Innovative approach by Waymark enhances health outcomes for Medicaid patients

Waymark, a public profit firm devoted to enhancing entry and high quality of care in Medicaid, right now revealed a peer-reviewed examine within the New England Journal of Drugs (NEJM) Catalyst evaluating the impression of its early intervention mannequin in its first yr of service. The examine discovered that Waymark’s community-based early interventions considerably lowered hospital and emergency division (ED) visits and improved each affected person aim completion and care high quality in 2023.

On this massive potential examine, researchers assessed outcomes from Waymark’s early interventions for 64,278 sufferers lined by two Medicaid well being plans and assigned to 2,298 major care suppliers (PCPs) spanning a number of practices within the states of Washington and Virginia. Waymark companions with PCPs to offer extra scientific and social assist for his or her rising-risk sufferers exterior of the clinic. This inhabitants is usually disconnected from major 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 major preventive care earlier than they develop into high-cost claimants for Medicaid applications.

Key findings from the examine embrace:

Decreased 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 total affected person inhabitants inside the calendar yr. These high quality metrics embrace completion of annual well-child visits (WCV), antidepressant medicine 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 aim completion: Amongst sufferers receiving Waymark’s companies, 63.3% of scientific and social objectives recognized by sufferers had been efficiently accomplished. Examples of scientific and social objectives embrace enhancing blood stress, connecting with native meals banks, managing tobacco and substance use, accessing utility cost help applications, and attaining goal hemoglobin A1c for diabetes administration. 

“For a lot of of our Medicaid members, particularly these with advanced care wants, receiving coordinated and holistic well being care is important for enhancing their well being and high quality of life,” mentioned Jerold Mammano, Division President of Aetna Medicaid in Virginia, one of many well being plans represented within the examine. “By way of our value-based collaboration with Waymark, we have demonstrably lowered hospital and ED visits and improved high quality by growing entry to major preventive care. We sit up for persevering with to assist the well being and wellbeing of communities throughout Virginia.”

Medicaid is the nation’s major medical insurance program for low-income and disabled populations-;offering entry to important well being and social look after over 80 million Individuals. Regardless of this system’s essential 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 folks receiving Medicaid. This peer-reviewed examine describes how Waymark delivered on this constitution for folks 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 situations escalate into expensive and preventable hospitalizations,” mentioned Dr. Rajaie Batniji, Co-Founder and CEO of Waymark. “Our peer-reviewed 2023 results-;that are in keeping 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), scientific pharmacists, pharmacy technicians, licensed behavioral well being therapists, and care coordinators. These care groups use superior information science applied sciences to establish and outreach sufferers vulnerable to avoidable ED visits and hospitalizations, and supply them with focused well being and social care-related companies. A 2024 peer-reviewed examine revealed in Nature Scientific Reviews demonstrated that Waymark SignalTM, the corporate’s proprietary machine studying know-how, predicts upcoming avoidable ED and hospital utilization for sufferers receiving Medicaid with higher than 90 % accuracy.

Waymark is at the moment managing care for about 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 information science applied sciences to establish 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 enhancing outcomes and high quality of look after sufferers, but in addition 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 the best way to set up the sustainable financing, operational infrastructure, and enabling applied sciences crucial to offer early interventions for rising-risk Medicaid sufferers.”

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

The total article titled “Supporting Rising-Danger Medicaid Sufferers By way of Early Interventions” was revealed in NEJM Catalyst, a peer-reviewed journal revealed by The New England Journal of Drugs. 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.