Marpai CEO Talks About How The Company Is Using AI To Help Self-Insured Employers Improve Health Outcomes and Slash Healthcare Costs By 30%

The Co-Founder and CEO of Marpai, Inc. MRAI Edmundo Gonzalez sat down with Benzinga’s Jordan Robertson to talk about the rising trend of self-insured employers and how the AI company’s tech is helping them manage health plans and improve employee health outcomes. Here are some of the key takeaways from the interview. 

The Rise Of The Self-Insured Small Business

Traditionally, self-insurance was really only a viable option for larger companies. “You were big enough to have a little insurance pool within your employee population,” Gonzalez told Benzinga. But that has changed over the last decade as the Affordable Care Act of 2010 (ACA) made health insurance mandatory and the premiums on that mandatory coverage rose. 

At first, smaller businesses were buying traditional health insurance to comply with the new ACA requirements. “The issue with that is that they are phenomenal products, but they are very expensive,” Gonzalez explained.

Premiums have been steadily rising, but medical inflation has reached new highs over the last few years and is expected to increase the cost of healthcare by as much as 6.8% in 2024. That could push already high insurance premiums up even higher next year. 

Those costs have been a major driver of the growth of self-insured employers which cover employee healthcare costs themselves rather than pay for employer-sponsored health insurance plans. Today, 65% of workers are covered by a self-funded health plan provided by their employer.

But providing health coverage directly comes with its own costs and complexities – and that’s where Marpai comes in. “We help them get control of their healthcare spending which is often the second largest expense for any employer outside of payroll,” Gonzalez said.

Marpai offers health plan administration services that take all the complexities off of employers’ plates. “We provide everything that they need: access to the best networks, all of the claims processing, the customer service that their employees deserve, and we make it very easy for their employees to onboard.”

The Role of AI And Tech In Improving Health Outcomes And Making Health Plans Cost Effective

“We were actually born as an AI startup,” Gonzalez said. Later, the company decided to buy its client which moved Marpai into the business of managing health plans. But it used its machine learning expertise to build an AI-powered health plan administration service that not only manages self-funded health plans but provides the tools employees need to take charge of their health. 

“We don’t just pay healthcare claims,” Gonzalez explained. “We actually look at the health of our members.”

“The most high-impact use of AI is really looking at the actual populations we serve and predicting where a member is going with respect to his or her health journey and then getting in front of it,” Gonzalez said. Marpai’s system uses predictive analytics based on historical claims data to flag at-risk members for the company’s in-house clinical team to reach out to. That early intervention can help connect the member with the right preventative care or specialized treatment they need to get ahead of a more serious health problem down the road.

“At the end of the day, healthy populations cost less,” Gonzalez told Benzinga. By proactively connecting employees with the care they need to manage their health risks early on, Marpai can not only help improve their health outcomes but reduce their need for expensive care.

That proactive and preventative care led to an estimated $10.4 million in total estimated program savings for Marpai’s customers in 2021. During the interview, Gonzalez said businesses often see 25% to 30% savings compared to traditional insurance by switching to self-insurance with health plans managed by Marpai. 

Those kinds of potential savings have helped the young company enjoy growth since it began doing business three years ago. “We are almost at $40 million of revenue. That’s from $0 literally a few years ago,” Gonzalez said. “We are on the journey to become profitable by 2024.”

Featured photo by National Cancer Institute on Unsplash.

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