A New Standard in Healthcare Payments
Flume Health, a digital benefits TPA introduces Flume Pay: a payment technology for self-insured employers to automatically cut claim costs, provide transparent pricing, and eliminate balance billing.
If you’ve visited a doctor recently, you’re probably wondering why the process of using healthcare is so intimidating:
- Research your plan coverage (buried on page 36 of your enrollment documents you can calculate what your deductible is)
- Find a registry of network doctors and try to find a provider that balances convenience, and good reviews
- [Optional] Use a price transparency site to estimate your deductible responsibility
- See doctor
- Wait 4–6 weeks for an expensive EOB to arrive to tell you a magical number you owe which you never knew before
- Pay or go to collections. Repeat
We literally don’t buy anything else this way. Through deductibles we’ve given patients the responsibility to manage their healthcare costs, but none of the tools to do so effectively.
Imagine if using your healthcare looked something like this:
This is the experience we’re creating with Flume Health and it’s powered by Flume Pay, a backend payment protocol which allows patients to receive the same service from the same provider for 20–40% less — without any billing friction.
- It’s an easier experience for patients
- Providers prefer being reimbursed with Flume Pay
- Plan sponsors save a ton of money (20–40%)
How is this possible?
It turns out the healthcare claim adjudication & reimbursement process isn’t just expensive for payers and patients, it’s also incredibly costly and cumbersome for providers. Here’s why doctors hate the current environment for dealing with insurance:
- Collection rates are low. Since ACA passing in 2008, we’ve seen a proliferation of high-deductible health plans (HDHP’s) which shift counter-party risk from payer to provider. Most people don’t know this but any deductible amount is the provider’s responsibility to collect. And when bills aren’t generated until 4–6 weeks after a visit, collecting from patients is hard. Some providers write off up to 70% of their patient accounts receivables!
- Billing is expensive. The litany of codes combined with ample reason for rejection means that providers spend a ton on billing administration. For smaller providers, they outsource to RCM vendors who charge anywhere from 8–20% of net revenue. Imagine if Visa charged merchants 20% just to process a transaction! Payers end up eating this cost.
- Cash is easy. The delivery of care is human, and not designed to fit into neatly defined CPT codes. You go in for an MRI, not XYZ321–ZZZ with billing exception 123ABC…
The result of this is providers are on the defense: creating hostile billing practices they don’t like but need — adding billing codes to squeeze extra dollars out of an appointment; anything to stay in the black.
That’s where we come in
The big secret is that in response to billing pain, a majority of outpatient providers have created discounted rates for paying cash (aka self pay). They do this because it allows them to focus on the most important thing: the delivery of care.
The Problem: these cash rates are inaccessible to anyone with a traditional health plan because TPA’s and payers operationally can’t handle cash terms — so employers end up footing the bill.
How Flume Pay Works
Flume Pay is a patent-pending payment protocol that allows any self-insured health plan to automatically pay these cash rates as opposed to the expensive, antiquated fee-for-service network rate. The same service with the same provider, just paid for differently. To the patient it looks like a bundle.
We are digitally integrated in the patient journey and automatically initiate Flume Pay transactions for all applicable outpatient services — without intervening with the patient experience. This means we capture close to 100% of events and use this pathway to lower the 27% of outpatient claims by 20–40%.
We expect that using Flume Pay will reduce overall claim spend by 5–10% in the first year for our clients.
We are currently accepting RFP’s for 1/1/19 renewals. If you are interested in getting in touch, you can contact me directly at Cedric@FlumeHealth.com or visit us at FlumeHealth.com. We can’t wait to meet you.
