Health Plan Data Management and Usability Solution

Overview

Healthcare payers face an unprecedented challenge: accessing and operationalizing the vast amounts of data required to meet regulatory mandates, optimize member outcomes, and control costs.

Abacus Insights is the U.S. leader in data usability for healthcare payers, serving 31+ million members with our proven "Buy+Build" approach that delivers usable data to your AWS backed solutions. Our Data Connectors integrate with your core systems of record, insights and analytics solutions, and consume vendor/external files in any format to create a unified, interoperable data framework. We also focus on the intra operability of data, ensuring that payers have visibility across sources and types of data to enable more informed decisions and comprehensive insights.

Our Platform Advantage Our Health Plan Data Management and Usability Solution establishes a unified data foundation that transforms how payers access, process, and utilize their data. Our solution delivers digitally interoperable data that meets six critical dimensions of usability:

1. Accurate: Clean data with redundancy elimination and full data lineage traceability
2. Complete: 360 degree longitudinal patient records consolidating structured, semi structured, and unstructured data
3. Current: Real time data updates in 15 minutes vs. industry average of 24 hours
4. Relevant: Context aware data filtering that separates germane from extraneous information
5. Versatile: Compatible with every analytical and operational application, system, and format
6. Use case Agnostic: Adaptable to any business need without platform constraints

Technical Architecture & Deployment

Our platform consolidates, standardizes, and validates billions of data points from:

1. Internal payer systems (claims, enrollment, prior authorization)
2. External sources (labs, pharmacies, EHRs, HIEs, digital health apps)
3. Real time data feeds and batch processing workflows

Key Technical Features:

1. Modular Deployment: Configurable to meet specific business needs and technical requirements
2. Enterprise Integration: Seamless co existence with existing platforms and architectures
3. Cloud Native Scalability: Built on best in class AWS technologies, supporting 31+ million members
4. Security & Compliance: HITRUST CSF and SOC2 certified with comprehensive data governance controls
5. API First Design: Modern interfaces supporting both legacy and contemporary integration protocols

Comprehensive Data Solutions Suite

CMS Interoperability: Purpose built to ensure compliance with Centers for Medicare and Medicaid Services requirements for patient access and interoperability. Accelerates payer readiness for complex CMS 0057 F government mandates effective January 2027.

Risk Adjustment: Unifies and delivers timely, accurate data for effective risk adjustment of government sponsored plans, optimizing care delivery for high needs members while maximizing risk score accuracy.

Clinical Data Integration: Integrates clinical, administrative, and health equity data into comprehensive longitudinal member records, providing holistic visibility into care journeys and enabling population health management.

Cost of Care Management: Supports performance measurement and scaling of complex value based care and fee for service arrangements by providing current, complete, and accurate cost and utilization data.

Pharmacy & Specialty Benefit Management: Creates unified data layers across medical and pharmacy domains to power cost and quality analytics, delivering timely data closer to the point of care for improved clinical decision making.

Behavioral Health: Collects, standardizes, and delivers unified medical, prescription, and behavioral health data from both in person and virtual care models, accelerating analytics and operationalization of care model redesign programs.