How Advanced AI Improves Self-Insured Health Plans

By Christina DiBona

Better health drives better living, and the employer health plan is a critical tool for most Americans. It can be difficult to find a health plan that improves health and care quality while simultaneously protecting against excessive and avoidable costs. Marpai is an AI technology company that entered the TPA segment in 2021, bringing the most advanced AI to self-insured employer health plans to empower healthier members, reduce plan costs and simplify everything.

 

Foresight is way better than hindsight 

The best way to reduce costs is to prevent them from happening in the first place, and to connect members to the right high-quality providers when a need emerges. Marpai uses proprietary deep learning, the most advanced AI, algorithms to identify near-term health events for members, and may enable early intervention by clinicians to ensure the best care journey. In addition, Marpai analyzes data to guide members to the right in-network providers for their need. The providers are ranked high in quality (including specialists ranked in the top 10% for quality, safety and patient satisfaction) who charge fair rates. This eliminates guesswork and protects members from low quality, overpriced care. Together, these AI-powered features work hard to empower healthier lives, elevate care quality and reduce unnecessary and excessive medical costs from the plan. Marpai CEO Edmundo Gonzalez adds, "Our goal is to someday cut health plan costs in half while significantly improving member health. That's the power of Marpai AI.”

 

SMART claims processing captures more savings. 

To change the cost curve in employer healthcare, cost containment and negotiated discounts are not enough. Marpai not only uses tech to prevent costly health events and overpriced care, it is revolutionizing claims processing with SMART technology. Marpai seeks to lead the industry in auto-adjudication that eliminates errors, fraud, waste, abuse and cost excesses. Today, Marpai's claims processing platform is the most efficient in the market. When it comes to high-cost codes and complex claims, Marpai brings in expert clinicians who can review pre-certification and pre-paid claims to uncover obscured savings. 

 

Reducing pharmacy with full transparency. 

The cost of prescription drugs has been skyrocketing for years. With big drug companies providing enticing rebates to incentivize their placement on formularies, member interests are not always best served. Marpai offers several PBM options, all of which are fully transparent about rebates. When rebates exists, Marpai discloses them to clients and passes them on 100%. Clients can opt to use the rebate money several ways, even to reduce plan administrative fees. Employers have a lot of influence over the formulary and can pick the PBM vendors that's right for them. Marpai aims to bring its technology capabilities to the pharmacy arena to create new ways to prevent the use of overprices or unnecessary prescription which could dramatically reduce costs for members and the plan. 

 

Filling gaps in care. 

With all the available date on members, a strong AI platform can predict needs, serve up the right solutions and encourage members to act. Today, Marpai's SMART systems sends friendly, personalized emails and texts to members in need and reminds them to make an appointment for annual exams, screenings and vaccinations. 

 

Health power in the palm of your hand.

Simplifying healthcare and the health plan helps to boost utilization and support better health. Marpai uses advanced technology to provide a self-serve member portal and the SMART app that allows members to make better data-driven decisions. With just a click, members can track deductibles and spending, see what’s covered, view claims, use tele-health, find a provider and manage family care. When members know more and feel more in control, they are more likely to make better decisions and use their health plan.

 

Getting ahead of it all.

Marpai's exclusive tech-enables services to highlight the value of AI, health predictions, early intervention and proactive health. This can create healthier lives and reduce health plan costs. When the health plan works to help prevent costly ER visits, re-admissions, and overprices surgeries, it averts physical, emotional and financial hardships. A SMART health plan can help members better understand and change their health trajectory and avoid catastrophic healthcare costs. 

 

Christina DiBona is Marketing Director, Member and Client Engagement for Marpai Health,

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