AUSTIN, Texas, Feb. 24, 2026 (GLOBE NEWSWIRE) -- Merit Medicine, Inc., a leading healthcare analytics company specializing in AI-driven predictive insights, today released a comprehensive white paper demonstrating how its Merit Predict platform could have improved underwriting outcomes by 107% for a national stop-loss carrier while delivering a 6.9X return on investment.

The retrospective case study, validated by independent actuarial firm Axene Health Partners, analyzed 19 employer groups covering 16,823 members that were originally underwritten and bound by a leading national carrier. The analysis revealed that Merit Predict successfully identified four of the six groups that ultimately generated material losses, flagging them as highest-risk (Tier 5) groups prior to underwriting decisions.

Key findings from the study include:

• Four Tier 5 groups, representing just 21% of total groups, accounted for 52% of underwriting losses
• Excluding or repricing Tier 5 groups would have improved the total loss ratio from 83.6% to 55%
• Profit margin would have increased from 16.4% to 45%
• Two Tier 5 groups experienced reimbursements 172% higher than collected premiums
• The single largest loss—$2.3M—had a Stop-Loss Risk Score 1.5X higher than any other group in the study
  

"This white paper validates what we've long believed: that a small number of high-volatility groups disproportionately drive losses in health insurance portfolios, and these groups can be identified before underwriting decisions are made," said Ali Panjwani, Founder of Merit Medicine. "More importantly, by isolating high-risk Tier 4 and Tier 5 groups, carriers can price more competitively on Tier 1-3 risks—improving win rates and portfolio growth without increasing overall capital exposure. This isn't just about loss avoidance; it's about reshaping how carriers approach the entire underwriting process."

The study demonstrates the critical challenge facing stop-loss carriers, MGUs, primary insurers, and reinsurance partners: traditional underwriting inputs often struggle to capture claim volatility, concentration of catastrophic exposure, and the predictability of future claim patterns. Merit Predict addresses this gap by combining advanced AI, machine learning, and clinical intelligence to deliver member-level and group-level risk insights.

"As an independent actuarial firm, we rigorously evaluated Merit Medicine's methodology and findings," said Joshua W. Axene, FSA, FCA, MAAA, Partner and Consulting Actuary at Axene Health Partners. "The results demonstrate a clear pattern of loss concentration that Merit Predict successfully identified prospectively. This level of predictive accuracy represents a meaningful advancement in underwriting discipline. For carriers managing tail risk and capital efficiency, these insights provide a defensible, auditable framework that complements traditional actuarial methods rather than replacing them."

The white paper outlines strategic implications across the risk-bearing ecosystem:

• Stop-Loss Carriers: Enhanced pricing discipline, reduced tail exposure, and improved competitiveness on low-risk groups
• MGUs: Defensible risk selection framework that strengthens carrier relationships and preserves capacity
• Captives: Proactive volatility management to prevent surplus erosion and unexpected capital calls
• Reinsurers: Improved cedent risk selection and more efficient capital deployment

Merit Predict evaluates groups using two primary metrics: the Merit Stop Loss Risk Score (measuring claim volatility and predictability) and the Merit Aggregate Risk Score (measuring first-dollar risk compared to national benchmarks). The platform also provides member-level health status summaries, primary diagnoses, high-cost drug usage, and predicted medical and pharmacy spend.

Availability

The full white paper, "Using AI-Led Predictive Analytics to Improve Underwriting Outcomes," is available for download at Link to full white paper: https://www.meritmedicine.com/_files/ugd/1d68ef_a1b5d395a19145ab8ca0d7678f468a9e.pdf

About Merit Medicine

Merit Medicine is a healthcare analytics company focused on delivering AI-led predictive insights that help carriers, captives, consultants, and employers better understand and manage group health risk. Merit Predict combines advanced AI, machine learning, and clinical intelligence to deliver actionable underwriting and risk selection insights before losses occur. For more information, visit www.meritmedicine.com.

About Axene Health Partners

Axene Health Partners (AHP) is an independent health actuarial consulting firm focused on helping organizations understand, manage, and predict healthcare costs. AHP emphasizes data-driven insights, analytical rigor, and practical strategies that help clients navigate the financial and operational complexities of healthcare while improving quality of care and controlling costs. For more information, visit www.axenehp.com.

Media Contact:

Robin McGinnis
Head of Growth, Merit Medicine
robin.mcginnis@meritmedicine.com
www.meritmedicine.com
LinkedIn: https://www.linkedin.com/company/merit-medicine/

Validator Contact:

Joshua W. Axene, FSA, FCA, MAAA
Partner and Consulting Actuary, Axene Health Partners
josh.axene@axenehp.com
www.axenehp.com