The Best Surgery is No Surgery. With Sword Predict, That’s Now Possible.

Healthcare spending in the United States has soared over the past few decades, consistently outpacing inflation and economic growth. In recent years, this trend has accelerated, putting mounting pressure on employers, their employees, and the broader economy. Despite decades of innovation in other industries, healthcare remains an outlier where more technology often means more spending, not less. Meanwhile, health outcomes have not generally improved. Consider obesity rates in America, which have risen consistently over the past 20 years, affecting nearly every age group and demographic. The financial impact on both employers and workers is massive: Annual family health insurance premiums now rival the cost of buying each employee a new car every year ($23,968 annually) Healthcare takes money out of the average family’s paycheck. Wage growth has stagnated as healthcare spending consumes an ever-larger share of compensation In 2023, 38% of U.S. adults said they or a family member skipped or postponed medical care due to cost As Warren Buffett once put it, healthcare has become the “tapeworm of the American economy.” What’s driving this persistent inefficiency? To find the answer, start with inappropriate care — particularly for musculoskeletal (MSK) disorders, which affect 1 in 2 adult Americans.

There Is a (Severe) Care Crisis in America

MSK conditions are the leading contributor to healthcare spend and lost productivity. Yet across the U.S., decisions about care are anything but consistent. A person in Dallas is 4x more likely to receive spine surgery than someone in New York Data from Dartmouth Atlas shows massive variation in orthopedic surgery rates by region, with spine surgeries spiking at least 30% higher than the national average in 59 hospital regions across the country According to research conducted by Dr. Vijay Yanamadala, a practicing neurosurgeon and Sword’s chief medical officer, up to 58% of spine surgeries may be unnecessary and avoidable, and may even lead to worse outcomes than no surgery at all One study found that 33% of total knee replacements were unnecessary MSK-related surgeries continue to skyrocket, despite growing evidence from major trials showing that physical therapy is as effective as surgery for many common MSK conditions, including lumbar spinal stenosis, hip osteoarthritis and rotator cuff tears. Knee and hip replacements have more than doubled since 2020, while hip replacements have tripled in the past two decades. Spinal fusions, one of the most common MSK surgical procedures, have risen 60% between 2004 and 2015. In fact, the U.S. performs more spine surgeries per capita than any other country. So why are unnecessary surgeries still so common? Because traditional physical therapy often fails to engage the very people who need it most. Inconvenience, access barriers, and low perceived value all contribute to abysmal adherence rates. Because of these factors, half of all PT patients drop out after just four sessions.

4% of People Drive 80% of MSK Costs. Predict Helps Find Them.

At Sword Health, we’ve helped tens of thousands of members avoid surgery and reclaim their lives through Thrive, our flagship MSK-care program. We’re allowing employers, health plans, and individuals to drastically cut their medical spending by making physical therapy the first intervention for chronic pain — not the last. However, when we look at claims data, a clear pattern emerges: Some of the highest-risk individuals aren’t engaging with our interventions that could save them from the financial and physical burden of surgery. We knew there was a critical need for a more proactive way to reach the people most in need of MSK care. How could we reach people before they head down the path toward expensive and invasive interventions like surgery? We needed a more personalized, proactive solution that overcomes barriers, boosts engagement, and maximizes clinical outcomes and cost savings. Enter Predict — our AI-driven triage engine that identifies high-risk members 6 to 8 months in advance of a potential surgery and engages them with concierge-level support to avoid unnecessary surgeries and invasive treatments. Predict is built to: Identify members who are at the greatest clinical risk of needing costly MSK procedures and who stand to benefit most from early, targeted intervention Understand and overcome the engagement barriers unique to this high-risk population Deliver personalized, human-centered outreach to build trust and activate care Predict combines predictive AI with one-to-one human support to help the most vulnerable members get the right care before they end up on the wrong path. The result: much lower MSK costs for employers and health plans, and better outcomes for people suffering from acute and chronic pain.

How Predict Works to Cut Costs and Maximize ROI

Step 1: Early, Accurate Identification

In our own analysis of thousands of medical claims, we find that a mere 4% of members account for 80% of MSK costs.

But what if we can disrupt the typical pathway toward unnecessary care for this high-risk cohort? This is the power of Predict, which leverages sophisticated machine-learning models to accurately identify people likely to require expensive surgeries or high-cost MSK interventions if left untreated. Predict uses proprietary machine learning models trained on: Eligibility and client data Clinical indicators, from comprehensive medical claims and pharmacy data to prior authorization records Social determinants of health (SDOH), such as demographic and geographic data Even with limited data inputs, Predict is able to pinpoint high-risk individuals with high accuracy. In fact, it can identify: 73% of future MSK surgeries up to six months before they occur Members projected to spend $5,000+ on MSK-related costs annually This allows us to shift from reactive outreach to timely, targeted intervention. Step 2: Concierge-Driven Engagement That Triggers Members to Act After identifying these high-risk members, Predict shifts their engagement from broader outreach efforts to a highly tailored, concierge-driven experience. Each Predict member receives personalized attention from a dedicated concierge, acting as their trusted advocate available via phone, text, or email. Concierges proactively support members by anticipating needs, answering questions, and guiding them smoothly through the enrollment process. Our high-touch concierge model focuses on: Urgent scenarios: Providing timely support to members nearing critical, high-cost interventions such as imaging and surgery Awareness gaps: Engaging directly with members who may not have understood or noticed general outreach communications because they prefer phone-based interactions Personalized support: Offering tailored conversations that go beyond broad marketing and clearly illustrate how our programs fit uniquely into members' lifestyles and health journeys Direct specialist access: Giving members opportunities to speak and work directly with our physical pain specialists even before they officially enroll, fostering trust and early engagement This isn’t about more emails or push notifications. It’s about human connection, about forging the kind of relationship that inspires action when it matters most.

The Impact: Better Care, Drastically Lower Spend

With Predict, we’ve been able to quickly demonstrate substantial, measurable results for our clients, validated by robust data and evidence-based outcomes:

• Validated ROI of 4.4:1: Every dollar invested in engaging and treating high-risk members through Predict results in a return of $4.40 by preventing avoidable health utilization
• 4.6x increase in participation: Predict significantly boosts engagement, achieving a nearly 5x increase in the rate of high-risk members participating in Sword programs, compared to high-risk member engagement in the absence of Predict services
• Successful engagement of over 20% of high-risk population: Predict consistently engages more than 20% of the targeted high-risk population in our clinical programs
• Early and precise detection: Our predictive models effectively identify 73% of all upcoming MSK surgeries at least six months before they occur, enabling proactive intervention and avoidance of unnecessary healthcare services
• Reduced surgery intent: Among high-risk members who enroll with an intent to undergo surgery, 62% report no longer having high surgery intent after completing the Sword program
• Concierge-driven engagement: Nearly half of all Predict enrollees benefit from personalized, white-glove concierge services, highlighting the power of tailored, human-driven support to meaningfully enhance member engagement and satisfaction Together, these outcomes illustrate Predict’s powerful impact: reducing healthcare waste, significantly enhancing member engagement, and delivering superior clinical outcomes and financial value.

What’s In It For Employers and Health Plans

Predict is already transforming how we identify and serve high-risk members. But we’re just getting started. As our machine learning models continue to adapt and improve, we will improve our ability to:

• Identify risk earlier
• Personalize care more precisely
• Deliver stronger ROI and cost savings If you’re a benefits leader or health plan executive looking to improve outcomes and reduce unnecessary MSK spend, we’d love to connect. Let’s explore how Predict can help your population receive the right care — before it’s too late. To learn more about Predict, visit https://swordhealth.com/solutions/predict.