Health plans

Reach your rising-risk members before crisis hits

Predictive technology and community-based care that prevents costly acute care events

The challenge

40% of hospital and ER visits in Medicaid are preventable

But traditional care programs miss them. Most programs identify members after they're already high-cost claimants. By then, interventions are expensive and less effective. The opportunity is in the rising risk population—patients who aren't high-cost yet, but will be within 6-12 months without intervention.

Source: AJMC (2024). DOI: 10.37765/ajmc.2024.89630

Our impact

Waymark’s Rising Risk Program prevents costly acute care events

48% reduction

in avoidable hospitalizations

20% reduction

in avoidable ER visits

$2,347 in savings

per member per year

3:1 ROI

in the first year for health plans

Source: NEJM Catalyst (2024). DOI: 10.1056/CAT.24.0060

The Waymark difference

Changing the focus to rising-risk patients

Why rising risk?

Traditional programs target high-cost claimants, whose costs naturally decline over time. Waymark uses predictive technology to identify rising-risk members before they become high-cost, delivering targeted interventions that are proven to prevent avoidable acute care.

Note: Data shown above is sourced from the TMSIS dataset for all Medicaid MCOs for 2019, 2021, and 2022 (excluding COVID year 2020) with a sample size of 49.4M Medicaid patients

NEJM Catalyst (2024). DOI: 10.1056/CAT.24.0060
HCCs are defined as greater than $50k in allowed amount claims per person per year [standard actuarial definition] cumulative in any 12 month period for people with >3 months of eligibility
Meta-analytics population-weighted average reduction (https://pubmed.ncbi.nlm.nih.gov/36121357/, https://pubmed.ncbi.nlm.nih.gov/21993059/, https://pubmed.ncbi.nlm.nih.gov/32672916/, https://pubmed.ncbi.nlm.nih.gov/20860506)

Our solutions

A comprehensive approach to Medicaid population health

Waymark Rising
Risk Program

Acute Care Reduction

90% accuracy predicting
avoidable acute care events

Identify rising-risk members and intervene before crisis — with community-based care teams and automated outreach powered by Signal Suite.

Waymark Quality Program

HEDIS Gap Closure

35pp increase in HEDIS gap
closure rates

Prioritize members most likely to benefit from outreach and close quality gaps at scale — with community-based care teams and automated outreach powered by Signal Suite.

Waymark
Signal Suite

Targeting & Intervention Guidance

Validated across
30.6M Medicaid members

Peer-reviewed predictive models that identify who is rising risk, who will benefit most from intervention, and what action to take.

Learn more about Signal Suite

Early Insight, Early Action

More effective care teams, empowered by technology

Waymark Signal tells care teams who needs help and what interventions will work best – reducing wasted outreach and maximizing their impact. Providers get targeted support for their at-risk Medicaid patients, without needing to adopt new technology or change workflows.

Provider

Patient

How it works

Simple implementation, measurable results

Data integration

We securely connect to your claims and eligibility data

Patient identification

Signal Suite identifies rising-risk members and HEDIS quality gaps

Care delivery

Local teams and automated outreach deliver targeted interventions

Performance reporting

We track utilization, outcomes, and ROI and report back to you

Patient stories

Helping People with Asthma and COPD During Periods of Heavy Smoke Exposure

The threats of wildfire season are serious for those with underlying respiratory disease, but with the right resources and support, their health impacts can be managed.

See what Waymark can do for your members

Schedule a conversation with our partnerships team

Get in touch