Abacus promises ‘revolutionary’ new healthcare data products for payers

Abacus Insights recently announced that it is rolling out a suite of products that will revolutionize the way healthcare payers can use healthcare data for faster and better decision making.

The data infrastructure products leverage the company’s data transformation platform, the only platform built specifically for payers. The platform aims to solve many data problems faced by payers, including collecting, integrating, validating and standardizing data from disparate internal and external systems, sources and formats.

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

Healthcare data solutions for payers

Abacus Insights currently has three data products on the market:

• The CMS interoperability solution enables compliance with the Centers for Medicare and Medicaid Services interoperability requirements for patient access.
• The risk adjustment solution improves risk adjustment accuracy and simplifies the complex process for government-sponsored and commercial ACA plans.
• Clinical Data Solution integrates clinical data with key administrative and health data in longitudinal member and patient records to provide a holistic view of the care journey.

Patel said the company will roll out data integration products in the coming months to support:

• Self-financed employers
• Pharmacy/Specialty Benefits Management
• behavioral health
• Healthcare cost management
• Telehealth

Payer Priorities Drive New Product Development Features

Abacus Insights products are essential building blocks that elevate the priorities of top payers, including improving the member experience, controlling costs and improving health outcomes, explains Patel. They do this by collecting large amounts of data and making it excellently and immediately usable by identifying and packaging timely, complete and accurate data so that business units can run and optimize their operations.

“Take risk adjustment. To ensure appropriate resources for needy seniors, children and other members under Medicare, Medicaid and Commercial Affordable Care Act, health plans must make accurate assessments of each member’s health status and predict the expected costs to members through the risk adjustment process, Patel said. notices. “That requires accurate, timely and complete data, which is constantly updated. Compensation from risk-adjusted plans accounts for up to one-third of a payer’s annual earnings.

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

• Integration of disparate payer resources, including claims, eligibility, records, and notes at scale, presented in a variety of formats, legacy systems, and platforms.
• Incorporating external data from electronic health records, labs and other clinical sources, plus information on health equity and social determinants.
• Working with and sharing this data with multiple stakeholders (such as risk-adjustment analytics providers), each requiring different data segments and integration models, with some calculations even varying by procedure.
• Accommodating frequent changes in regulations applicable to plans, requiring regular process updates and changes in data specifications.
• Meet quarterly and other risk adjustment reporting requirements that 60% of payers say they struggle with.
• Multiplication of the number and variety of compensation models based on the risk adjustment data.

A data platform specially developed for healthcare payers

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

“We are application agnostic. Our data transformation platform and data solutions are not tied to a specific analytic or other application, giving payers more freedom to meet their needs through existing or new software applications,” notes Patel. “Our platform and solutions are scalable, compliant and secure, with solutions going live in 4 months versus 1 year or longer for a built-from-the-start approach.”

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

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

Importantly, Patel says the company decouples data from analytics or other specific applications. He explained that this gives CIOs more control and flexibility over the data because the data products work with any existing or new payer software applications.

Focus on quality of healthcare data is more important than ever

While the focus on data quality is perfectly justified and fundamental, healthcare cannot afford to stop there. The value of high-quality data is in its usability, Patel emphasized.

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

• More appropriate, just and quality care.
• Improved experiences for members, patients and caregivers.
• Better and faster analysis and decision making.
• More efficient and effective business operations.
• Increased compliance.
• Less waste in healthcare.
• Lower costs.
• Innovation.

“Healthcare continues to work to ensure that data is current, complete and accurate. It’s an escalating challenge because health data, especially unstructured data — which is estimated to make up 80% of all health data — is multiplying exponentially,” Patel explained. protect, update, query, and so on.”

One stepping stone to better data and analytics in healthcare is data interoperability, Patel said. The government’s rollout of the FHIR standard for exchanging information in medical records is an important step forward in interoperability, as is the payer interoperability requirements for CMS programs to allow patients access to their records. The first wave of CMS interoperability requirements came into effect last year and more are expected in 2023, inspiring Abacus’ CMS Interoperability solution.

“The right data is a prerequisite for analysis — or really any use — because garbage in, garbage out,” Patel said. “That’s why we are laser-focused on data quality and usability.”