About Marpai

Marpai, Inc. operates as a technology-driven healthcare payer. The company uses artificial intelligence (A.I.) and data analytics to help its clients (Clients) lower their cost of healthcare by enabling better health outcomes for their employees and families. The company is creating the healthcare payer of the future for self-insured employers in the U.S., what it refers to as the 'Payer of the Future'. The company provides administrative services, and act as Third-Party-Administrator (TPA) to self-insured employers who provide healthcare benefits to their employees. Most of the company's Clients (who are self-insured employers that pay for their employees' healthcare benefits and engage the company to administer the latter's healthcare claims) are small and medium-sized companies, as well as local government entities. The company has over 200 Clients. It provides services to a total of over 41,000 of its Clients' employees, and including their spouses and dependents, it serves a total of over 73,000 Members in 44 states in addition to the District of Columbia. Most of the company's clients are small to medium size businesses that rely on their brokers to select their third party administrators, or their fully insured health plan, usually in a competitive bid process. The company therefore distributes its services primarily via healthcare brokers. In 2021 and 2022, the company made significant investments in building its sales and marketing channels. The company has created relationships with some of the largest brokers in America. The company's direct sales force focuses mostly on these brokers. The recent acquisition of Maestro Health with its ancillary in-house services, the company is also focused on upselling these ancillary services to its legacy customers. Brokers, such as Lockton Companies, Inc., the world's largest privately held insurance brokerage firm, are a key sales channel for the company to reach the self-insured employer market. On November 1, 2022, the company acquired Maestro Health, LLC. (Maestro Health). Maestro Health has a very similar business to it with the core being a traditional third-party administrator (TPA) of healthcare claims for self-funded employers. Maestro Health services over 60 clients. On average, Maestro Health's clients are similar to the company's legacy clients in size, and the vast majority of clients were sold via a healthcare broker. Maestro Health is a Self-Funded Health Plan service provider which delivers a complete, all-in employee health and benefits solution to brokers, carriers, and employers. The acquisition brought the company several product lines that it previously had in-house. Clinical Care Management - This group is largely consisted of registered nurses, who work with Members (employees and their family members who receive these healthcare benefits from the company's Clients) on their health journey. These nurses work with Members on pre-authorizations for costly procedures, and they also outreach to members after a health event, like a hospitalization, to make sure their care is optimized. With the complexities in the company's healthcare system, members often need a guide, and its team ensures that they have this and that they can access the care they need. The company charges its Clients for these activities as claims. Out of Network Claims Processing - A portion of the claims the company processes for its Clients do not have a network, such as Aetna or Cigna. While in-network providers are typically pricing their services based on prices that have been previously negotiated with the network, out of network services are typically unilaterally set by the provider and are usually substantially higher than the prices of similar services that are provided within a network. Some employers engage third parties to negotiate the reduction of these out of network charges so that they ultimately pay fair and reasonable prices for these out of network services. There are vendors that just do this function within the healthcare payer market. Maestro Health developed its own software tool and process to execute this function on its own. The company charges its Clients for these claims on a shared savings model. Pharmacy Cost Containment - With approximately one-fourth of all healthcare spending being on prescription drugs, the company's Clients often have large opportunities for savings in this area. Maestro created products that identify opportunities to save via alternative sourcing of high-cost drugs, access to manufacturers' discounts, and access to alternative funding sources. Similar to the company's out of network claims processing services, these products are charged to its customers on a shared savings model. Flagship Program - Marpai Cares In 2022, the company launched Marpai Cares, which encapsulates its approach to maximize the value of the self-funded health plan by creating the healthiest member population, given a Client's budget. The company does this for its Clients for a competitive administration fee. The company's Clients get much more than the processing of claims for its management fee. They get a healthier employee population. The key attributes of Marpai Cares include the company's use of A.I. and other advanced analytics to do the following for the benefit of its Members' health: Knowing Member Needs: The company continually analyzes member data (including historical claims, app data, portal data, social determinants) to monitor member health needs and identify action opportunities. Targeting Interventions: The company uses machine learning and predictive models to identify at-risk Members where an intervention can make a meaningful difference; and proactively connect Members to proven clinical solutions to support positive outcomes. Finding High-Value Providers: The company guides Members to make high-value provider choices: fair-priced, in-network providers ranked high in quality, safety and satisfaction based on Healthcare Bluebook data. Filling Gaps in Care: The company proactively drives Members to make annual checkups, vaccinations, and screenings when it's time, so they stay on track. For Clients, who have opted into the company's Pharmacy and Clinical Care Management Program, it also adds the following: Pharmacy Savings: The company provides Members with deep medication discounts, find alternate funding sources and experience reduced/eliminated copays. Clinical Care Management: The company provides guidance to its Members across the care continuum, so they access the right care in the right setting with affordable rates. Marpai Cares + Clinical Care Management - Delivering Value for Clients and Members Matching Members with high-quality providers is a key component of the company's services. In 2021, the company expanded their program called TopCare, which found quality providers for Members. With the acquisition of Maestro Health, the company has a full Clinical Care Management division in-house. This is completely complementary to its approach, and the company's own clinical staff can work with legacy and newly-acquired Members. The company continues to identify at-risk members and match them to the right care. The Members with the highest risk are well-known and identified. These are Members who have had or are fighting serious conditions. Often these Members, although a small portion of the overall population (e.g. often less than 5% of total Members), can represent a large portion of the total spend for an employer health plan. The company addresses the needs of these Members via active Clinical Care Management, where nurses are making outreaches to them and making sure they have the care they need. There is an opportunity to deliver better health outcomes for the population as a whole, while containing costs for the company's clients by also focusing on the next rung of Members at risk. These Members represent 'cost bloomers' in that they have similar costs to the average of the plan, but in the future, they may cost several times the average. This rung of Members often represents a fifth or so of the population. They have complex chronic conditions, multiple comorbidities, and sometimes ignored or misdiagnosed symptoms. These also represent the highest cost Members of the future. The company has deployed its technology to identify these cost bloomers as early as possible. Identification is a critical piece, but engagement with a compelling intervention is what actually drives better outcomes for the Member and lower costs for the Client. Products and Services The company derives its revenues from three general sources: Health Plan Administration Services, ancillary in house services and third party vendor services. Health Plan Administration The company's core product and service offering includes handling all aspects of administration related to a healthcare plan. It typically designs for its Client a healthcare benefit plan which outlines exactly what coverage the Client would like to provide to its employees. The company then manages the plan for the Client by providing the following services: Providing Members access to a provider network via relationships with Aetna, Cigna, and regional networks; Answering Members' calls and requests related to their health plan via phone, email and via its App; Concierge type services to help Members find providers and care management, as well as to answer questions, such as on claims and benefits; Validating and adjudicating claims from Clients' employees, including automated adjudication; Concierge type services to help Members find providers and care management, as well as to answer questions, such as on claims and benefits; Validating and adjudicating claims from Clients' employees, including automated adjudication; Promoting health and use of high-quality providers to the member population across Clients; Paying claims on behalf of its Clients; and Sourcing stop-loss insurance via one or several providers. The company sells complementary services to its Clients, including care management, case management, actuarial services, health savings account administration and bill review services. In-House Ancillary Services The company's Ancillary Services revenues include all the revenues that it derives from its inhouse products excluding the administration fees. This revenue is related to products that relate to the company's role as the administrator of the health plan, but are ancillary to paying claims. Clinical Care Management - A nurse-led, proactive guide for at-risk members across the care continuum so they get the right high-quality care at the right time and avoid excessive, inappropriate, and overpriced care. Instead of simply treating a condition, they take a personal, holistic approach, to help plan members every step of the way. Repricing Insights - Out-of-network claims are a reality for any health plan. This product encompasses all the negotiation and adjudication related to out of network claims. Clients often save up to 60% on their out-of-network claims versus the initial billed amount. Marpai PACCS - Pharmacy Advocacy Cost Containment Solution (PACCS) is the company's member-driven pharmacy savings program that focuses on specialty and high-cost medications to generate up to a 75% savings. MarpaiRx - The company's new, national pharmacy benefit management program that saves Clients and Members money and delivers a high-touch Member experience. The company grants access to prescriptions at affordable rates and coordinate pharmacy and medical benefits to ensure that the right care is delivered and paid for in a way that reduces the overall cost of healthcare. Third Party Services Some of the company's revenues were derived from services that were provided to its Clients and Members by third party vendors. The company typically passes through most of these revenues to these vendors and their contribution to its gross profit is relatively small. These services include network access fees that are charged by the provider networks (such as Aetna or Cigna) which are used by its Members when they visit network providers (doctors, hospitals etc.), as well as some cost containment services, and other services provided by third party vendors (i.e. not by the company). The company's subsidiaries include: Marpai Captive, Inc. The company owns Marpai Captive, Inc. (Marpai Captive). Marpai Captive is intended to be engaged in the captive insurance market. Marpai Captive commenced operations with a small membership in the first quarter of 2023. Marpai Health, Inc. (Marpai Health) Marpai Health engages in developing and marketing A.I. and healthcare technology to analyze data with the goal of predicting and preventing costly healthcare events related to chronic conditions and expensive medical and surgical procedures. EYME Technologies, Ltd. (EYME), a wholly owned subsidiary of Marpai Health located in Israel, serves as Marpai Health's research and development center with eight employees in Israel. Marpai Administrators, LLC (Marpai Administrators) Marpai Administrators provides benefits outsourcing services to clients in the U.S. across multiple industries. Marpai Administrators' backroom administration and TPA services are supported by a customized technology platform and a dedicated benefit call center. Under its TPA platform and TopCare program, Marpai Administrators provides health and welfare administration, dependent eligibility verification, Consolidated Omnibus Budget Reconciliation Act (COBRA) administration, and benefit billing. Research and Development For the year ended December 31, 2022, the company's research and development expenses were $3,708,068. Government Regulation In addition to HIPAA (the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations), the company is subject to other state and federal laws and regulations that address privacy, data protection and the collection, storing, sharing, use, transfer, disclosure and protection of certain types of data. Such regulations include the CAN-SPAM Act, the Telephone Consumer Protection Act of 1991, Section 5(a) of the Federal Trade Commission Act, and the California Consumer Privacy Act (CCPA), as amended by the California Privacy Rights Act (CPRA), which, where applicable, provides consumers with additional privacy rights. As a TPA, the company must maintain active TPA licenses in all states that are not expressly exempt from requiring a TPA license where it conducts business. History Marpai, Inc. was founded in 2021. The company was incorporated in 2021.