Merit Medicine seeks to bring AI insights to the often-opaque employer-sponsored health insurance market. Employers who self-fund their employees’ health plans face escalating healthcare costs. And with the expansion of high-cost medical spending and the rapid introduction of more targeted and expensive specialty drugs, the unpredictable nature of these expenses can decimate budgets and ultimately lead to fewer people getting the care they need.
Company founder and CEO Ali Panjwani is a leader in improving market access to treatments for people suffering from complex conditions with stops at Genentech, BridgeBio Pharma, Coherus Biosciences, and Aetion-created Merit Medicine to guarantee everyone has a fair shot at the best care.
Stop-loss carriers, which are responsible for insuring employers against substantial claims arising from these drugs and treatments – handle extensive information to calculate the premiums for employers. In contrast, self-funded employers rely on their employee population.
Merit Medicine levels the playing field by utilizing its extensive dataset, consisting of millions of data points, to generate predictions tailored to the specific population of each employer. And the company combines its proprietary models and unique dataset with employer-specific population data to make budgeting more predictable for self-funded employers.
Going beyond the industry standard of simply extrapolating from last year’s results to predict this year’s, Merit Medicine empowers benefits leaders with AI-driven predictions based on patient journeys, enabling them to offer the best benefits to their employees.
KEY QUOTES:
“Large self-funded employers cover over a quarter of the US population today. And employer contributions to healthcare now make up roughly $600 billion of annual healthcare spending in the United States. Using AI insights from millions of patients, Merit Medicine ensures a smoother, more predictable budget for employers’ catastrophic healthcare spend, which leads to more people getting affordable access to the care that they need when they need it.”
- Ali Panjwani
“Self-funded employers are faced with rising healthcare costs and significant financial risk based on the health of their employee base. Unfortunately they have very few tools today to evaluate this risk and plan for it.
“When I met the Merit Medicine team, I was inspired by their mission to help employers address this risk by using AI to predict high-cost specialty drug usage and rare, chronic, and complex conditions. The team’s domain experience also stood out with experience in drug pricing, market access, and healthcare data analytics.”
- Mike Marcantonio, who is leading the investment for LiveOak Ventures
