Abacus Insights Delivers Data Solution for Healthcare Payers to Improve Risk Adjustment Accuracy

Risk Adjustment Solution contributes to expanded access and improved outcomes by delivering data for payers’ specific populations

Abacus Insights, a healthcare technology leader with the only cloud-based data transformation platform built specifically for health plans, has launched a data solution that enables accurate risk adjustment for government-sponsored health plans. Abacus Insights’ 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.

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“We are giving payers both the power to take control of their own risk adjustment data program and the foundation for true business intelligence and reporting by providing integrated, streamlined, and constantly updated data from multiple payers, providers, and external sources including health equity data”

Securing appropriate resources for high-needs seniors, children, and other members in Medicare, Medicaid, and commercial Affordable Care Act health plans depends on accurate assessment of each member’s health status and forecasting anticipated costs for the members through the risk adjustment process. Reimbursement from risk-adjusted plans account for up to one-third of a payer’s annual revenues.

This critical function is growing increasingly difficult due to the underlying data challenges:

• 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 determinants 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
• Frequent changes to regulations that govern plans, requiring regular process updates and data specification changes
• Need to meet quarterly and other risk adjustment reporting requirements with which 60% of payers say they struggle
• Multiplying the number and variety of reimbursement models predicated on the risk adjustment data

“As payers strive to expand care access, quality and equity by adding new plans, we are helping them make decisions that drive improved clinical care and outcomes, a goal shared by patients, payers, and providers that can only be achieved with the right data,” said Minal Patel, MD, founder and CEO of Abacus Insights.

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Data Solutions Drive Payer Performance

The Risk Adjustment Solution is the first in a suite of data integration solutions that Abacus Insights will be introducing in the coming months. Each is tailored to a specific payer operation, delivering a major leap forward in data usability.

“We are giving payers both the power to take control of their own risk adjustment data program and the foundation for true business intelligence and reporting by providing integrated, streamlined, and constantly updated data from multiple payers, providers, and external sources including health equity data,” said Gokul Varadharaj, Abacus Insights’ Vice President of Client Solutions.

Abacus Insights’ data solutions rest on the company’s data transformation platform, which provides payers with the data ecosystem to fuel all key business operations and strategic initiatives. The HITRUST CSF-certified and SOC 2-certified platform delivers high-quality, transformed, and validated data at optimal latency to accelerate business value for both analytical and operational use.

Business executives can trust that Abacus Insights’ data is accurate, current, complete, and aligned with their company’s goals. CIOs and CTOs can gain increased data control and flexibility through the solutions’ integration with any legacy or new software applications.

Other Abacus Insights solutions include those for clinical data, self-funded employers, pharmacy/specialty benefit management, behavioral health, telehealth, cost-of-care management, and compliance with the Centers for Medicare and Medicaid Services’ requirements for interoperability for patient access.

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