Abacus Insights

#Payers, the new #CMS-0057-F #data #interoperability and #priorauthorization mandates are a golden opportunity to go beyond #compliance to realize strategic value for members, providers, and your business performance—all for lower total cost of ownership than the expensive #CMS-9115-F implementations with disappointing adoption rates. To succeed at the significantly more ambitious and complex #FHIR APIs and other requirements of CMS-0057-F starting in 2026, read our blog for best practices. https://hubs.ly/Q034DpQq0

We’re excited to announce that John Pyhtila, Ph.D. is our new Chief Operating Officer. To learn more about him, read our press release. It’s been an exciting year of growth at Abacus Insights, during which we doubled our revenue. As we start our next chapter, delivering even greater value to payers, we applaud John for his contributions and anticipate the strong leadership he will bring to elevate our customer experience and outcomes. Please join us in congratulating him! https://hubs.ly/Q02_58RF0 #healthtech #medtech #interoperability #data

#Payers, worried about complying with tough Centers for Medicare & Medicaid Services interoperability rules starting in early 2026? We can help you make it happen: Our new CMS Interoperability #data solution accelerates compliance with #CMS-0057-F as well as current #CMS-9115-F interoperability rules. Built on Abacus Insights’ usable data platform and fully integrated with Onyx's CMS interoperability platform, our solution provides seamless and cost-effective modules for expanded patient access, provider access, and payer-to-payer APIs, plus improved prior auth support. Read the news announcement. https://hubs.ly/Q02Yf9PM0

#Payers: We are collaborating with Highmark subsidiary enGen on next-generation platforms and solutions that enable health plans to increase efficiency, reduce costs, improve member care, meet regulatory mandates and realize other enterprise priorities. enGen is embedding our #data transformation platform, data models and data connectors into its industry-leading administration and #analytics solutions for enGen’s 50+ #Blues and other payer clients with more than 20 million members. Read about this exciting news and our three initial joint initiatives: https://hubs.ly/Q02X66V40

#MA plans, current #StarRatings headwinds underscore the need for greater resilience. Learn how one #Blues plan improved #data usability and enterprise agility to cope with #Star and #MedicareAdvantage changes in partnership with Abacus Insights and ZS. The stakes for all #payers are high: Moving from 3.5 to 4.0 stars can add up to $62.5 million in annual quality bonus payments per #MedicareAdvantage contract. Read: Discover How a Blues Payer Revamped Their Data Strategy To Navigate the Shifting Medicare Advantage Landscape. https://hubs.ly/Q02W8hFj0 #HealthIT #Healthtech

#Payers have massive advantages over would-be industry disrupters in the race to operationalize #GenAI. Payers own the all-important #data, plus processes and functional expertise for optimizing LLMs that would take years to replicate. But not all payers will necessarily thrive: Incumbents that move fast with #GenAI may reduce costs and grow revenue so much that other #healthplans could not catch up. Read our blog Generative AI Favors Incumbent Payers Over Disrupters to learn how payers can accelerate GenAI success. https://hubs.ly/Q02TrDRr0 #healthtech #interoperability #HealthIT John Pyhtila, Ph.D. Gokul Varadharaj

Leading #PBM Prime Therapeutics is taking pharmacy management to the next level by transforming medical claims #data. Tune into?Data-Driven Pharmacy Management Levels Up to learn how. In this latest Abacus Insights #HealthPlanning video, Matthew Mertel, Prime’s SVP and COO, and Minalkumar Patel, MD, Founder and CEO of Abacus Insights, discuss bridging the gap between predictable, structured pharmacy data and medical claims data in “wildly different formats”.? ? #healthit?#healthtech??#healthcareinnovation??#interoperability

#Payers, moving from a 3.5 to 4.0 Star Rating means earning up to $62.5 million in quality bonus payments for a #MedicareAdvantage plan with 150,000 members and average quality bonus of $417 per enrollee for 2023. If you’re striving to reach or maintain 4.0 or higher #StarRatings, our new Stars Performance Data Solution is a gamechanger. It delivers insights-ready data? for prioritizing interventions with the biggest impact on quality, member health and experience, and Star Ratings. Replace data wrangling with usable #data that accelerates analysis, action, and improved results. Learn more. https://hubs.ly/Q02MbPWb0 #HealthIT #Interoperability #Healthtech #usabledata

Underwriting, risk and other #payer finance operations depend on the tech team to consistently deliver usable #data for powering analyses and decisions. In the latest Abacus Insights Health Planning video, Ruby Y. Kam, CFO of Blue Cross Blue Shield of Massachusetts?and Abacus Insights CEO Minalkumar Patel, MD discuss forging a strong relationship between finance and tech that optimizes data-driven analytics, operations, and innovation. Tune in to Finance and Tech--The Critical Payer Partnership. #healthtech

#Physicians, interested in making a successful leap to business and/or entrepreneurship? Tune into the Conversations with Clinicians video podcast to learn how our founder and CEO Minalkumar Patel MD moved from physician to consultant, #payer executive and 3-time entrepreneur. Reena Pande MD, former chief medical officer for AbleTo, is launching this series to hightlight lessons from physician leaders and entrepreneurs for the next generation of clinician executives. Watch the series kickoff with Minal and Reena: https://hubs.ly/Q02HJ8_v0. #healthit #healthtech #healthcareinnovation #interoperability