Our Analytics & Economics team conducts monthly and quarterly reviews of Waymark’s impact on patients receiving Medicaid. A recent peer-reviewed study published in the New England Journal of Medicine (NEJM) Catalyst last month summarizes those findings from 2023, demonstrating that Waymark’s unique approach to community-based care, driven by technology that identifies rising-risk patients before they become high-cost claimants, significantly improved outcomes for patients, versus a matched control group. Key findings include:

1. Waymark achieved a 22.9% reduction in all-cause emergency department (ED) and hospital visits for patients receiving Waymark’s services (versus the matched control group), including a 48.3% reduction in avoidable hospital visits and a 20.4% reduction in avoidable ED visits¹.
2. We improved 7 of 9 pre-selected HEDIS quality measures² by an average of 11.8 absolute percentage points for the full study population within the calendar year
3. Our care teams helped patients achieve over 63% of their chosen clinical and social goals.

What can Medicaid health plans and primary care providers—particularly those exploring new ways to improve outcomes for their Medicaid populations—learn from these results? In this explainer, we summarize the study’s methodology and key takeaways for health plans and providers in the words of the paper’s co-authors.

Managing costs through interventions

From a health economist’s perspective, understanding whether an intervention actually improves outcomes and reduces costs requires estimating what would happen if patients never received an intervention (the “counterfactual” outcome). To do this, economists use a standard approach called a “difference-in-differences” analysis to estimate utilization changes associated with the intervention, after controlling for secular trends and confounding variables between the groups, including unmeasured factors that cause differences between intervention and control populations. This evaluation method—commonly used by academics, health economists, and policymakers at the Centers for Medicare and Medicaid Services—allowed Waymark’s economists to confidently and reliably estimate the impact of Waymark’s interventions on clinical outcomes and cost savings.

“This evaluation process gives us a way to understand the link between outcomes and interventions,” said study co-author Aaron Baum, PhD, Waymark’s VP of Analytics and Economics. “For example, we can understand the cause and effect between reliable housing or access to healthy food on a population’s health, and make inferences based on that relationship.”  

Significantly, the analysis revealed that Waymark reduced avoidable hospital and ED visits compared to a matched control group. This reduction in avoidable acute care utilization also resulted in significant cost-savings to the health plans and providers represented in the study—averaging $253 per patient per month.

Enabling PCPs to better support patients

A critical driver of these positive outcomes is the close integration between Waymark's community-based teams and the primary care practices we serve. Waymark does not replace PCPs, but rather “wraps around” their practice and patients to give them free support outside of the clinic. As an example from the study: For a patient with hypertension, the PCP would continue the usual workflow for diagnosis and treatment, but a Waymark community health worker (CHW) would join the care team to ensure the patient picks up their medications from the pharmacy, obtains an upper-arm blood pressure cuff and uses it correctly, reminds the patient to record their blood pressure on the provider’s preferred log template, and accompanies the patient to the follow-up appointment for medication titration. The CHW also works with the patient to address any social determinants of health (SDOH) that may impact their ability to adhere to their treatment plan or attend PCP appointments, such as access to healthy food and transportation to appointments. 

The key to this approach, said study co-author and Waymark’s VP of Care Model and Quality Hannah Ratcliffe, MSc, is centering around the patient’s goals and working collaboratively with their PCP throughout the care delivery process. This approach can also alleviate the administrative burden many providers are struggling with.  

“PCPs receive the support of a multidisciplinary team of pharmacists, pharmacy technicians, therapists, CHWs and care coordinators, and all of them come together to wrap around the patient in the community, outside the brick-and-mortar practice,” she said. “There’s a flexibility there that I think is pretty unique to Waymark.”

Waymark’s care teams use proprietary care management software built by and for community-based teams operating in Medicaid. This tool helps care teams identify and outreach patients who need support, manage their care plans, automate prior authorization and medical equipment paperwork, and identify relevant clinical or social interventions and resources that patients might benefit from. The NEJM study found these technologies reduced administrative intake time from 38 minutes to 25 minutes–and those minutes add up to more time spent in the field, with patients, making an impact.

“I believe part of why we contribute so positively to patient outcomes is because we take a multidisciplinary approach that centers the patient while also streamlining workflows,” said Hannah. “These early interventions pay off, literally, for payers and providers because we’re focused on that efficiency across the board.”

Creating value for health plans

For many Medicaid health plans, concerns around duplicative care management practices often hinder the adoption–and thus the impact–of approaches focused on early intervention. To counter these concerns, Waymark’s team focuses on engaging rising-risk patients—those patients who are not yet high-cost claimants, but on the pathway to becoming so without early intervention—in addition to patients with open gaps in care. Rising risk patients are identified through a proprietary set of algorithms that have achieved >90% accuracy at predicting upcoming avoidable emergency room visits and hospitalizations, as Waymark’s data science team previously published in a peer-reviewed article in Nature Scientific Reports.

Traditional health plan care management programs focus primarily on existing high-cost claimants or patients with open quality gaps (e.g., missing a vaccination or mammogram). In the NEJM Catalyst study, Waymark’s economists found that preventive care for rising-risk patients combined with quality gap closure reduced unnecessary acute care utilization and improved HEDIS gap closure for health plans. 

“This is another reason why all this data is so important,” said paper co-author and Waymark’s VP of Implementations Margalit de Gosztonyi. “We leverage our tools and data, like the data in the study, and we work with partners and within their data to support more patients more effectively."

Ultimately, the study validates what Waymark’s care team members have seen to be true in every patient story they share: that combining a community-based care approach with technology to identify patients who need support can deliver value on multiple fronts.

“When you focus on the patient, and on intervening before they become a high-cost claimant, you’re not just course-correcting a health concern,” said Hannah. “You’re also making lives better, and you’re saving costs across the board, and we’re finding new ways to improve on all of that through data and research.”