Abacus Insights Enables Health Plans to Track Total Cost of Care Throughout the Claims Process

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. As a result, payers can closely track costs to target care for all members, address higher than expected claims and ensure sufficient reserves.

Medical costs account for 85 to 87 cents of every $1 spent by payers. 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.

“This usable data on claims and the cost of care is foundational for improving quality and member experience and outcomes while controlling costs. 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.

Eliminating the lags and gaps in claims information improves a host of core operations and analytics, including:

• maintaining adequate reserves
• forecasting costs
• designing and pricing value-based care arrangements and health-plan products
• assessing network adequacy
• developing risk scores for Medicare and ACA lines of business

Abacus 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. The usable data for claims also can be segmented and analyzed by line of business, product, geography, or other variables.

To improve claims cost planning and projections, Abacus Insights also can mine and incorporate other valuable information before, during and after care. The Abacus platform can add data about members searching the payer website or calling a service representative about whether a specific procedure is covered.

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. Abacus Insights begins delivering business value in 4 to 6 months and at a 60% lower total cost than an internal build.

About Abacus Insights

Abacus Insights is a healthcare technology leader with the only data transformation platform and solutions built specifically for health plans. By setting the new standard of payer data to usability, Abacus Insights gives payers a new level of control and flexibility to support analytics and operational use cases. Managing data for 21 million members, Abacus Insights partners with payers to deliver scalable solutions that drive strategic initiatives, control costs, and improve member lives and experiences.

View source version on businesswire.com: https://www.businesswire.com/news/home/20230509005210/en/