![]() ![]() ![]() With the only HITRUST r2 data transformation platform and data solutions developed specifically for health plans, Abacus Insights makes healthcare data usable by ensuring it meets six dimensions-accurate, complete, timely, relevant, versatile and use case and application agnostic. The Abacus platform can add data about members searching the payer website or calling a service representative about whether a specific procedure is covered. To improve claims cost planning and projections, Abacus Insights also can mine and incorporate other valuable information before, during and after care. The usable data for claims also can be segmented and analyzed by line of business, product, geography, or other variables. developing risk scores for Medicare and ACA lines of businessĪbacus Insights’ Cost of Care Management Solution pulls, consolidates and validates claims data wherever it is in the process, including pharmacy benefit managers, utilization management companies, delegated entities and other vendors and providers, so payers know how much has been paid or committed to spend at any moment in time, including by its delegated vendors.designing and pricing value-based care arrangements and health-plan products.It gives payers the information and insights they need to pursue key goals, from increasing preventative and early interventions for highly acute members and those with chronic conditions to working with providers to reducing out-of-network referrals,” said Minal Patel, CEO and founder of Abacus Insights.Įliminating the lags and gaps in claims information improves a host of core operations and analytics, including: “This usable data on claims and the cost of care is foundational for improving quality and member experience and outcomes while controlling costs. For a plan with 100,000 Medicare members and 100,000 commercial members, reducing annual cost of care by 1% would generate more than $14 million in savings. Medical costs account for 85 to 87 cents of every $1 spent by payers. ![]() As a result, payers can closely track costs to target care for all members, address higher than expected claims and ensure sufficient reserves. Boston, – Abacus Insights, the leader in data usability for healthcare payers, is introducing a data solution that better enables health plans to calculate and monitor their total cost of care in real-time and across all lines of business throughout the claims process. ![]()
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