Use Cases

flume's data integration capabilities is being used for a variety of use cases within payers, tpas, program managers, brokers and solution vendors plan product integrations (point solutions) modern health plans require an ever expanding set of member facing providers, solutions, and services for employer sponsored plans these are point solutions driven by employer and broker interest for government plans these are supplemental benefits these plan products service a wide range of specific services for a member examples include telehealth, disease management, care management, navigation, digital front door, pharmacy carve out, direct primary care, etc traditionally plan product integrations have been challenging, given the just in time nature and unique data formats for each vendor furthermore these integrations are seasonal and lumpy with integration demand surging around plan effective dates flume streamlines integrations and reduces timelines and cost by 80 90% as plan product vendors and services mature they also aim to trade richer data types with payers (i e engagement, health equity data) flume also natively supports integrations of these richer data types health plan operations integrations payers increasingly rely on an increasing number of disparate services and systems to perform health plan operations (i e utilization management, care management, bill review, fw\&a vendors, networks, billing, etc ) some are internal to payer organizations, others are third party vendors each service requires various data types shared in unique formats these service providers can become connections on flume pbm integrations employers seeking pharmacy cost savings will often look to carve out and replace their pbm payers in turn are integrating with dozens of pbms to support that demand flume simplifies integrations and enables pbms to be applied to specific population sub groups through the use business objects most pbm integrations involve three data trades outbound eligibility and accumulators inbound rx claims flume also supports additional configurations, depending on the unique billing arrangements that may be in place cms interoperability compliance flume enables payers to quickly establish standardized data trading exports to comply with upcoming cms interoperability rules including interoperability and prior authorization rule medicare prescription payment plan (mp3) data lake enablement flume enables customers to accelerate their data lake strategies by housing both raw and strucured forms of your data in your own environment inbound and outbount data is stored and available in both its native source/destination formats and the flume data model format for future querying flume is based on the apache iceberg open table format iceberg can be plugged into your query engine (snowflake, redshift, bigquery, etc ) to provide access to organized, tranformed data through your query engine in an optimized way eligibility management flume supports custom and 834 standard eligibility and enrollment files from any source to any destination use flume to transform from individual hris, ben admin systems into a single system specific model each system is treated as a unique endpoint with independent map/transform rules and transmission protocol configuration (api + sftp + stream) these endpoints update the eligibility records in the consolidated data store (cds) analytics enablement disparate data sources with custom formats need to be transformed and loaded into various analytics platforms with flume, there is a single pipe connecting all dependent systems to each analytics platform consolidated and transformed into that platform's native format system migration enablement payers seeking to migrate core systems such as core administrative processing system (caps) are tasked with the challenge of maintaining two parallel systems (legacy and new) for some period of time this parallel maintenance is key to ongoing plan operations during client transitions and enables aggregated reporting the challenge is that both systems import/export data in unique formats and each has their own dependent integrations flume simplifies many aspects of system migration by condolidating all integrations into a single data pipe with a system native format for each legacy and new systems both systems can also simultaneously trade data with an aggregated reporting system