Waymark

We’re excited to share the latest edition of Pathways, our curated newsletter full of the latest updates and insights on Medicaid transformation. What you can look forward to in this edition: 👉 A new peer-reviewed study published in JMIR AI found that Waymark’s reinforcement learning model reduced acute care events for patients receiving Medicaid by 21% 👉 Waymark’s latest whitepaper details how Waymark’s Signal Suite addresses the limitations of traditional risk prediction through validated models to predict rising risk patients, more efficiently close HEDIS gaps, and accurately identify 4 out of 5 high-risk pregnancies 👉 A patient testimonial out of Hampton Roads, VA, highlighting the impact Waymark’s multidisciplinary care team drove for one patient and her family facing a myriad of complex health and social needs Check it out below — and be sure to subscribe for more updates!

Each year, Waymarkers nominate their colleagues for our Core Value Awards – our internal awards intended to recognize those who go above and beyond in four different ways: 💡We act with focused urgency. 💡We are bold builders. 💡We are humble learners. 💡We experiment to improve. Congratulations to this year’s winners: Griffin Myers, Melissa Jacobs, Bracie Vose, Parth Sheth, Silu Zuo, PharmD, BCACP, CDCES, Margalit D., Iman Rahim and Jeffrey Tingen, PharmD, MBA, BCPS, BCACP, CDCES! Read more about their accomplishments: https://wymrk.co/4oemoUq

AI in healthcare holds tremendous promise – but for those who serve patients who already face the greatest barriers to care, getting AI governance right isn't optional. A 2019 landmark study revealed that a widely-used healthcare algorithm exhibited significant racial bias, requiring Black patients to be consistently sicker than white patients to receive the same care recommendations. Unfortunately, this wasn't an isolated incident. At Waymark, we know that we are responsible for ensuring the history discussed above doesn’t repeat itself. We reject the notion that AI's primary function is to deny care or automate away human connection. Instead, we see AI as a tool to enable faster, unbiased, and more efficient care decisions. Our approach centers on three core principles: ✅ Transparency in how AI systems make care decisions ✅ Community engagement in technology development and deployment ✅ Continued focus on empowering human-centered care and the multidisciplinary teams that deliver it Learn more about how we're building AI that advances health equity—not undermines it—in our latest blog post: https://wymrk.co/4oznsmL

𝗧𝗵𝗲 𝗯𝗶𝗴𝗴𝗲𝘀𝘁 𝗼𝗽𝗽𝗼𝗿𝘁𝘂𝗻𝗶𝘁𝘆 𝗶𝗻 𝗠𝗲𝗱𝗶𝗰𝗮𝗶𝗱 𝗰𝗮𝗿𝗲 𝗺𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁 𝗶𝘀𝗻'𝘁 𝗺𝗮𝗻𝗮𝗴𝗶𝗻𝗴 𝗵𝗶𝗴𝗵-𝗰𝗼𝘀𝘁 𝗽𝗮𝘁𝗶𝗲𝗻𝘁𝘀 – 𝗶𝘁’𝘀 𝗽𝗿𝗲𝘃𝗲𝗻𝘁𝗶𝗻𝗴 𝘁𝗵𝗼𝘀𝗲 𝗰𝗼𝘀𝘁𝘀 𝗶𝗻 𝘁𝗵𝗲 𝗳𝗶𝗿𝘀𝘁 𝗽𝗹𝗮𝗰𝗲. New research we published today in AJMC - The American Journal of Managed Care reveals why traditional care management programs targeting high-cost patients show limited real-world impact, and why observational studies often overstate their effectiveness. We analyzed data from 13.1 million Medicaid beneficiaries across 15 states and found that high-cost patients naturally see spending decrease 42% over time - 𝘸𝘪𝘵𝘩 𝘰𝘳 𝘸𝘪𝘵𝘩𝘰𝘶𝘵 𝘪𝘯𝘵𝘦𝘳𝘷𝘦𝘯𝘵𝘪𝘰𝘯. 𝗪𝗵𝘆? High-cost patients are identified during periods of unusually high utilization that naturally normalize on their own. This is why multiple randomized controlled trials of high-cost care management programs show null results. When programs report savings without control groups (e.g. retrospective analyses), they’re often just observing this natural pattern, not true intervention effects. The real opportunity lies in targeting rising-risk patients – before they become high-cost: ✅ Rising-risk patients represent 𝟭𝟯.𝟲% of the Medicaid population (vs. 0.64% high-cost) ✅ Their healthcare costs surged by 𝟵𝟵% when left unaddressed, whereas spend for high-cost patients naturally declined by 𝟰𝟮% without intervention ✅ 𝟱𝟬% of new high-cost patients were previously identifiable as rising-risk ✅ These former rising-risk patients account for 𝟲𝟬% of all high-cost spending Instead of reactive care management for patients already in crisis, Waymark focuses on proactive intervention for rising-risk patients – those on a trajectory toward becoming tomorrow's high-cost claimants. Our approach, published in NEJM Catalyst and evaluated using control groups to isolate true intervention effects, shows meaningful reductions in avoidable hospital/ER visits and a 3:1 return on investment for health plans and providers. Read the full research: https://wymrk.co/49x8AAD H/T to Sadiq Y. Patel Harold Pollack Sanjay Basu, MD, PhD for this important work

As Medicaid work requirements approach, health plans and state agencies have a unique opportunity to build infrastructure that supports both coverage retention and economic mobility for 10-15 million beneficiaries. The key is moving from reactive crisis management to proactive, data-driven intervention. By leveraging predictive analytics to identify at-risk members before procedural issues arise, and integrating clinical expertise with workforce development resources, organizations can create comprehensive support systems that address interconnected health and employment needs. "Every organization, every care team member who touches patients has the opportunity to help here," said Sara Greenbaum, Waymark's Head of Operations. "Thinking about how we integrate them into standard workflows is incredibly important to preparing for the work requirements mandate." The most effective strategies we're seeing include: 💡Predictive tools that trigger proactive outreach workflows 💡Community-based care teams that address clinical and social barriers simultaneously 💡"No wrong door" approaches that let members access support at any system touchpoint 💡Robust community partnerships built on sustainable funding mechanisms "Signal and our next best action models help care team members understand which actions are most likely to benefit which patients," said Sanjay Basu, MD, PhD, Waymark's co-founder and Head of Clinical. "We couple this with real-world outreach to make sure patients don't lose coverage." Learn how health plans can turn this challenge into an opportunity to strengthen both health outcomes and economic stability in our latest analysis: https://wymrk.co/3WDUC8G H/T Jeremy Schifberg, Liz Cagianesa, MBA, John Morgan

Jessica's healthcare journey was defined by one word: overwhelm. The Hampton Roads resident was pregnant, managing her own chronic health conditions, and coordinating complex medical care for her children – all while navigating the administrative barriers that come with Medicaid coverage. “When you're trying to manage everything, having somebody to help make sure the system doesn't fail you is huge," she said. "Everyone at Waymark, they know how to work around the system when you, the patient, are hitting walls." From stepping in to address an urgent prescription-related concern to connecting Jessica’s children with mental health care and essential personal care supplies, Waymark’s care team members supported the hard work Jessica was putting into caring for her family. Today, Jessica's family is thriving, and she continues to work with Waymark's care team. Most importantly, she has the confidence and peace of mind that comes from having advocates who know how to navigate the system on her behalf. Read her full story here: https://wymrk.co/47ln5pO

We're continuing to grow our team at Waymark! We have several remote and hybrid positions available across Washington, Illinois, and Ohio. 📌 Browse through the carousel to see our current openings. 📌 Find a role that aligns with your skills and background? Submit your application here: https://wymrk.co/3Dp3SY3 📌 Think someone in your network would be a great match? Tag them in the comments 👇 We're looking for mission-driven professionals who are committed to advancing health equity and expanding access to care for underserved populations. Our teams can’t wait to hear from you!

Traditional risk prediction models identify patients after crisis patterns emerge – but what if we could intervene early, preventing avoidable hospital/ER visits before they occur? Our new whitepaper introduces the 𝗪𝗮𝘆𝗺𝗮𝗿𝗸 𝗦𝗶𝗴𝗻𝗮𝗹 𝗦𝘂𝗶𝘁𝗲™️: a unified approach to early intervention across Medicaid populations. Our four core products: ✔️𝗦𝗶𝗴𝗻𝗮𝗹 𝗳𝗼𝗿 𝗥𝗶𝘀𝗶𝗻𝗴 𝗥𝗶𝘀𝗸: >90% accuracy predicting avoidable hospital/ER visits (Nature Scientific Reports, 2024) ✔️𝗦𝗶𝗴𝗻𝗮𝗹 𝗳𝗼𝗿 𝗤𝘂𝗮𝗹𝗶𝘁𝘆 𝗜𝗺𝗽𝗿𝗼𝘃𝗲𝗺𝗲𝗻𝘁: 85% accuracy identifying patients who benefit from proactive outreach to close HEDIS gaps (npj Digital Medicine, 2025) ✔️𝗦𝗶𝗴𝗻𝗮𝗹 𝗳𝗼𝗿 𝗠𝗮𝘁𝗲𝗿𝗻𝗶𝘁𝘆: Early detection of high-risk pregnancies 55 days sooner than existing approaches (npj Digital Public Health, 2025) ✔️𝗦𝗶𝗴𝗻𝗮𝗹 𝗳𝗼𝗿 𝗗𝘂𝗮𝗹-𝗘𝗹𝗶𝗴𝗶𝗯𝗹𝗲 𝗣𝗼𝗽𝘂𝗹𝗮𝘁𝗶𝗼𝗻𝘀: 80% accuracy predicting future avoidable hospital/ER visits (under review) Existing models identify risk. Our approach goes further: predicting not just who is at risk, but who will benefit from intervention and what action to take. For health plans and providers serving Medicaid populations, this represents a fundamental shift in how we identify, prioritize, and intervene with at-risk members. Read the full whitepaper below 👇

This year, Waymark’s Care Operations, Care Delivery and Data Science teams had the opportunity to share the impact of their work at Camden Coalition's Putting Care at the Center conference. Sadiq Y. Patel, Abum Ezeonwu, and Jeremy Schifberg presented real-world data on how shifting from traditional risk-based prioritization to benefit-based approaches can prevent costly emergency care for Medicaid populations.  Attendees were invited to explore how this benefit-based approach could help community-based care teams maximize their impact with limited resources. In addition to this workshop, Sadiq also participated in a plenary session on AI applications, ethics, and opportunities in complex care alongside Health Hats’ Danny van Leeuwen and Camden Coalition's Aaron Truchil. Thank you to Camden Coalition for a great conference, and to all the attendees for the thoughtful and inspiring sessions!

This month, our care teams in Ohio, Virginia and Washington state came together for in-person collaboration, strategic planning, and some well-earned team bonding in our local markets. These offsites strengthen the local relationships that make community-based care work, and serve as an important part of how we live our core values. As we continue to grow and expand into current and new markets, we're grateful to both our team leads and care team members for making time to gather in person to learn from one another and build the relationships that strengthen our community-based care delivery. We all look forward to more in-person team building to come!