Abacus Insights, a healthcare technology leader with the only cloud-based data transformation platform built specifically for health plans, is rolling out a data solution that enables health plans to create comprehensive longitudinal patient records. The Clinical Data Solution does so by integrating and validating structured and unstructured clinical data from HIEs, EMRs, member devices and apps, as well as other external sources with core payer data including claims eligibility and case management, which offers an expanded foundation for improving member care and outcomes.
U.S. healthcare has been striving for decades to find a way to compile and access each patient’s entire health history in one longitudinal record. These records are considered fundamental building blocks for achieving value-based care and payments at scale.
“Data usability is the straight line to improving healthcare in America. We are helping payers, which are the hub of massive amounts of healthcare data, unlock their siloed systems, disconnected sources, and formats to realize major milestones on the path to better care, equity, and affordability,” said Minal Patel, MD, founder and CEO of Abacus Insights.
Driving Immediate Payer Needs
The Abacus Insights solution maximizes payers’ use of clinical data beyond patient records by also organizing and delivering it to meet immediate payer needs, including:
- HEDIS® and CMS Star ratings rely on clinical data to help demonstrate the plans are tracking and meeting quality, performance and other standards required for participation in federal programs.
- Value-based care and value-based payment (VBC/VBP) contracting, monitoring, and reimbursement depend on clinical data inputs to forecast and measure spending, costs, and outcomes to improve care and affordability.
- Population health management needs robust clinical data to segment members, identify specific needs, deliver care, measure outcomes and share that data with providers and other key stakeholders, enabling payers to confidently accelerate the shift with VBC/VBP model.
The Clinical Data Solution helps payers by:
- Accessing, combining, and validating different sources and systems of clinical data from electronic health records, health information exchanges, Centers for Medicare and Medicaid Services, labs, dentists, member devices and apps, claims, enrollment, and more into a cohesive clinical data ecosystem.
- Extracting pertinent clinical data to inform and improve core administrative workflows, operations, and analytics.
- Enabling sharing of relevant, timely, and accurate clinical information with providers, patients, and other key stakeholders.
Abacus Insights is focused on bringing to market innovations that make high-quality data more usable for payers. The Clinical Data Solution is one in a suite of solutions that Abacus Insights is developing to support key payer functions. These include solutions for more accurate risk adjustment and for compliance with the Centers for Medicare and Medicaid Services’ requirements for interoperability for patient access. New data solutions also target carve-outs related to pharmacy/specialty benefit management, behavioral health, telehealth, and self-insured employers.
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