Health plans

Flume seeks to create behind-the-scenes framework for health plans

Starting a new insurance plan can be long, expensive and difficult. One of the challenges is creating systems to process complaints, track registrations, and manage other administrative tasks.

Although some insurers seek to build these features in-house, it can be expensive and time-consuming. Others partner with a third-party administrator (TPA) for this work.

Flume Health, which bills itself as a state-of-the-art TPA, seeks to make this process easier for insurance companies.

The New York-based startup, which was founded in 2017, first worked with self-insured businesses, like a construction company in Indiana and a car dealership in North Carolina. Today, the company is looking to work with insurers.

“Right now, building a health plan is like asking people to build a server farm in the basement,” CEO Cedric Kovacs-Johnson told MedCity News. “…In order for you to get into the market, you had to build all this infrastructure and raise a lot of money to do it. This is a huge hurdle to overcome as an entrepreneur.

Its goal is to streamline this process by managing claims handling, enrollment, compliance and payments to vendors, brokers and point solutions.

Currently, Flume works with a few insurance plans. It partners with primary care startup Firefly Health, which recently launched a first virtual health plan aimed at small and medium-sized enterprises.

“Firefly Health had this really compelling virtual primary care offering,” Kovacs-Johnson said. “They realized their ability to influence behavior downstream was limited by the fact that they were connecting to health plans that had no context about what they were trying to do.”

Firefly Health CEO Fin Rotenberg said in a prepared statement that without Flume, the company could not have launched its health plan in less than a year.

Flume also partners with stop-loss insurer Radion Health, which caters to small and medium-sized businesses.

Health plans are changing. They include a growing number of point solutions and apps, and put more thought into how members navigate their benefits. But the fundamentals, for the most part, have remained the same.

“The administrative layer feels like the big elephant in the room when it comes to healthcare transformation,” he said. “We believe that all of these solutions are built into a very old system.”

Going forward, he expects to see more health plans launched, some tailored to specific communities or patient groups. His goal is to make it easier for them.

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