arXiv Computation and Language By Fan Ma, Yuntian Liu, Xiang Lan, Weipeng Zhou, Jun Ni, Mauro Giuffr\`e, Lingfei Qian, Xueqing Peng, Yujia Zhou, Ruey-Ling Weng, Huan He, Lu Li, Huiyuan Wang, Qingyu Chen, Andrew Loza, Laila Rasmy, Degui Zhi, Yuan Lu, Chenjie Zeng, Joshua C Denny, Lee Schwamm, Daniella Meeker, Brian Ondov, Lucila Ohno-Machado, Yong Chen, Hua Xu

Foundation Models to Unlock Real-World Evidence from Nationwide Medical Claims

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ReClaim is a family of generative foundation models trained on 43.8 billion administrative claims from over 200 million enrollees in the MarketScan Research Databases. The models jointly learn diagnoses, procedures, medications, and expenditures, and outperform disease‑specific gradient‑boosted models and transformer baselines in predicting more than 1,000 diseases, forecasting next‑year expenditure, and identifying high‑need, high‑cost enrollees. ReClaim’s representations also improve effect estimates in real‑world evidence studies compared with algorithm‑derived covariates, demonstrating the value of nationwide insurance claims as a scalable substrate for healthcare foundation models.

Machine-generated by The Flow from the publisher's headline and feed description — not written or checked by a human. The full article lives at arXiv Computation and Language.

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