22.9%
reduction
Medicaid Transformation Report
Understanding Medicaid’s past and examining our role in its future.
Medicaid at 60: Charting the path forward
In its 60th year, Medicaid is set to enter a new phase of policy evolution. This report was developed as a free resource to empower stakeholders at all levels—from community health workers and primary care providers to policymakers—to make better decisions about the way we deliver care for Medicaid patients and ultimately support positive transformation of the program.
Our results
Evidence-based impact
Medicaid programs nationwide are grappling with persistent access, quality, and cost challenges that threaten the program's long-term viability. In 2024, Waymark published a peer-reviewed study in NEJM Catalyst demonstrating how our model is making Medicaid more efficient and sustainable.
in all-cause ED and
hospital visits1
48.3%
reduction
in avoidable hospital visits1
20.4%
reduction
in avoidable ED visits1
+16.2%
increase
in outpatient primary care visits1
63%
of patient clinical and social goals completed2
+11.8
percentiles
Average improvement for 7 of 9 HEDIS quality measures2
$253
in total cost-savings per intervened patient per month
Source: Baum A, Batniji R, Ratcliffe H, DeGosztonyi M, Basu S. Supporting Rising-Risk Medicaid Patients Through Early Intervention. NEJM Catalyst Innovations in Care Delivery. 2024;5(11). doi:10.1056/CAT.24.0060
1Reduction (%) among rising risk patients relative to a matched comparison group of rising risk patients who were not activated, using a difference-in-differences statistical analysis to control for measured confounders (demographics, risk factors), secular trends, and time-invariant unmeasured confounding.
2Among all patients receiving Waymark's service
The problem
What Medicaid needs for transformation
Longstanding challenges in Medicaid delivery are now compounded by recent policy changes, making efficient, sustainable, and evidence-based care models more critical than ever.
Acute and emergency care overuse
A 2024 analysis of acute care visits among 48 million Medicaid patients found that 39% of acute care visits are for nonemergent conditions — demonstrating a lack of access to high-quality primary care and preventive services.
Growing workforce shortages
During COVID-19, policymakers began incorporating community health workers (CHWs) into care models. While some Medicaid programs continue these initiatives, many have lost funding, and adoption remains inconsistent across states, straining provider capacity
Limited technology adoption
Poor integration of clinical and social risk data have limited Medicaid programs' ability to identify and support rising-risk patients. This fragmentation results in skyrocketing costs and worsening health outcomes, as vulnerable populations cycle through expensive and avoidable hospitalizations and emergency visits.
Our solution
How we’re
transforming Medicaid
Waymark combines advanced targeting with community-based care teams to identify and support rising-risk patients, delivering measurable health improvements and cost savings.
Targeting Technology
Care Team
Evidence-Based Care Pathways
Provider
Patient
Medicaid in review
Understanding the scale and impact of Medicaid
For nearly 60 years, Medicaid has played an essential role in healthcare access for more than 90 million people across the United States.
Who and what does Medicaid cover?
4 in 10
children
1 in 5
people living in the United States
5 in 8
nursing home residents
41%
of all births
40%
of adults with HIV
41%
of disabled adults
Download the full Medicaid Transformation Report
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