Progressive strategy 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, right this moment printed a peer-reviewed research within the New England Journal of Drugs (NEJM) Catalyst evaluating the affect of its early intervention mannequin in its first yr of service. The research 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 massive potential research, 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 supply extra scientific and social help for his or her rising-risk sufferers exterior of the clinic. This inhabitants is commonly 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 packages. 

Key findings from the research embrace: 

• Diminished 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 mean 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 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 scientific and social objectives recognized by sufferers have been efficiently accomplished. Examples of scientific and social objectives embrace bettering blood stress, connecting with native meals banks, managing tobacco and substance use, accessing utility fee help packages, and reaching 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 crucial for bettering 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 research. “By means of our value-based collaboration with Waymark, we have demonstrably decreased hospital and ED visits and improved high quality by rising entry to major preventive care. We stay up for persevering with to help 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 take care of over 80 million People. Regardless of this system’s important function as a well being care security web, Medicaid packages are sometimes related to fragmented care supply, bureaucratic boundaries 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 research describes how Waymark delivered on this constitution for individuals enrolled in Medicaid packages 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 pricey 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 packages.” 

Waymark’s multidisciplinary care groups embrace neighborhood well being staff (CHWs), scientific 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 prone to avoidable ED visits and hospitalizations, and supply them with focused well being and social care-related companies. A 2024 peer-reviewed research 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 better 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 help 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 take care of sufferers, but additionally advancing the proof base for what works in Medicaid care supply. This research builds upon present randomized trials and presents a blueprint for Medicaid packages on the best way to set up the sustainable financing, operational infrastructure, and enabling applied sciences essential 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-Danger Medicaid Sufferers By means of Early Interventions” was printed in NEJM Catalyst, a peer-reviewed journal printed 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.