Cut Your Medical Costs While Improving Care
Our Cost of Care Management Solution enables health plans to calculate and monitor total medical costs in real-time and across all lines of business throughout the claims process so they can:
- set adequate reserves
- forecast costs
- design and price value-based care arrangements and health-plan products
- assess network adequacy
- develop risk scores for Medicare and ACA lines of business
- increase preventative and early interventions for high-risk members
- work with providers to reduce out-of-network referral
How We Do It
Abacus Insights pulls, consolidates and validates claims data throughout the process from:
- Payer systems
- Pharmacy benefit managers
- Utilization management companies
- Delegated entities
- Providers
We create interoperable usable data, which is accurate, complete, timely, relevant, versatile and use case and application agnostic.
Usable data on claims and cost of care delivers information and insight for improving quality, outcomes and member experience while controlling costs.
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