Abacus Insights Risk Adjustment Solution

Make Risk Adjustment More Accurate and Efficient with Tailored Data

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The stakes for accurate risk adjustment are high: It is the basis for securing appropriate reimbursements and resources for high-needs seniors, children, and other members in Medicare, Medicaid, and commercial Affordable Care Act health plans. Reimbursement from risk-adjusted plans account for up to one-third of a payer’s annual revenues.

But the hurdles for getting risk adjustment right are also high — and getting higher every day as data skyrockets and the process grows increasingly complicated.

Get the Right Data for Your Members

Our Risk Adjustment Solution provides correct, complete, and timely data tailored for each health plan. It helps you stay ahead of the rapidly escalating complexity of scoring and calculating risk so you can drive more equitable access and improved outcomes.

The Risk Adjustment Solution

Intraoperability

Integrates claims, eligibility, case records, and other payer data from various systems and formats
Interoperability

Incorporates external data from EMRs, labs, and other sources including health equity and social determinants information
Data Exchange

Combines and shares data with other stakeholders, such as risk adjustment analytics vendors, accommodating their need for different slices of data and integration models
Compliance

Supports regular process and data specification updates to meet frequent regulatory changes
Reporting

Enables quarterly and other risk adjustment reporting requirements with which 60% of payers say they struggle
Scale

Handles multiplying numbers and varieties of reimbursement models and risk scoring
Improved Performance

Creates the foundation for true business intelligence and decision making

Gain Control of Your Risk Adjustment Data Program

A foundation of integrated, validated, and constantly updated data from multiple payers, providers, and other sources powers our targeted Risk Adjustment Solution, enabling payers to drive effectiveness, efficiency, and innovation toward improving clinical outcomes.

This solution draws from our unique platform, the only cloud-based data transformation platform built specifically for health plans. Our HITRUST r2-certified and SOC 2-certified platform excels at making high-quality data available at optimal latency to accelerate business value for both analytical and operational use.

Learn more about all the Abacus Insights Data Solutions for payers.

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