Stop-loss coordination starts with better risk prediction.
Predict catastrophic claim risk across your book of business. Demonstrate proactive risk management to stop-loss carriers and arm your employer clients with actionable intelligence.
15%
of members drive
80% of claims
$250K+
average catastrophic
claim cost
30-60
days advance
risk visibility
0.807
AUC validation
AMI cohort
The stop-loss conversation is changing.
Stop-loss carriers are tightening underwriting. They want to see that you have visibility into high-risk members and are actively managing them before they become catastrophic claims.
Generic risk scores built on claims data alone miss the clinical trajectory that predicts who will end up in the ICU next month. Marqi Index reads EHR data to surface risk that claims-only models cannot see.
The Cost of Surprise
The gap between 0.65 and 0.807 AUC represents the difference between reactive claims management and proactive clinical intervention.
How TPAs Use Marqi Index
From stop-loss negotiations to employer renewals, validated risk prediction changes the conversation.
Stop-Loss Coordination
Share validated risk scores with stop-loss carriers to support underwriting conversations. Demonstrate that you have visibility into high-risk members and are actively managing them.
Improve renewal termsCatastrophic Claim Prediction
Identify members most likely to generate claims above specific attachment points. Flag potential $250K+ claims 30-60 days before they materialize.
Early warning systemClaims Platform Integration
API-based delivery integrates with your existing claims adjudication and care management workflows. FHIR-compatible for seamless data exchange.
Minimal IT liftEmployer Reporting
Provide self-funded employer clients with actionable risk intelligence. Justify care management investments with peer-reviewed validation data.
Client retentionCare Management Triage
Route high-risk members to the right care management intensity. Prioritize nurse outreach and disease management resources where they will have the greatest impact.
Resource optimizationPopulation Stratification
Segment your book of business by risk level. Identify which employer groups have the highest concentration of emerging high-risk members.
Portfolio visibilityIntegration Architecture
Data Ingestion
Claims + EHR feed via API or sFTP
Risk Scoring
Transformer ensemble + XGBoost meta-learner
Score Delivery
Real-time API or batch file delivery
Workflow Integration
Route to care management, reporting, stop-loss
Built for your existing workflows.
Marqi Index delivers risk scores where your team already works. No new portals to log into, no manual data entry, no disruption to existing processes.
The Economics of Early Intervention
Preventing one catastrophic admission pays for a year of risk prediction.
$250K+
Average catastrophic claim
5-8%
High-risk members in typical plan
15-25%
Potential cost avoidance
For a 10,000-member plan with 500 high-risk members, preventing just 2-3 catastrophic admissions through targeted intervention can yield 10-20x ROI on risk prediction investment.
Ready to Change the Stop-Loss Conversation?
Schedule a 30-minute call to see how Marqi Index can help you identify high-risk members and demonstrate proactive risk management.