We recently spoke with the chief executives of companies that participated in the recent AWS Startup Showcase: The Next Big Things in AI, Security & 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 make an impact in patients’ lives. Almost three decades later Patel is doing exactly that, but in a very different way than he ever imagined.

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

The company initially focuses on payers, such as health plans, Medicare and Medicaid, that set service rates, collect payments, process claims and pay provider claims. These insurers have been bundling tons of data over decades, every time their members visit a doctor or hospital, undergo a test, or file a claim. The problem is that this information is often locked in dispersed legacy technology systems and is hard to share. While claims data is housed in one area, for example, membership and enrollment are in another, and procedure- authorizations in yet another.

What Patel and his team of around 90 full-time employees aim to do is break down those silos and free up data to be used by different stakeholders in the industry. The Abacus Insights platform ingests data from disparate data sources and brings that data into one environment. 

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

While Abacus is not an analytics company, it applies artificial intelligence and machine learning in its data pipelines, so the processes of gathering data, making connections and gleaning actionable insights get smarter, faster and overall more efficient. The whole idea, according to Patel, 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, flagging unfilled prescriptions or stopping a duplicate test or scan.

The need for a focus on the data layer

Patel’s diverse experience in healthcare ultimately served as inspiration for the creation of Abacus Insights. As a physician and researcher for almost 10 years, as well as being a faculty member at Harvard Medical School, he learned how data is crucial to a precise diagnosis and better care. But it was the business side of the healthcare system, working as an insurance executive, that he quickly learned the difficulties of having timely access to the proper data. Despite the massive amount of information insurers have, running the simplest of analyses across different systems, such as how many members with a certain disease live in a region, can take months to process. 

“And that was happening again, again and again,” Patel recalled.

His way of dealing with this was to deepen his understanding of the challenges large healthcare companies face when trying to determine what to do with their data to help customers. While he discovered the size of the challenge, he found no solution on the market able to address the problem at scale. 

“I realized that we needed a company solely focused on the data layer. It’s like I was almost accidentally involved in this business,” Patel said.

In 2017, Patel left his position as chief strategy officer at Horizon Blue Cross Blue Shield of New Jersey to found Abacus Insights, with the insurer coming on 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 his son made was even more insightful, Patel recalled. He said that in all internet searches, “AB” from “Abacus” would be at the top of the list. 

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

A smooth transition for a non-technologist

Although Patel’s career path is not that common, it’s been seemingly effortless. His transition from medical clinics to executive business offices was smooth and gradual. 

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

The process of slowly giving up his medical roles lasted until 2006, when he finally left medicine as other parts of his career and his personal responsibility grew more demanding. Patel, a father of two, was also building a family.

Patel is a trained physician and does not have an academic background in computer science, artificial intelligence or analytics. He has learned a lot about technology in practice, but his main focus has centered on “finding the right people that work with me to advance the cause,” he said. “I’ve got a phenomenal chief technology officer and a really talented chief product officer, challenging professionals that bring each of their disciplines to the table.”

In fact, surrounding oneself with talent committed to the business at hand is one of the keys to a successful company, according to Patel. But the main suggestion he gives to anyone who wants to create 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 there is a pandemic — that if you are not sure about the problem you are going to solve — and that it is really important — you are going to give up,” he explained.

It was in this way — identifying a market need and building a solution to remedy it — that Patel started all three of his ventures. Before Abacus Insights, he founded Care Management International, a pioneer in leveraging offshore clinical talent 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, spun out and sold to SeniorLink. Both businesses are still active.

Unique moment to grow

Despite the hardships inherent in any new business, there is an opportunity for Abacus Insights to grow. And the moment is unique, primarily, due to two fundamental technology shifts: The digitization of data has finally come to healthcare; and regulatory changes have opened new doors for the industry. 

On July 1, a final rule from the Centers for Medicare & Medicaid Services went into effect granting individuals access to their health data in an effort to “build on the roadmap to improve interoperability and health information access for patients, providers, and payers,” according to CMS. It means companies will have to release data from their current proprietary silos to facilitate the healthcare journeys of members and patients.

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

Abacus Insights is already noticing growth as a result of the changes. The platform has onboarded healthcare companies equaling around 21 million covered lives. It processes millions of healthcare transactions through its systems. 

With a $35 million Series B funding round last year from new and returning investors, the four-year-old Boston-based company’s total venture backing is $53 million to date.

One metric Patel is especially proud of comes from Abacus Insights’ data connector library. The platform has reached the milestone of over 100 connectors in production, ranging from core claims datasets, like medical, pharmacy and vision, to eligibility, enrollment, formulary, utilization management and billing. They enable the ingestion of billions of datasets daily across a broad spectrum of disparate data sources to deliver a holistic view of all the entities and transactions that comprise the modern healthcare payer data universe.

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

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

Photo: Minal Patel