Waymark’s innovative approach improves health outcomes for Medicaid patients

Waymark, a utility company dedicated to improving access to and quality of care in Medicaid, today published a peer-reviewed study in New England Journal of Medicine (NEJM) Catalyst evaluating the impact of its early intervention model in its first year of service. The study found that Waymark’s early community-based interventions significantly reduced hospital and emergency department (ED) visits and improved both patient goal completion and quality of care in 2023.

In this large prospective study, researchers evaluated outcomes from Waymark’s early interventions for 64,278 patients covered by two Medicaid health plans and assigned to 2,298 primary care providers (PCPs) covering multiple practices in the states of Washington and Virginia. Waymark works with PCPs to provide additional clinical and social support to high-risk patients outside of the clinic. This population is often disconnected from primary care and experiences escalating and unmanaged medical, behavioral, and social needs—resulting in increased hospital visits and hospitalizations. Waymark combines community-based care teams and predictive technologies to connect high-risk patients to primary preventive care before they become high-cost Medicaid applicants.

Key findings from the study include:

• Reduced ED and hospital visits: 22.9% reduction in all-cause ED and hospital visits, including a 20.4% reduction in avoidable visits¹ 48.3% reduction in ED visits and avoidable hospitalizations for high-risk patients receiving Waymark services (compared to a matched control group of increased-risk patients over a 6-month follow-up period).
• Improved quality of care: Seven of nine default quality metrics² improved by an average of 11.8 absolute percentage points for the full patient population within the calendar year. These quality measures include completion of annual well-child visits (WCV), antidepressant medication management (AMM), follow-up after mental illness hospitalization (FUH), follow-up after ED visit for mental illness (FUM), hemoglobin A1c diabetes management (HBD), breast cancer screening (BCS) and postpartum care (PPC).
• Clinical and social goal completion: Among patients receiving Waymark’s services, 63.3% of patient-identified clinical and social goals were successfully completed. Examples of clinical and social goals include improving blood pressure, connecting with local food banks, managing tobacco and substance use, accessing utility payment assistance programs, and reaching the hemoglobin A1c goal for diabetes management.

“For many of our Medicaid members, especially those with complex care needs, receiving coordinated and holistic health care is essential to improving their health and quality of life,” said Jerold Mammano, Aetna Medicaid Division President at Virginia, one of the health plans. represented in the study. “Through our value-based partnership with Waymark, we have proven to reduce hospital and ED visits and improve quality by increasing access to primary preventive care. We look forward to continuing to support the health and well-being of communities across Virginia.”

Medicaid is the nation’s primary health insurance program for low-income and disabled populations – providing access to essential health and social care for more than 80 million Americans. Despite the program’s critical role as a health care safety net, Medicaid programs are often associated with fragmented care delivery, bureaucratic barriers to care, poor health outcomes, and high avoidable costs. As a public utility, Waymark is chartered to improve access, quality of care and health equity for people who receive Medicaid. This peer-reviewed study describes how Waymark delivered on that map for people enrolled in Medicaid plans in its first year of service.

“We created Waymark to ensure that patients enrolled in Medicaid receive the care they need before their conditions escalate into costly and preventable hospitalizations,” said Dr. Rajaie Batniji, Co-Founder and CEO of Waymark. “The 2023 peer-reviewed results—which are consistent with the randomized controlled trials on which our model is based—confirm that data-driven preventive interventions can dramatically improve outcomes for the chronically underserved and deliver sustainable economic savings for the Medicaid programs.”

Waymark’s multidisciplinary care teams include community health workers (CHWs), clinical pharmacists, pharmacy technicians, licensed behavioral health therapists and care coordinators. These care teams use advanced data science technologies to identify and reach patients at risk of avoidable visits and hospitalizations, and provide them with targeted health and social care services. A 2024 peer-reviewed study published in Nature Scientific Reports proved that the Waymark mark^TMthe company’s proprietary machine learning technology predicts upcoming ED avoidance and hospital utilization for Medicaid patients with greater than 90 percent accuracy.

Waymark currently manages care for approximately 60,000 Medicaid patients in Washington and Virginia. The company enters into value-based contracts with health plans and Medicaid PCPs to provide community-based care for their high-risk populations. By creating a new community health workforce to support PCPs—enabled by advanced data science technologies to identify and reach increased risk patients—Waymark seeks to increase the capacity of the health care delivery system and reduce unnecessary and avoidable cost.

As a public utility, we are committed not only to improving outcomes and quality of care for patients, but also to advancing the evidence base of what works in Medicaid care delivery. This study builds on existing randomized trials and offers a blueprint for Medicaid programs on how to build the sustainable funding, operational infrastructure, and technologies needed to provide early interventions for high-risk Medicaid patients.”

Dr. Sanjay Basu, Co-Founder and Head of Clinical at Waymark

The full article, “Supporting Increasingly Risk Medicaid Patients Through Early Interventions,” was published on NEJM Catalysta peer-reviewed journal published by The New England Journal of Medicine. The authors of this article are Aaron Baum, Ph.D., of Waymark. Rajaie Batniji, MD, Ph.D of Waymark; Hannah Ratcliffe, MPH, of Waymark; Margalit DeGosztonyi, MBA, of Waymark. and Sanjay Basu, MD, Ph.D., of Waymark.