AI can help employees with health plan costs according to Marpai | EBA – Employee Benefit News

How much money could an employer and their employees save if their insurance company could predict — and possibly prevent — costly healthcare events?

An estimated 69% of workers in the U.S. are covered by self-funded insurance plans, according to insight platform Statista, which can be easily derailed by an unexpected expense. That’s why insurance company Marpai has launched Marpai Cares, an AI-powered service that uses data to offer members with a chronic illness a predictive look at their health for the year ahead, specifically whether they’re likely to need expensive emergency medical procedures.

“We’re trying to help our members make the right choices,” says Edmundo Gonzalez, CEO of Marpai. “And for that to happen, we need to be able to predict these events before they happen — way before they happen.”

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But how does it work? Marpai Cares partnered with other insurance providers in order to build a bank of anonymous insurance claims submitted throughout the years. Then, using a combination of artificial intelligence and algorithms, the service compares the medical history of members to those insurance claims in order to pick up patterns and similarities. Marpai Cares then offers employees a six-month look ahead at their possible medical future to help them make decisions about their current health and care.

“It’s comparing all of those realities to tens of millions of people in our research world,” Gonzalez says. “And it’s saying, ‘this now completes this part of the puzzle.’”

That data is then sent to Marpai’s care team, made up of clinicians and nurses associated with the member who will prompt them to schedule an appointment to review the findings, with the goal of offering preventative measures with enough time to choose the most cost-effective and quality option available to them.

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One of the biggest drivers of costly hospitalizations or ER visits is when preventative treatment and care is delayed or ignored completely, according to Gonzalez. For example, a patient with a chronic illness may benefit greatly from a $50 monthly maintenance procedure for their ailment, but in their current plan that maintenance isn’t offered — landing the patient in the emergency room with a big problem and an ever bigger hospital bill.

Even if Marpai’s prediction doesn’t come to fruition, Gonzalez says, the benefit remains: the employee likely has scheduled a check-up with their doctor that can help save eventual time, effort and money.

“This is really about being proactive in helping people get the right care at the right time,” he says. “And do you know when the right time is? It’s early.”