Abacus Insights Files IPO Prospectus: Unlocking Healthcare Data Interoperability to Transform Patient Care and Reduce Costs

Over the past few decades, medicine has made significant strides, such as major advances in complex neurosurgical procedures and cancer research. However, there has been little change in healthcare access, cost control, and quality. Some seemingly simple tasks remain highly challenging for patients, such as deciding which physician to consult, determining out-of-pocket costs, and ensuring better care coordination among providers. This stems from industry-wide information asymmetry caused by the “siloed” nature of medical data.

In recent years, big data and cloud computing have gradually entered the healthcare sector, enabling the integration of vast amounts of data and catalyzing the transformation of the healthcare industry.

Abacus Insights(hereinafter referred to asAbacus) was established in2017Year, is aMedical Data Integration Company, with offices in New York and Boston, is dedicated to enabling data sharing between health insurance companies and healthcare systems, allowing physicians, pharmacists, and other healthcare practitioners to gain a more comprehensive understanding of complete medical record data, thereby helping the entire healthcare system streamline processes and reduce medical costs.

Approximately 30 years ago, Minal Patel began his career in the healthcare sector.PatelHe holds a bachelor’s degree and an M.D. from Boston University, as well as a Master of Public Health from Harvard University. He completed his internal medicine residency at Brigham and Women’s Hospital and served as a full-time physician and faculty member at Harvard Medical School for nearly a decade. He also worked as a partner at McKinsey & Company. Outside of work,PatelHe and his wife have two sons, with whom they spend time skiing in the winter and playing golf in the summer.

When Patel served as Chief Strategy Officer at Horizon BCBSNJ, he experienced firsthand how “rigid” data in the health insurance industry could be. Even for internal analysis, simple questions that should have been answerable with a single mouse click often took weeks or even months to resolve.

Patel observed that, for many insurance companies, functional operational systems are far more important than data reporting. This means that claims data are stored in one system, membership enrollment in another, and prior authorizations in yet another. Conducting a simple analysis, such as determining the number of diabetic patients in a given county, could take several months.

In 2017, Patel left Horizon and foundedMedical Data Integration CompanyAbacus, hoping toBreak down data silos and integrate health information data, enabling consumers to make better health choices and doctors to make more informed treatment decisions, thereby improving individual lives.

Patel stated that Abacus Insights grew by identifying market demands and building solutions in a similar process.According to Patel, Abacus has signed contracts with six companies, including health insurance providers and healthcare service providers. The company charges operational and licensing fees for its software platform, with contract terms ranging from three to five years.

Abacus targets insurance companies as its primary customers because patients make payments through these insurers, granting them access to more comprehensive and in-depth patient healthcare data. By fully leveraging this medical data, Abacus can enhance patients’ health insurance reimbursement experiences while simultaneously reducing costs.

2019On May 31, Abacus completed a $12.7 million Series A financing round,Led by CRV, with participation from .406 Ventures and Echo Health Ventures, the funding will be used to attract talent and expand the company’s scale.On June 16, 2020, Abacus completed a $35 million Series B financing round,Led by Blue Venture Fund, with participation from CRV, .406 Ventures, Horizon Healthcare Services Inc., and Echo Health Ventures. The funding will be used to scale operations and enhance the capabilities of its technology platform. To date, the company has raised a total of $53.6 million in financing.

Abacus is tackling one of the most thorny issues in healthcare technology: interoperability.

Over the past few decades, the healthcare industry has developed a multitude of incompatible technologies. While this may seem foolish on the surface, it is the reality faced by many companies.

Abacus Insights’ data integration platform standardizes, manages, and enriches currently underutilized yet valuable healthcare data. It moves this data out of restrictive silos and securely transfers it to the cloud, where it is subsequently combined with hundreds of third-party data sources for further enrichment.

By harmonizing thousands of unique attributes of individual consumers and their health data, it enables health insurers to integrate and share data with physician offices, hospitals, urgent care clinics, pharmacies, dialysis centers, laboratories, and numerous digital health applications.Creating a more seamless, personalized care experience across every aspect—from diabetes management to wearable devices and wellness programs, which is something traditional systems cannot achieve. Today,Abacus manages data for over 10 million members and 15 million consumers for its health insurance clients.

“Our solution essentially interfaces with disparate systems across insurers and consolidates the data into a single environment,” said Patel. “All data linkage, curation, and optimization are automated on our platform.” The underlying rationale is that when insurers, healthcare providers, and patients have improved access to data, they can make choices that ultimately lead to better outcomes and lower costs.

It is no coincidence that insurance companies are seeking to adopt this technology. Last March, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) issued two rules prohibiting “information blocking” when patients request access to their medical data. These regulations require health plans, healthcare providers, and hospitals to implement open systems that facilitate data exchange. These rules will enable patients to genuinely access their medical data, thereby making more scientifically informed healthcare decisions and better managing their care.

CMS Administrator Seema Verma stated, “Data silos continue to fragment care resources, increasing the healthcare burden for patients and providers, while redundant tests and examinations further raise healthcare costs for patients. We have raised standards for payers and simultaneously protected patient privacy through secure access to patients’ health information. Patients can achieve higher quality of care and better health outcomes at lower costs.”

Although the government has mandated the provision of a range of health information to consumers, most health plans currently fail to meet this requirement. More importantly, security requirements for sharing sensitive data are likely to become increasingly stringent over time, further exacerbating the challenge.

Last July, Abacus announced that it had obtained CMS Qualified Entity certification. This means that, leveraging the Abacus platform, health insurance companies can comply with CMS interoperability requirements, share complete, reliable, and interoperable health information data, accelerate innovation to achieve business transformation, and, more importantly, deliver solutions that improve customers’ lives.

In February this year, Abacus announced a partnership with California-based data cloud company Snowflake, enabling the healthcare industry to access data analytics seamlessly at scale.

Snowflake Data Cloud can centralize healthcare data, reduce inefficiencies, and scale with increasing data volumes to support deeper data insights more rapidly.

“Many health plans are built on vast amounts of data that can be leveraged to improve member health outcomes and experiences. With our capabilities in collecting and managing healthcare data, combined with Snowflake’s data analytics capabilities, our customers will be able to quickly unlock the value of their data and scale their analytics,” said Sumant Rao, Chief Product Officer at Abacus Insights.

Snowflake’s unique multi-cluster shared data architecture delivers the performance, scale, elasticity, and concurrency required by healthcare organizations.Abacus Insights will leverage the Snowflake Data Cloud as the central hub of its data ecosystem, enabling insurance company clients to quickly and seamlessly access, analyze, and visualize all data on Snowflake’s integrated platform.

Abacus Insights’ data management, integration, and enrichment capabilities, combined with Snowflake’s secure data sharing technology and scalability, enable healthcare systems to achieve true interoperability, generate seamless data insights faster and at greater scale, and derive greater value from their data.