From medical school to tech entrepreneur, Minal Patel, CEO of Abacus Insights, tackles old-guard healthcare with data

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We recently spoke with business leaders who attended the recent AWS Startup Showcase: The Next Big Things in AI, Security, and Life Sciences to find out what drives them and learn about their visions for the future. This feature is part of theCUBE’s ongoing CEO Startup Spotlight series.

When Minal Patel first entered medical school, his aspiration was to solve health problems and impact the lives of patients. Almost three decades later, Patel is doing just that, but in a very different way than he ever imagined.

Patel is the founder and CEO of Abacus Insights Inc., a startup with a intelligent data platform that harnesses the explosion of healthcare data to empower patients, insurers and providers to make better decisions.

The company focuses first on payers, such as health, Medicare, and Medicaid plans, which set prices for services, collect payments, process claims, and pay provider claims. These insurers have been collecting tons of data for decades, every time their members visit a doctor or hospital, get tested, or file a claim. The problem is that this information is often locked in dispersed legacy technology systems and is difficult to share. While complaints data is hosted in one domain, for example, membership and registration is in another, and procedural permissions in another.

The goal of Patel and his team of approximately 90 full-time employees is to break down these silos and free up data that can be used by different stakeholders in the industry. The Abacus Insights Platform ingests data from disparate data sources and aggregates that data into a single environment.

“Then we connect, define and master all the context behind that data, enriching that data,” Patel explained.

Although Abacus is not an analytics company, it applies artificial intelligence and machine learning in its data pipelines, so that the processes of collecting data, making connections, and collecting data actionable information becomes smarter, faster, and overall more efficient. The idea, Patel says, is that when patients, insurers, and providers all have better access to data, they can make choices that ultimately lead to better outcomes and lower costs. Examples include optimizing treatment plans, reporting unfulfilled prescriptions, or stopping a duplicate test or scan.

The need to focus on the data layer

Patel’s diverse healthcare background ultimately served as the inspiration for the creation of Abacus Insights. As a physician and researcher for nearly 10 years, as well as a faculty member at Harvard Medical School, he learned how crucial data is for accurate diagnosis and better care. But it was on the business side of the healthcare system, as an insurance framework, that he quickly understood the challenges of having timely access to the right data. Despite the massive amount of information available to insurers, running the simplest scans on different systems, such as the number of members with a certain disease living in an area, can take months to process.

“And it happened over and over and over again,” Patel recalls.

Her way of handling this was to deepen her understanding of the challenges large healthcare companies face when trying to figure out what to do with their data to help customers. While he discovered the scale of the challenge, he found no solution in the market capable of solving the problem on a large scale.

“I realized we needed a business that was all about the data layer. It’s like I’m almost accidentally involved in this business, ”Patel said.

In 2017, Patel stepped down as Chief Strategy Officer at Blue shield of the blue cross of the horizon from New Jersey to found Abacus Insights, the insurer coming in as an investor. The name Abacus was suggested by his 10-year-old son after Patel explained how the new business “would help customers count.” The second point her son made was even more insightful, Patel recalls. He said that in all Internet searches, “AB” from “Abacus” would be at the top of the list.

“And that’s right. If you visit my venture capital firm’s websites, we’re the first company to show up, ”Patel said.

A smooth transition for a non-technologist

While Patel’s career path is not that common, it has been seemingly effortless. Its transition from medical clinics to executive offices has been smooth and gradual.

“I was a full-time doctor, then I did part-time clinic and part-time research. And then I got into the business world, but I still kept my clinical practice – and so once a month I would go to Boston to see patients in the hospital because I loved it, ” did he declare.

The process of phasing out his medical duties lasted until 2006 when he finally left medicine as other parts of his career and personal responsibility became more demanding. Patel, father of two, also started a family.

Patel is a doctor by training and has no college education in computer science, artificial intelligence, or analysis. He has learned a lot about the technology in practice, but his main focus is “to find the right people who work with me to advance the cause,” he said. “I have a phenomenal CTO and a really talented Product Manager, challenging professionals who bring each of their disciplines to the table. “

In fact, surrounding yourself with talented people who are committed to the business at hand is one of the keys to a company’s success, according to Patel. But the main suggestion he gives to anyone who wants to start a startup: be clear about the problem to be solved, and be passionate about it.

“When you start a business, you’re going to run into so many hurdles – whether it’s because you can’t get funding right away, or you can’t attract the talent you want, or because you can’t get it right away. there’s a pandemic – that if you’re not sure what problem you’re going to solve – and it’s really important – you’re going to give up, ”he explained.

It was in this way – by identifying a market need and developing a solution to address it – that Patel launched his three businesses. Prior to Abacus Insights, he founded Care Management International, a pioneer in harnessing clinical talent offshore to support payer clinical functions, which was successfully sold to iHealth Technologies (now Cotiviti (COTV)). This was preceded by Vayu Technologies, a telecommunications platform developed by Bell Labs, created and sold to SeniorLink. Both companies are still active.

Unique moment to grow up

Despite the challenges inherent in any new business, there is an opportunity for Abacus Insights to grow. And the moment is unique, mainly due to two fundamental technological changes: the digitization of data has finally arrived in healthcare; and regulatory changes have opened new doors for the industry.

On July 1, a final rule of Medicare and Medicaid Service Centers came into effect by granting individuals access to their health data with the aim of “building on the roadmap to improve interoperability and access to health information for patients, providers and providers. payers, ”according to CMS. This means companies will need to publish data from their current proprietary silos to ease the care journey for members and patients.

Patel believes that the CMS mandate is just a necessary first step in enabling patients to have better access to health data. Merely following the mandate is a missed opportunity to innovate and create real change in consumers’ healthcare experience, according to Patel. Organizations keen to move beyond compliance can spur a new wave of innovation when they become adept at analyzing and sharing valuable information among multiple stakeholders.

Abacus Insights is already seeing growth as a result of the changes. The platform has integrated healthcare companies representing approximately 21 million lives covered. It processes millions of healthcare transactions through its systems.

With a $ 35 million Series B fundraising round last year From new and known investors, the total funding for the four-year-old Boston-based company is $ 53 million to date.

One metric that Patel is particularly proud of comes from the Abacus Insights data connector library. The platform has passed the milestone of more than 100 connectors in production, ranging from basic claims data sets such as medical, pharmacy and visual data, to eligibility, registration, form, usage management and billing. They enable the daily ingestion of billions of data sets across a wide range of disparate data sources to provide a holistic view of all the entities and transactions that make up the modern universe of healthcare payers data.

“We think we have a very good place in the ecosystem, given the domain expertise and the real connections we have made in the sectors we operate,” said Patel. “But that’s only part of the process. The long-term goal is to bring the entire delivery system together, not just payers, but doctors, hospitals, retail pharmacies and insurance companies all together on a common data platform to have the opportunity to truly transform the industry.

As Patel likes to point out, it’s about solving problems and making an impact.

Photo: Minal Patel

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