinds of questions to help you understand where they fit, how you could leverage them as a partner, and where they feel a client can really thrive with their solution set.

 

 

The big takeaway

 

There are so many items that the video covers, but the biggest item and the one that we strive and struggle with most is Direct Contracting.

We really like the way that Flume approaches it Proactively & Reactively.  Obviously the member experience is better then there is no disruption on the day of a doctor’s appointment. And Proactive Member @ Provider engagement makes this process more palatable during a major change.  So here are those action steps we derived from talking about the “Flume Community”.

  1. Do some legwork before the go-live date of the health plan (or major change to the health plan) and work on payment arrangements with providers the employees already use.  i.e. Get Claims data or target the doctors that employees disclosure over IMQs and make some outbound calls so the doctor’s offices don’t reject your plan members.

2. Talk about Direct Contracts and Prompt-Pay language with providers and create plans where members don’t pay any cost-sharing for those providers…..that way the contract and convenience of bill collections are leveraged to advantage your employees and overall drive down the healthcare costs.

 

3.  Don’t ignore new doctors, but reach to new claims with new providers as a way to identify the next conversation that needs to occur around Direct Contracting.  And continually build that community of providers in a way that benefits the employees and plan members as a whole.

And, the other big caveat to this……Brokers and Advisors get sidetracked and aren’t built for facilitating Direct Contracts with a doctor’s office or facility.  It is nice when your solution partner invests that time and helps to compliment the efforts your company, your advisor, and your employees depend on.

Bret Brummitt

Bret Brummitt

Founder

About the author: An avid learner and resourceful leader with a passion for problem-solving, Bret is a calming force in the chaos and fast-paced evolution of health insurance, employee benefits, and the growing burden of regulatory compliance. He helps people develop the confidence to see beyond the problem at hand and start to re-imagine their goals. Whether he’s helping a client or a colleague, Bret believes a successful interaction is one that allows us all to dream a little bigger when we’re done.

About Generous Benefits:  Generous Benefits (www.generousbenefits.com) focuses on solutions that improve the community you serve.