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

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.

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.

Stay in the Loop

If you’d like to be one of the first to learn about our upcoming solutions announcements, use cases, and other news, please sign up here.