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
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)
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.
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
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 patients
Schedule a conversation with our partnerships team
