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Abacus promises revolutionary new healthcare data products for payers

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Abacus Insights recently announced that it’s rolling out a suite of products which will revolutionize how payers in the healthcare space can leverage healthcare data for faster and better decision-making.

The data infrastructure products draw on the firms data transformation platform, the only real such platform built designed for payers. The platform aims to resolve many data headaches facing payers, including collecting, integrating, validating, and standardizing data from disparate internal and external systems, sources and formats.

Our platform is targeted on making high-quality data offered by optimal latency to accelerate business value for both analytical and operational use, company CEO and founder Minal Patel told VentureBeat. Our data management products certainly are a revolution in data usability, because we sort, bundle and continually update validated, transformed data to serve the requirements of specific payer business functions and strategic initiatives.

Healthcare data solutions for payers

Abacus Insights currently has three data products in market:


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  • CMS Interoperability Solution enables compliance with the Centers for Medicare and Medicaid Services requirements for interoperability for patient access.
  • Risk Adjustment Solution improves risk adjustment accuracy while simplifying the complex process for government-sponsored and commercial ACA plans.
  • Clinical Data Solution integrates clinical data with core administrative and health equity data into longitudinal member and patient records to supply a holistic view of the care journey.

On the next couple of months, Patel said the business will roll out data integration products to aid:

  • Self-funded employers
  • Pharmacy/specialty benefit management
  • Behavioral health
  • Cost-of-care management
  • Telehealth

Payer priorities drive features in new product development

Abacus Insights products are crucial blocks that ladder around top payer priorities, including enhancing member experience, controlling costs and improving health outcomes, Patel explains. They achieve this by firmly taking volumes of data and rendering it eminently and immediately useable by identifying and packaging timely, complete and accurate data make it possible for business units to perform and optimize their operations.

Take risk adjustment. To make sure appropriate resources for high-needs seniors, children, along with other members in Medicare, Medicaid, and commercial Affordable Care Act, health plans must make accurate assessments of every members health status and forecast anticipated charges for the members through the chance adjustment process, Patel notes. That will require accurate, timely and complete data, continually updated. Reimbursement from risk-adjusted plans makes up about around one-third of a payers annual revenues.

Yet this critical function keeps growing increasingly complex and difficult because of the underlying healthcare data challenges, Patel says. These challenges include:

  • Integrating disparate payer sources, including claims, eligibility, case records and notes at scale, which are presented in a variety of formats, legacy systems and platforms.
  • Incorporating external data from electronic medical records, labs along with other clinical sources, plus health equity and social determinant information.
  • Dealing with and sharing this data with multiple stakeholders (such as for example risk-adjustment analytics vendors), each requiring different slices of data and integration models with some calculations even varying by procedure.
  • Accommodating frequent changes to regulations that govern plans, requiring regular process updates and data specification changes.
  • Meeting quarterly along with other risk-adjustment reporting requirements with which 60% of payers say they struggle.
  • Multiplying number and selection of reimbursement models based on the risk-adjustment data.

A data platform developed designed for healthcare payers

Patel stresses that Abacus is rolling out the only real data transformation platform built designed for payers. Its capability to collect, integrate, validate and standardize internal and external data for payers is unmatched available on the market, and the business is managing data for 21 million members, he said.

We have been application-agnostic. Our data transformation platform and data solutions aren’t linked with any specific analytic or other application, giving payers greater freedom to meet up their needs through any existing or new applications, Patel notes. Our platform and solutions are scalable, compliant and secure, with solutions that go live within 4 months vs. 12 months or even more for a built-from-scratch approach.

Concentrating on specific tasks, Patel says our Risk Adjustment Solution simplifies the rapidly escalating complexity of scoring and calculating risk by delivering correct, complete and timely data tailored for every health plan.

Customers can leverage our data answers to run their sections, make smarter and faster decisions and improve reporting compliance. We send automated data feeds, customized for the business enterprise purpose. With easy-to-use dashboards, the solutions also roll-up analytics along with other information from various business-unit applications to provide operating executives a thorough, real-time view of these entire business unit, Patel said.

Also, importantly, Patel says the business uncouples data from analytics or any specific application. He explained that provides CIOs greater data control and flexibility as the data products use any legacy or new payer applications.

Concentrate on healthcare data quality is more critical than ever before

As the concentrate on data quality is completely right and fundamental, healthcare cannot afford to avoid there. The worthiness in high-quality data is in its usability, Patel stressed.

Creating lakes of validated data can be an important stepping stone nonetheless it isnt the finish of the journey, Patel explained. The chance is based on extracting useful information flows that drive:

  • Appropriate, equitable and quality care.
  • Improved member, patient and provider experiences.
  • Better and faster analysis and decision-making.
  • Better and effective business operations.
  • Increased compliance.
  • Decreased healthcare waste.
  • Lower costs.
  • Innovation.

Healthcare continues to be working on making certain its data is current, complete and accurate. Its an escalating challenge because healthcare data, especially unstructured data that is estimated to take into account 80% of most healthcare data is multiplying exponentially, Patel explained. It is a multifaceted challenge, including collecting all of the correct data, cleaning it, storing it, protecting it, updating it, querying it and so forth.

A stepping stone for better healthcare data and analysis is data interoperability, Patel said. The federal government rollout of the FHIR standard for exchanging information in medical records can be an important advance in interoperability, as are payer interoperability requirements for CMS programs to supply patients with usage of their records. The initial wave of CMS interoperability requirements went into effect this past year and more are anticipated in 2023, that is what inspired Abacuss CMS Interoperability Solution.

The proper data is really a prerequisite for analysis or really any use because garbage in, garbage out, Patel said. Thats why we have been laser-focused on the info quality and usability.

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