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Abacus Insights recently announced that it is rolling out a suite of products that 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 firm’s data transformation platform, the only such platform built specifically for payers. The platform aims to solve many data headaches facing payers, including collecting, integrating, validating, and standardizing data from disparate internal and external systems, sources and formats.
“Our platform is focused on making high-quality data available at optimal latency to accelerate business value for both analytical and operational use,” company CEO and founder Minal Patel told VentureBeat. “Our data management products are a leap forward in data usability, because we sort, bundle and continually update validated, transformed data to serve the needs 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 provide a holistic view of the care journey.
Over the next few months, Patel said the company will roll out data integration products to support:
- Self-funded employers
- Pharmacy/specialty benefit management
- Behavioral health
- Cost-of-care management
Payer priorities drive features in new product development
Abacus Insights’ products are essential building blocks that ladder up to top payer priorities, including enhancing member experience, controlling costs and improving health outcomes, Patel explains. They do so by taking volumes of data and making it eminently and immediately useable by identifying and packaging timely, complete and accurate data to enable business units to run and optimize their operations.
“Take risk adjustment. To ensure appropriate resources for high-needs seniors, children, and other members in Medicare, Medicaid, and commercial Affordable Care Act, health plans must make accurate assessments of each member’s health status and forecast anticipated costs for the members through the risk adjustment process,” Patel notes. “That requires accurate, timely and complete data, continually updated. Reimbursement from risk-adjusted plans accounts for up to one-third of a payer’s annual revenues.”
Yet this critical function is growing increasingly complex and difficult due to 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 various formats, legacy systems and platforms.
- Incorporating external data from electronic medical records, labs and other clinical sources, plus health equity and social determinant information.
- Working with and sharing this data with multiple stakeholders (such as 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 and other risk-adjustment reporting requirements with which 60% of payers say they struggle.
- Multiplying number and variety of reimbursement models predicated on the risk-adjustment data.
A data platform developed specifically for healthcare payers
Patel stresses 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 marketplace, and the company is managing data for 21 million members, he said.
“We are application-agnostic. Our data transformation platform and data solutions are not tied to any specific analytic or other application, giving payers greater freedom to meet their needs through any existing or new software applications,” Patel notes. “Our platform and solutions are scalable, compliant and secure, with solutions that go live within 4 months vs. 1 year or more for a built-from-scratch approach.”
Focusing 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 each health plan.”
Customers can “leverage 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 roll up analytics and other information from various business-unit applications to give operating executives a comprehensive, real-time view of their entire business unit,” Patel said.
Also, importantly, Patel says the company uncouples data from analytics or any other specific application. He explained that gives CIOs greater data control and flexibility because the data products work with any legacy or new payer software applications.
Focus on healthcare data quality is more critical than ever
While the focus on data quality is absolutely right and fundamental, healthcare cannot afford to stop there. The value in high-quality data is in its usability, Patel stressed.
Creating lakes of validated data is an important stepping stone but it isn’t the end of the journey, Patel explained. The opportunity lies in extracting useful information flows that drive:
- More appropriate, equitable and quality care.
- Improved member, patient and provider experiences.
- Better and faster analysis and decision-making.
- More efficient and effective business operations.
- Increased compliance.
- Decreased healthcare waste.
- Lower costs.
“Healthcare is still working on making sure its data is current, complete and accurate. It’s an escalating challenge because healthcare data, especially unstructured data — which is estimated to account for 80% of all healthcare data — is multiplying exponentially,” Patel explained. “This is a multifaceted challenge, including collecting all the correct data, cleaning it, storing it, protecting it, updating it, querying it and so on.”
A stepping stone for better healthcare data and analysis is data interoperability, Patel said. The government rollout of the FHIR standard for exchanging information in medical records is an important advance 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 went into effect last year and more are expected in 2023, which is what inspired Abacus’s 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 the data quality and usability.”
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