What You Should Know:
– Flume Health, a New York City-based health plan administration platform for the modern fragmented healthcare today announced a $6M Seed II round, bringing its total amount raised to $10M. The Seed II round was led by new investor Crosslink Capital, with participation from new investors Route 66 Ventures and Convene CEO Ryan Simonetti. Existing investors Accomplice, Founder Collective and Primary Venture Partners also participated in the Seed II round, which brings Flume’s total raise to $10 million.
– Launched in 2020, Flume Health is a new generation of health plan administrator intentionally built to reduce healthcare costs, improve quality of care and transform the user experience for both employers and members.
What is a TPA (Third Party Administration)?
Flume is bringing tech- and data-enabled proactive plan management and member engagement into one of healthcare’s most opaque legacy spaces: third-party (health plan) administration (TPA). TPAs help with the design, launch, and ongoing management of self-insured employers’ health plans. Because their relational orbit includes employers, members, payers, providers, brokers, TPAs are a single store of truth with a universal view into member eligibility and every pre-certification or pre-authorization request. TPAs also pay and process every medical claim, gaining insight into members’ healthcare journeys.
Flume Health Saves Self-insured Employers Nearly $5,000 Per Employee Per Year
Flume’s administrator model allows self-insured employers and their workforces to unbundle their health plans and augment or replace legacy off-the-shelf plans with specialized providers who address specific populations with conditions such as MSK pain, diabetes, mental health and many more. By marrying active employer and member engagement with a tech- and data-forward product, Flume leapfrogs legacy health plan administrators’ capabilities. On average, Flume-designed plans save employers nearly $5,000 per employee per year.
New care models like virtual primary and behavioral care, insurance navigation and digital therapeutics have emerged during healthcare’s current digital transformation moment. Each play a role in reducing costs and improving quality of care, but all are limited in their ability to create systemic change. Sustainable change requires not only that plan members can access new care models, but that they can intelligently and pro-actively navigate their care landscape in real-time, as their care needs arise.
Why It Matters
Flume Health is more than another health tech venture, it’s an opportunity to help American businesses thrive again. Much like the proposed American Jobs Plan aims to modernize U.S. infrastructure so manufacturers and small businesses can have a competitive edge again, Flume aims to help these same companies with game-changing savings on employee health plans.
– A North Carolina building supply company saved ~$300K by replacing its legacy PPO plan with a fair and transparent provider contract.
– A California car dealer saved ~$500K in one year by switching from Blue Cross to Flume after suffering through yearly costs spikes of 15-25%.
“TPAs are in an incredible position to empower employers to run leaner, more efficient plans and improve quality of care, but most are stuck in the pen and paper era. By supercharging the role of the TPA through digital transformation, real-time data and true proactive member engagement, care access improves and care costs go down,” said Cedric Kovacs-Johnson, CEO and founder, Flume Health. “For small and medium-sized businesses, saving hundreds of thousands of dollars on healthcare can mean the difference between thriving or shutting down.”