Progressive method by Waymark enhances well being outcomes for Medicaid sufferers

Waymark, a public profit firm devoted to bettering entry and high quality of care in Medicaid, in the present day printed a peer-reviewed examine within the New England Journal of Medication (NEJM) Catalyst evaluating the affect of its early intervention mannequin in its first yr of service. The examine discovered that Waymark’s community-based early interventions considerably decreased hospital and emergency division (ED) visits and improved each affected person objective completion and care high quality in 2023. 

On this giant potential examine, researchers assessed outcomes from Waymark’s early interventions for 64,278 sufferers coated by two Medicaid well being plans and assigned to 2,298 main care suppliers (PCPs) spanning a number of practices within the states of Washington and Virginia. Waymark companions with PCPs to supply further medical and social assist for his or her rising-risk sufferers exterior of the clinic. This inhabitants is commonly disconnected from main care and experiences escalating and unmanaged medical, behavioral, and social needs-;resulting in elevated ED visits and hospitalizations. Waymark combines community-based care groups and predictive applied sciences to attach rising-risk sufferers with main preventive care earlier than they develop into high-cost claimants for Medicaid applications. 

Key findings from the examine embrace: 

• Lowered ED and hospital visits: 22.9% discount in all-cause ED and hospital visits, together with a 20.4% discount in avoidable¹ ED visits and 48.3% discount in avoidable hospitalizations for rising-risk sufferers receiving Waymark companies (in comparison with a matched management group of rising-risk sufferers over a 6-month follow-up interval).
• Improved care high quality: Seven of 9 pre-selected high quality metrics² improved by a median of 11.8 absolute proportion factors for the complete affected person inhabitants throughout the calendar yr. These high quality metrics embrace completion of annual well-child visits (WCV), antidepressant treatment administration (AMM), follow-up after hospitalization for psychological sickness (FUH), follow-up after ED go to for psychological sickness (FUM), diabetes hemoglobin A1c administration (HBD), breast most cancers screening (BCS), and postpartum care (PPC). 
• Medical and social objective completion: Amongst sufferers receiving Waymark’s companies, 63.3% of medical and social targets recognized by sufferers had been efficiently accomplished. Examples of medical and social targets embrace bettering blood strain, connecting with native meals banks, managing tobacco and substance use, accessing utility fee help applications, and reaching goal hemoglobin A1c for diabetes administration. 

“For a lot of of our Medicaid members, particularly these with complicated care wants, receiving coordinated and holistic well being care is crucial for bettering their well being and high quality of life,” stated Jerold Mammano, Division President of Aetna Medicaid in Virginia, one of many well being plans represented within the examine. “By our value-based collaboration with Waymark, we have demonstrably decreased hospital and ED visits and improved high quality by rising entry to main preventive care. We look ahead to persevering with to assist the well being and wellbeing of communities throughout Virginia.”

Medicaid is the nation’s main medical health insurance program for low-income and disabled populations-;offering entry to important well being and social look after over 80 million People. Regardless of this system’s vital function as a well being care security internet, Medicaid applications are sometimes related to fragmented care supply, bureaucratic limitations to care, poor well being outcomes, and excessive avoidable prices. As a public profit firm, Waymark is chartered to enhance entry, high quality of care, and well being fairness for individuals receiving Medicaid. This peer-reviewed examine describes how Waymark delivered on this constitution for individuals enrolled in Medicaid applications in its first yr of service. 

“We created Waymark to make sure that sufferers enrolled in Medicaid obtain the care they want earlier than their circumstances escalate into pricey and preventable hospitalizations,” stated Dr. Rajaie Batniji, Co-Founder and CEO of Waymark. “Our peer-reviewed 2023 results-;that are in step with the randomized managed research upon which our mannequin is based-;reaffirm that proactive, data-driven interventions can dramatically enhance outcomes for the chronically underserved and ship sustainable monetary financial savings for Medicaid applications.” 

Waymark’s multidisciplinary care groups embrace neighborhood well being employees (CHWs), medical pharmacists, pharmacy technicians, licensed behavioral well being therapists, and care coordinators. These care groups use superior knowledge science applied sciences to determine and outreach sufferers liable to avoidable ED visits and hospitalizations, and supply them with focused well being and social care-related companies. A 2024 peer-reviewed examine printed in Nature Scientific Stories demonstrated that Waymark Sign^TM, the corporate’s proprietary machine studying expertise, predicts upcoming avoidable ED and hospital utilization for sufferers receiving Medicaid with larger than 90 p.c accuracy. 

Waymark is presently managing care for roughly 60,000 sufferers receiving Medicaid in Washington and Virginia. The corporate enters into value-based contracts with Medicaid well being plans and PCPs to ship community-based care for his or her rising-risk populations. By constructing a brand new neighborhood well being workforce to assist PCPs-;enabled by superior knowledge science applied sciences to determine and attain rising-risk patients-;Waymark seeks to extend the capability of the healthcare supply system and cut back pointless and avoidable prices.

As a public profit firm, we’re dedicated to not solely bettering outcomes and high quality of look after sufferers, but additionally advancing the proof base for what works in Medicaid care supply. This examine builds upon present randomized trials and affords a blueprint for Medicaid applications on methods to set up the sustainable financing, operational infrastructure, and enabling applied sciences needed to supply early interventions for rising-risk Medicaid sufferers.”

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

The total article titled “Supporting Rising-Threat Medicaid Sufferers By Early Interventions” was printed in NEJM Catalyst, a peer-reviewed journal printed by The New England Journal of Medication. The authors for this text 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.