Abacus promises ‘game-changing’ new healthcare data products for payers

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Abacus Insights recently announced the rollout of a suite of products that will “revolutionize” how healthcare payers can leverage healthcare data for faster and more effective decision-making.

Data infrastructure products are built on the company’s Data Transformation Platform, the only platform of its kind designed specifically for payers. The platform aims to solve many data problems faced by payers, including the collection, integration, validation and standardization of data from disparate internal and external systems, sources and formats.

“Our platform is focused on delivering high-quality data with optimal latency to accelerate business value for both analytical and operational use,” said Minal Patel, CEO and founder of the company, at VentureBeat. “Our data management products are a leap forward in data usability, as we continuously triage, aggregate and update validated and transformed data to meet the needs of specific business functions and strategic payer initiatives. »

Healthcare data solutions for payers

Abacus Insights currently offers three data products on the market:


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  • The CMS interoperability solution helps meet Centers for Medicare and Medicaid Services interoperability requirements for patient access.
  • The risk adjustment solution improves the accuracy of risk adjustment while simplifying the complex process of government-sponsored and commercial ACA plans.
  • The clinical data solution integrates clinical data with core administrative and health equity data in longitudinal member and patient records to provide a holistic view of the care journey.

Over the next few months, Patel said the company will be rolling out data integration products to support:

  • Self-funded employers
  • Management of pharmacy/specialty services
  • Behavioral health
  • Cost of care management
  • Telehealth

Payer Priorities Drive Features in New Product Development

Abacus Insights products are essential building blocks that address major payer priorities, including improving the member experience, controlling costs and improving health outcomes, Patel says. They do this by taking volumes of data and making it eminently and immediately usable by identifying and aggregating timely, complete and accurate data to enable business units to manage and optimize their operations.

“Take the risk adjustment. To ensure appropriate resources for seniors, children, and other members with high needs in Medicare, Medicaid, and the Affordable Care Trade Act, health plans must conduct accurate assessments of the health status of each member and projecting expected member costs through the risk adjustment process,” notes Patel. “This requires accurate, timely and comprehensive data that is continuously updated. Reimbursement from risk-adjusted plans represents up to one-third of a payer’s annual earnings.

Yet this critical function is becoming increasingly complex and difficult due to underlying health data challenges, says Patel. These challenges include:

  • Integrate disparate payer sources, including claims, eligibility, case files, and notes at scale, which are presented in various legacy formats, systems, and platforms.
  • Incorporate external data from electronic medical records, laboratories, and other clinical sources, as well as information on health equity and social determinants.
  • Work with and share this data with multiple stakeholders (such as risk adjustment analysis providers), each requiring different slices of data and integration models, with some calculations even varying by procedure.
  • Adapt to frequent changes in the regulations that govern the plans, requiring regular process updates and changes to data specifications.
  • Meeting quarterly reporting and other risk-adjustment requirements that 60% of payers say they struggle with.
  • Multiplication of the number and variety of reimbursement models based on risk adjustment data.

A data platform developed specifically for healthcare payers

Patel points out that Abacus has developed the only data transformation platform designed specifically for payers. Its ability to collect, integrate, validate and standardize internal and external payer data is unmatched in the market, and the company manages the data of 21 million members, he said.

“We are application independent. Our data transformation platform and data solutions are not tied to any specific analytical or other application, giving payers greater freedom to meet their needs through any existing or new software applications,” notes Patel. . “Our platform and solutions are scalable, compliant and secure, with solutions going live within 4 months versus 1 year or more for a fully-built approach.”

Focusing on specific tasks, Patel says, “Our risk adjustment solution simplifies the growing complexity of risk scoring and calculation by providing correct, complete and timely data tailored to each health plan.”

Customers can “leverage our data solutions to manage their business units, make better decisions faster and improve reporting compliance. We send automated, personalized data feeds for marketing purposes. With easy-to-use dashboards, the solutions also bring together analytics and other information from various business unit applications to give operational executives a comprehensive, real-time view of their entire business unit,” Patel said.

Also, importantly, Patel says the company separates the data from analytics or any other specific application. He explained that this gives CIOs greater control and flexibility over data, as the data products work with all payer software applications old or new.

Focusing on the quality of health data is more critical than ever

While the focus on data quality is absolutely right and fundamental, healthcare cannot afford to stop there. The value of high-quality data lies in its ease of use, Patel stressed.

Building validated data lakes is an important stepping stone, but it’s not the end of the journey, Patel explained. The opportunity lies in extracting streams of useful information that lead to:

  • More appropriate, equitable and quality care.
  • Improved experiences for members, patients and providers.
  • Better and faster analysis and decision making.
  • More effective and efficient business operations.
  • Increased compliance.
  • Reduction of medical waste.
  • Cost reduction.
  • Innovation.

“Health is always working to ensure its data is up-to-date, complete and accurate. This is a growing challenge as health data, especially unstructured data – which is an estimated 80% of all health data – is growing exponentially,” Patel explained. “This is a multi-faceted challenge, including collecting all the correct data, cleaning it, storing it, protecting it, updating it, querying it, etc.”

Data interoperability is a springboard for better healthcare data and analytics, Patel said. The government’s deployment of the FHIR standard for exchanging information in medical records is a significant step forward in interoperability, as are payer interoperability requirements for CMS programs to provide patients with access to their records. The first wave of CMS interoperability requirements came into effect last year with more expected in 2023, which inspired Abacus’ CMS interoperability solution.

“Good data is a prerequisite for analysis — or really any use — because garbage goes in, garbage goes out,” Patel said. “That’s why we focus on data quality and usability.”

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