Use cases

There are many interoperability and data aggregation products and vendors available today. Sorting the signal from the noise and determining how each can solve the problems you face at your organization can be quite challenging.

Flexpa is the simplest and easiest way to connect your patients' claims data, which can power a number of use cases across healthcare, benefits, and fintech.

#Who Flexpa helps

Flexpa's most useful and differentiated feature is the capability to link clean, timely, identified claims data from a patient's insurer. Other tools and mechanisms that provide claims data are often delayed weeks or months, whereas claims through Flexpa are available as soon as adjudication occurs. The Flexpa API offers a far more normalized claims data set than other routes. As a result, it is best used to power or enhance any experiences needing financial information about a patient's care during onboarding or ongoing interactions.

Flexpa relies on patient authorization as a key step in retrieving claims. As such, it is best suited to organizations that either have an existing patient digital experience or those that can insert one easily into their workflows.

#Medicare brokers and broker software

As a Medicare broker, you look to advise patients on the best plans, given their unique history and needs. With Flexpa, you can serve these patients more effectively than ever:

Flexpa can help you retain plan members on a given plan by giving you access to claims and utilization data over the course of the year in anticipation of the renewal window
Flexpa can power your Medicare recommendation engine with detailed historical claims data, allowing you to personalize and optimize the Medicare plan guidance you offer
Flexpa validates the existing Medicare plan that is active for a patient and includes a variety of clinical information related to that coverage
With Flexpa data, you can track usage year over year to build your data models and serve your patients more effectively

Additionally, Flexpa acts as a key building block as you look to build out or enhance your member portal:

Flexpa can help you retain and renew members by enriching your member portal with real data about their plan usage over the course of the year in anticipation of renewal
Overcome the challenge of having limited (if any) data access about usage from the carrier by retrieving data directly from members after health plan enrollment

#Bill negotiation and financial assistance

Claims can represent an overwhelming financial liability for patients. For bill negotiation applications like yours, this net-new capability is incredibly empowering to offer the right assistance at the right time:

Flexpa allows you to synchronize patients' bills from payers easier than existing manual upload of claims images or PDFs, reducing the chance that patients drop off of your onboarding flows
Flexpa's claims connection means that information is discretely and uniformly encoded, removing the errors of natural language processing and optical character recognition needed for existing manual uploads
Flexpa's connection process means you can be kept up-to-date on new claims for a patient for up to a year, removing the friction of repeated user upload

#Digital health provider organizations

Digital health organizations often look to distribute their solution through employers or payers. In order to do so, proving out the decrease in cost of care is vital.

For digital health provider organizations like you, Flexpa is uniquely positioned to help:

Flexpa allows you to synchronize claims history for patients during or before onboarding, supplementing traditional claims exchange with timely information weeks in advance of those bulk flat files
Flexpa's claims connection means that information is discretely and uniformly encoded, reducing the manual labor and removing the errors of mapping from bulk files to standard formats
Flexpa's connection process means you can be kept up-to-date and alerted on new claims for a patient, drastically reducing the lagginess of traditional file exchange

#Health insurance carriers

Patient access may be compliance, but it can be so much more. Innovative payers nationwide are taking advantage of the new capabilities of the CMS regulation to better serve their members and reduce inefficiencies:

Flexpa allows you to synchronize claims history for patients during onboarding from their previous insurers. Claims history from prior payers provides a consolidated and accurate picture of care across care institutions.
Additionally, claims history is one of the most accurate ways to identify where care has occurred. This record location can be used to follow up for more detailed clinical information from the right institutions and allows for better care coordination with historic providers
Claims history also helps payers identify higher-risk populations and guide them toward appropriate benefits, such as specialty virtual care partners

#ICHRA administration and management software

For ICHRA startups, Flexpa offers valuable insights and functionalities that can enhance the overall experience for both employers and employees:

Flexpa enables you to access timely and accurate claims data for employees participating in ICHRA plans, helping you better understand their healthcare needs and preferences, which can be used to recommend personalized health plans.
With Flexpa's clean and normalized claims data, you can analyze healthcare cost trends, identify potential savings, and suggest adjustments to plan designs that are cost-effective for both employers and employees.
Flexpa's data can be used to evaluate the performance of healthcare providers within your network, enabling you to recommend high-quality, cost-effective providers to employees for better healthcare outcomes and potential cost savings.
By leveraging claims data, you can identify patterns and risk factors associated with certain health conditions, enabling you to design more effective strategies for managing and mitigating health risks among employee populations.
Flexpa's claims data can help you establish benchmarks for your ICHRA offerings and track your performance against these benchmarks, which can demonstrate the value of your services to potential clients and facilitate continuous improvement of your offerings.
Claims data can be utilized to ensure regulatory compliance and accurate reporting for your ICHRA solutions, helping you avoid penalties and maintain compliance with relevant healthcare regulations.

#Value-based care organizations

In the world of value-based care, you aim to prioritize patient outcomes and the quality of care provided. Flexpa becomes an indispensable tool for VBCOs like yours:

You gain real-time access to patient care episodes with Flexpa, enabling quicker interventions and improved patient outcomes.
You can refine and optimize Risk Adjustment Factor (RAF) scores using Flexpa's accurate claims data, ensuring your organization is correctly compensated for the complexity of care provided.
Flexpa provides you with a comprehensive view of a patient's care journey, helping you coordinate care more effectively and prevent redundant procedures.
With Flexpa's normalized claims data, you can monitor clinical outcomes, patient satisfaction, and financial metrics, making adjustments to your care models as needed.
Flexpa aids you in early identification of high-risk patients, allowing for specialized care plans and better health management.
You can analyze broader health patterns within your patient population using Flexpa, guiding your preventive and intervention strategies.
Flexpa helps achieve improved outcomes in HEDIS measures and STARs scores, ensuring adherence to clinical guidelines.

#Other Flexpa uses

The value of Flexpa's connectivity is not limited to just the scenarios above and extends to a variety of other functions and tools:

Care navigators
Traditional provider organizations
Clinical trials
Decentralized clinical trials
Fintech applications
First-party health data aggregators and wallets

We'd love to discuss more about how claims and other payer data can enable and accelerate what you're building, so contact us to chat!