Health Plans
Prevent avoidable hospital and ER visits for Medicaid members
Deliver better outcomes with proven predictive technology and community-based care.
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.
Waymark’s interventions have been shown to reduce avoidable hospitalizations by 48%
Our early interventions with rising-risk patients deliver measurable clinical and financial impact:
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
Source: NEJM Catalyst, 2024
Changing the focus to rising-risk patients
Why rising risk?
With no intervention, rising-risk patients become high-cost claimants within 6-12 months. Waymark identifies rising-risk patients before their health issues turn into a crisis, delivering targeted interventions that are proven to prevent avoidable hospital/ER visits.
Our Technology
Waymark Signal: A predictive platform built exclusively for Medicaid and Duals
Waymark Signal is a comprehensive suite of data science models that help care teams identify patients, prioritize interventions, and optimize care delivery – all validated through peer-reviewed research.
Identify rising-risk patients early
Signal for Rising Risk: 90% accuracy predicting future avoidable hospital/ER visits
Signal for Duals: 80% accuracy predicting future avoidable hospital/ER visits
Signal for Maternity Risks: 55 days earlier identification of potential maternity and newborn complications
Prioritize your resources effectively
Signal for Quality Improvement: 85% accuracy predicting who needs proactive outreach to close HEDIS gaps
Most Likely to Benefit: Identifies which patients will respond best to intervention–driving 49% reduction in acute events compared to traditional risk-based targeting
Deliver the right intervention
Next-Best-Action Recommendations: Uses advanced machine learning to predict which intervention works best for each patient and when to deliver it–resulting in a 20% reduction in acute events
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.
Simple implementation, measurable results
Data integration
We securely connect to your claims and eligibility data
Patient identification
Waymark Signal identifies rising-risk members
Care team deployment
Local teams begin outreach and deliver interventions
Continuous reporting
We track utilization, outcomes, and ROI and report back to you
