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.
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.
#Value-based care organizations
In the world of value-based care, you aim to prioritize patient outcomes and the quality of care provided. You need as much data on a new patient as possible to:
- Stratify patient risk and deploy targeted care management from day 1, helping you proactively manage costs and improve outcomes.
- Establish a baseline for performance on quality and utilization metrics so you can identify areas for improvement from the start of the care relationship.
Flexpa becomes an indispensable tool for VBCOs like yours in getting access to this data:
- You gain instant access to patient claims data with Flexpa, including diagnoses, medications, procedures, encounters and care team members.
- Begin to develop an understanding of a new patient at the moment of onboarding with electronic explanation of benefits and reported encounters.
- You can stratify patient risk, identify high-cost patients, and establish quality and utilization baseline metrics.
- 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 provides you with a comprehensive view of a patient's care journey, helping you coordinate care more effectively and prevent redundant procedures.
- You can analyze broader health patterns within your patient population using Flexpa, guiding your preventive and intervention strategies.
#Clinical Trials
For organizations and researchers running clinical trials, research success is dependent on finding the right participants at the right time. Flepa helps you get a headstart on research participation screening:
- Using clinical claims data straight from participants' health plans you can pre-screen your research participants and save your most valuable resources for the most qualified participants.
- Flexpa helps reduce your organization’s dependency on self-reported data and in-person screening by offering electronic access to verified health claims, enhancing your participant screening process.
- By leveraging comprehensive claims and clinical data, Flexpa dramatically improves research success and accrual rates, ensuring your research remains on schedule and within budget.
Flexpa's capabilities also offer a game-changing advantage in the execution phase:
- By integrating Flexpa, you can have instant and ongoing access to a patient's claims data. This helps in closely monitoring any other medical treatments the patient is receiving, ensuring there are no conflicts or interactions that could compromise the trial.
- Utilizing Flexpa's rich and timely claims data, you can more accurately estimate the cost of various aspects of the trial, from patient care to medication and procedure costs, making budget planning more reliable.
- Flexpa allows for easy tracking of patients post-trial, providing a wealth of data that can be valuable for longitudinal studies and post-market surveillance.
#Medicare enrollment
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 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
#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.
#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
- Digital health solutions
- Fintech applications
- First-party health data aggregators and wallets
- Life insurance
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!