Health Plan Data Management and Usability Solution

Healthcare payers looking to beat the challenge of accessing usable data to improve their operations and member experience look to the Abacus Insights "Buy+Build" approach.

We are the U.S. leader in data usability for payers, supporting their tech teams, data teams and business units. Payers work with us because we offer them usable data at an unprecedented 4-6 month time-to-value and 60 percent lower TCO. Our key offerings include:

1. Data Transformation Platform: Our platform enables payers to achieve a unified data foundation with digitally interoperable data that reach a new standard for usability by meeting six dimensions: accurate, complete, current, relevant, versatile, and use-case and application agnostic. It consolidates, standardizes and validates billions of pieces of structured, semi-structured and unstructured data from multiple internal systems and external sources including labs, pharmacies, EHRs, HIEs and digital apps. Our delivery model allows payers to tap into our platform's best in cloud technologies and leverage its benefits across four distinct data stages with automated operational support: acquisition, organization, enrichment and access. Core features: Modularly deployed to meet specific business needs Configurability - co-exist with existing enterprise platforms and architectures Data Control Integration with Tech Stack Scalability - 21+ million members Security: HITRUST CSF, SOC2 Tech Currency Interoperability

2. Data Solutions: Our suite enables payers to give key functions and delegated entities the usable data needed to power both key organizational initiatives and business unit goals. They can use data for faster and better decision-making with confidence and flexibility. Emanating from our Data Transformation Platform, our Solutions include: --CMS Interoperability: Enables compliance with the Centers for Medicare and Medicaid Services requirements for interoperability for patient access. --Risk Adjustment: Unifies and delivers timely data for effective risk adjustment of government-sponsored plans to optimize care for high-needs members. --Clinical Data: Integrates clinical, administrative, and health equity data into longitudinal member and patient records to provide a holistic view of the care journey. --Cost-of-Care Management: Supports performance measurement and scaling of complex value-based and fee-for-service arrangements by providing current, complete, and accurate data. --Pharmacy/Specialty Benefit Management: Creates a unified data layer across medical and pharmacy data to power cost and quality analytics and operationally provide timely data closer to the point of care. --Behavioral Health: Collects, cleans, and delivers unified medical, Rx, and behavioral health data from in-person and virtual care models to accelerate analytics and operationalization of care model redesign programs.

3. MyMetrics: This tool offers unprecedented direct, on-demand access to metrics tailored to specific payer functions and business needs, including risk adjustment, cost-of-care clinical data and CMS interoperability, enabling improved decision making, management and alignment with strategic priorities. The metrics are presented in a table accessed through a cloud dashboard, and they can be further divided by line of business, product, geography, attributed provider, and disease cohort. Abacus Insights has built more than 100 metrics, with more under development.

Abacus Insights only supports Private Offers through the AWS Marketplace at this time.