Waymark, a public benefit company dedicated to improving access and quality of care in Medicaid, today published a peer-reviewed study in the 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 community-based early interventions significantly reduced hospital and emergency department (ED) visits and improved both patient goal completion and care quality in 2023.
In this large prospective study, researchers assessed 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) spanning multiple practices in the states of Washington and Virginia. Waymark partners with PCPs to provide additional clinical and social support for their rising-risk patients outside of the clinic. This population is often disconnected from primary care and experiences escalating and unmanaged medical, behavioral, and social needs—leading to increased ED visits and hospitalizations. Waymark combines community-based care teams and predictive technologies to connect rising-risk patients with primary preventive care before they become high-cost claimants for Medicaid programs.
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 avoidable1 ED visits and 48.3% reduction in avoidable hospitalizations for rising-risk patients receiving Waymark services (compared to a matched control group of rising-risk patients over a 6-month follow-up period).
- Improved care quality: Seven of nine pre-selected quality metrics2 improved by an average of 11.8 absolute percentage points for the full patient population within the calendar year. These quality metrics include completion of annual well-child visits (WCV), antidepressant medication management (AMM), follow-up after hospitalization for mental illness (FUH), follow-up after ED visit for mental illness (FUM), diabetes hemoglobin A1c management (HBD), breast cancer screening (BCS), and postpartum care (PPC).
- Clinical and social goal completion: Among patients receiving Waymark's services, 63.3% of clinical and social goals identified by patients 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 achieving target hemoglobin A1c for diabetes management.
"For many of our Medicaid members, especially those with complex care needs, receiving coordinated and holistic health care is essential for improving their health and quality of life," said Jerold Mammano, Division President of Aetna Medicaid in Virginia, one of the health plans represented in the study. "Through our value-based collaboration with Waymark, we've demonstrably reduced hospital and ED visits and improved quality by increasing access to primary preventive care. We look forward to continuing to support the health and wellbeing 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 over 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 benefit company, Waymark is chartered to improve access, quality of care, and health equity for people receiving Medicaid. This peer-reviewed study describes how Waymark delivered on this charter for people enrolled in Medicaid programs 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. "Our peer-reviewed 2023 results—which are consistent with the randomized controlled studies upon which our model is based—reaffirm that proactive, data-driven interventions can dramatically improve outcomes for the chronically underserved and deliver sustainable financial savings for 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 outreach patients at risk of avoidable ED visits and hospitalizations, and provide them with targeted health and social care-related services. A 2024 peer-reviewed study published in Nature Scientific Reports demonstrated that Waymark SignalTM, the company's proprietary machine learning technology, predicts upcoming avoidable ED and hospital utilization for patients receiving Medicaid with greater than 90 percent accuracy.
Waymark is currently managing care for approximately 60,000 patients receiving Medicaid in Washington and Virginia. The company enters into value-based contracts with Medicaid health plans and PCPs to deliver community-based care for their rising-risk populations. By building a new community health workforce to support PCPs—enabled by advanced data science technologies to identify and reach rising-risk patients—Waymark seeks to increase the capacity of the healthcare delivery system and reduce unnecessary and avoidable costs.
"As a public benefit company, we're committed to not only improving outcomes and quality of care for patients, but also advancing the evidence base for what works in Medicaid care delivery," said Dr. Sanjay Basu, Co-Founder and Head of Clinical at Waymark. "This study builds upon existing randomized trials and offers a blueprint for Medicaid programs on how to establish the sustainable financing, operational infrastructure, and enabling technologies necessary to provide early interventions for rising-risk Medicaid patients."
The full article titled " Supporting Rising-Risk Medicaid Patients Through Early Interventions " was published in NEJM Catalyst, a peer-reviewed journal published by The New England Journal of Medicine. The authors for this article are Aaron Baum, Ph.D., of Waymark; Rajaie Batniji, M.D., Ph.D of Waymark; Hannah Ratcliffe, M.P.H., of Waymark; Margalit DeGosztonyi, M.B.A., of Waymark; and Sanjay Basu, M.D., Ph.D., of Waymark.
1. Avoidable visits refer to visits that occur in urgent care or ED settings which could have been prevented with timely access to primary care (e.g., urinary tract infections). Based on standard national definitions from the New York University (NYU) ED Algorithm and Agency for Healthcare Research and Quality (AHRQ).
2. Based on the Healthcare Effectiveness Data Information Set (HEDIS) developed by the National Committee for Quality Assurance (NCQA).
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