April 25, 2023
Health Plan Efforts to Meet CMS Interoperability Mandates and Leverage Data Toward Health Improvements Get a Boost from a New Industry Partnership
Abacus Insights, the leader in data usability for payers, and Onyx Technology, the leader in healthcare data interoperability, bring to market a new capability.
Boston and Elkridge, MD, April 25, 2023–Abacus Insights’ and Onyx Technology’s new partnership provides an immediate solution for payers needing to close the gap on complying with state and federal mandates for data interoperability. It also strengthens payers’ ability to support new consumer-driven and value-based models of healthcare.
The partnership combines Abacus Insights’ new standard of usable data with Onyx Technology’s FHIR-based APIs in a new Interoperability Solution. The new solution will replace manual processes that are delaying compliance and expand health plans’ capability to transform their operations, analytics and reporting to innovate. Abacus Insights has added Onyx Technology’s OnyxOS platform, winner of the 2021 Frost & Sullivan Award North American Enabling Technology Award for Healthcare Data Interoperability, to its current Interoperability Solution.
The enhanced Interoperability Solution from Abacus Insights, leveraging the OnyxOS platform, meets the needs of payers at all stages of their interoperability journey whether they
- are satisfied with their current implementation of patient access/provider directory but worried about the cost and time involved in future implementations, such as the Proposed Rule on Advancing Interoperability and Improving Prior Authorization.
- want to replace their current patient access/provider directory due to underperformance.
- elect to leverage the interoperability mandates to drive broader business or data transformation for their companies.
“The partnership between Abacus Insights and Onyx unleashes the full power of interoperability for payers in a single solution, eliminating the need for them to undertake massive and costly internal development efforts,” said Minal Patel, MD, founder and CEO of Abacus Insights.”
For Abacus Insights, this partnership is a further advance in making data usable for payers in pursuing healthcare improvement goals. In its achievement of setting a new standard for usable data that is accurate, complete, timely, relevant, versatile and use-case and application agnostic, Abacus Insights has enabled payers to better serve over 21 million members with milestones such as the first longitudinal patient record and near-real-time record updates.
“So many of the operational and strategic goals that payers aim to achieve are dependent on data and they need interoperability and enrichment to make data usable and actionable,” said Susheel Ladwa, CEO of Onyx. “With the Abacus Insights and Onyx partnership, health plans can now leverage a single solution to accelerate and dramatically improve business and health outcomes.”
When it comes to compliance, the solution provides the most efficient way for payers to catch up with the past, July 2021, deadline for the Centers for Medicare and Medicaid Services Interoperability and Patient Access Rule requiring patient access, provider directory and formulary APIs. It will also ensure they are prepared to meet future upgrade deadlines required by the phased implementation of Advancing Prior Authorization and Improving Prior Authorization Proposed Rule (CMS 0057-P). That rule requires three new APIs: Payer-to-Payer, Payer-Provider Bulk, and Prior Authorization Requirements, Documentation and Decision (PARDD). It also requires reporting. CMS predicts implementation of its 3 new APIs will span 30 months – from the expected publication of the final rule in mid-2023 until the applicable compliance date in 2026.
In addition, California health plans will be required to meet California SB 1419 on Health Information with patient access API, provider directory API, payer-to-payer, exchange API, and in the future prior authorization APIs and Provider access APIs. Under state law, California plans must achieve full implementation by January 2024. Under state law, California plans must achieve full implementation by January 2024.
“We can no longer ignore the need for exchangeable, reliable data in healthcare,” said Patrick Munis, CEO of NewWave, Onyx’s parent company. “The partnership between Abacus Insights and Onyx provides a first look at the incredible value of interoperable usable data to improve care and reduce costs.”
About Abacus Insights
Abacus Insights is a healthcare technology leader with the only data transformation platform and solutions built specifically for health plans. Focused on data quality and usability, Abacus Insights gives payers a new level of control and flexibility with their data by developing accurate, timely, and robust ecosystems that can support any analytics or other applications. 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.
About Onyx Technology
Onyx Technology, LLC is a healthcare interoperability solutions provider. Onyx, a NewWave company, emerged from work with CMS in establishing the nation’s first nationwide FHIR-based API, Blue Button 2.0. Building on this experience and expertise. Focused on standards-based, interoperable technologies Onyx solutions help break data silos across the Healthcare ecosystem.