A New Approach to Healthcare Spending

Overview 
Merit Medicine is changing how self-funded employers manage healthcare costs. For these employers, the unpredictable nature of healthcare can be one of their biggest financial burdens. About 1 in 5 employers have faced a claim over $1 million in the last four years, but they simply don’t know when these claims will happen. 

The Challenge 

The unpredictability of healthcare costs can significantly impact the financial stability of self-funded employers. Unforeseen medical claims, especially those exceeding $1 million, can severely disrupt budget forecasts and allocations, forcing companies to reallocate resources from other critical areas such as employee development, infrastructure improvement, or innovation. This financial volatility restricts a company’s ability to plan for growth and make long-term investments, ultimately affecting its competitiveness and sustainability in the market. The strain of managing these unexpected costs can also lead to increased premiums or reduced benefits for employees, affecting morale and retention. 

In collaboration with claims and RWD providers, Merit Medicine aims to improve the prediction of high-cost healthcare claims with superior accuracy, providing stability in the unpredictable domain of healthcare spending. 

The Solution

Merit Medicine leverages extensive datasets, including Veritas’ unique Fact of Death Mortality Index, to enhance predictive analytics and fine tune our advanced analytical tools. The use of Veritas’ Mortality Index enriches our models by allowing researchers to identify deceased patients, to accurately predict disease burden and total cost of care. 

Results

Merit Medicine’s application of AI in predictive analytics excels in processing large datasets to identify patient journeys related to severe health issues, blending AI with approaches focused on human experiences. This strategy highlights our dedication to understanding the stories behind the data. The AI models are trained over tens of millions of patient journeys to predict both frequency and magnitude of specific medical diagnoses and/or utilization of high-cost specialty drugs. Analysis of real-world data is based on diagnosis and procedure codes in patient journeys, drug therapies utilized and reference datasets of cost of care for specific chronic, complex and rare diseases. 

What’s Next?

Our goal is to improve healthcare cost forecasting by an order of magnitude. This cooperation helps employers make informed decisions about budgeting, employee benefits, and stop-loss insurance. This is particularly valuable for organizations with smaller risk pools like self-funded employers. Preliminary work indicates Merit Medicine’s insights can help employers find the right balance of cost-efficiency, through reduced stop-loss premiums, and risk-profiling to protect against catastrophic healthcare spending. Employers will be able to predictably budget for healthcare while also ensuring that every employee gets the healthcare they need. 

About Veritas Data Research 
Veritas provides the most comprehensive, current, and accurate mortality data in the United States, helping our clients make smarter, more sensitive decisions grounded in real-world data.

Merit Medicine is an innovative health tech startup revolutionizing employer-sponsored healthcare. Leveraging advanced AI insights, the company specializes in predicting high-cost medical spending and specialty drug utilization in rare, chronic, and complex conditions for self-funded employers. Founded by industry visionary Ali Panjwani in 2022, Merit Medicine empowers benefits leaders with AI-fueled predictions, enabling more effective budgeting and ensuring optimal healthcare for every employee. Merit Medicine is headquartered in Austin, Texas, with remote employees across the United States.