Practices

Waymark provides free services to patients of contracted Medicaid managed care organizations. Medicaid Managed Care Organizations identify primary care practices and patients that might benefit from our program, and Waymark contacts those practices and patients who are eligible for our services.

Waymark uses proprietary data science technologies to contact patients early in their disease course, and match them with the right intervention at the right time.

According to peer-reviewed studies, these data science insights significantly improve outcomes over standard reactive care management approaches. For example, combining data on food insecurity with information about which patients are taking insulin can help reduce emergency room visits for hypoglycemia; adding information on air pollution to pharmacist registries for patients with asthma or COPD can help identify patients who need early refills during wildfire smoke exposure; and data on 911 calls for ambulatory care-sensitive conditions can help identify which transit stops to position outreach workers for proactive redirection to primary care.

What does Waymark offer to primary care practices?

Waymark offers a series of services to assist practices and their patients, at no cost to them:

Care coordination assistance

Including accompanying patients to visits to reduce no shows, transportation coordination, hospital discharge and post-incarceration medication adherence support, social service coordination, and specialist referral coordination including facilitating use of e-Consult where available and appropriate, with an emphasis on closing gaps in care and improving care quality outcomes.

Behavioral health therapy

Including cognitive behavioral therapy, behavioral activation, interpersonal therapy, and problem solving therapy provided by licensed clinical social workers and therapists providing telehealth services using a trauma-informed approach.

We cover the full spectrum of behavioral health conditions, including psychotic disorders from mild to severe.

Medication and equipment assistance

Including, with provider permission, completion of prior authorizations, assistance obtaining durable medical equipment or infusion services, titration of common chronic medications to a goal per standard guidelines (for anticoagulation, hypertension, heart failure, asthma/COPD, or diabetes), and provision of health education and adherence support by advanced practice pharmacists providing telehealth services.
Which patients are eligible?

What does a partnership with Waymark look like?

Imagine having a partner to lean on to track down patients, reduce no-shows, and handle paperwork and coordination. Or having a vetted pharmacist on hand to complete your prior authorization paperwork, instead of digging through your inbox on Saturday night.

Simply put, having Waymark serve you can be part of your plan to prevent team burnout. We’re not interested in competing with or poaching your staff members, but in increasing your workforce, so that more trained staff are available and quality scores remain high.

Waymark provides collaborative case management for mutual patients. Waymark reimburses your practice for the cost of access and use of your electronic health records, and we pay fair market value to providers for any time spent coordinating care with us.

If you’re interested in discussing network terms, give us a call at 323-592-9627 or referrals@waymarkcare.com.

What’s the evidence that this approach works?

Our model is based on three randomized controlled trials among patients receiving Medicaid.

The first trial revealed that community health workers and social workers reduced hospital readmissions and length of stay when helping patients with multiple chronic conditions, particularly after discharge.

The second trial showed greater effectiveness including reduction of initial hospitalizations when these staff members coordinated more closely with primary care practices.

The third trial revealed the benefit of data science algorithms to help identify patients in need, and match them to specific interventions delivered by a multidisciplinary team. The trial showed reductions in emergency room visits and hospitalizations that were not achieved without the benefit of the data science-driven approach.

In addition to these trials, our protocols are driven by a series of additional studies and data science work detailed in peer-reviewed publications.

Community team without integration in PCP clinic: Pennsylvania Medicaid

Covariate
Highest rating for quality (comprehensiveness)
Highest rating for quality (supportiveness of self-management)
First admission
Repeat admission
30-d Readmission
Total hospital days
No. of hospitalizations
Length of stay
Control Arm
(n = 288)
83 (28.8)
95 (33.0)
35 (12.2)
14 (40.0)
9 (25.7)
345
1.5 (0.7)
9.9 (17.5)
Intervention Arm
(n = 304)
137 (45.1)
157 (51.6)
38 (12.5)
4 (10.5)
3 (7.9)
155
1.1 (0.4)
4.1 (3.1)
Risk Difference
(95% CI)
0.12 (0.06 to 0.18)
0.12 (0.06 to 0.18)
-0.01 (-0.06 to 0.05)
-0.24 (-0.40 to -0.07)
-0.17 (-0.32 to -0.02)
NA
-0.3 (-0.6 to 0.0)
-3.1 (-6.3 to 0.2)
Health Affairs, 39(2), 207-213

With integration in PCP clinic: Tennessee Medicaid

Covariate
ED visits, annualized rate
Inpatient admissions, annualized rate
Inpatient admission days, annualized
Total medical expenditure, annualized, $
Control Arm
(n = 71)
2.79
0.73
5.87
20,823
Intervention Arm
(n = 127)
2.77
0.41
2.41
13,091
Risk Difference
(95% CI)
-0.02 (-0.51, 0.47)
-0.32 (-0.54, -0.11)
-3.46 (-4.04, -2.89)
-7,732 (-14,914, -550)
Am J Manag Care. 26(2):e57-e63

The benefits of incorporating data science: Targeting rising risk patients in California Medicaid

Covariate, change 12 months after randomization
ED visits, annualized rate
Avoidable ED visits
Inpatient admissions, annualized rate
Avoidable inpatient admissions
Control
(N = 36,550)
99.6
63
14.9
2.6
Intervention
(N = 21.422)
96.1
62
13.3
2.0
Standardized Rate
Difference (95% CI)
-4.2 (-8.8 to -0.5)
-1.7 (-5.1 to 1.7)
-1.5 (-2.8 to -0.2)
-0.7 (-1.3 to -0.2)
Ann Int Med, https://doi.org/10.7326/M22-0074

Frequently Asked Questions

1. What types of providers does Waymark partner with?

Waymark partners with primary care providers who serve patients receiving Medicaid. The provider group must be in-network with a health plan that Waymark has contracted with and identified by the health plan as eligible for Waymark’s network.

2. Who pays for the services Waymark provides?

We enter into contracts with Medicaid managed care health plans to deliver services; these contracts typically hold us responsible for part or all of the total cost of healthcare services covered by Medicaid health plans. Waymark provides our services at no cost to patients or contracted primary care physicians.

3. How do providers interact with the Waymark team?

Each practice is assigned a coordinator who serves as a key point of contact for providers. Waymark provides regular updates to providers on progress towards improving health outcomes. Waymark helps patients find an alternative provider if our clinicians or another provider is unable to deliver needed services, by providing care coordinators and community health workers that help patients find appropriate providers, make appointments, and complete referral paperwork.

4. How is Waymark different from existing Medicaid Managed Care Organization community health workers or care coordinators?

We embed with our PCP partners both in the office (physically) and with their electronic health record, if permitted an account (which we pay for). We therefore link the healthcare claims and electronic health record data, and share our documentation to ensure good communication across teams. We provide most of our services through face-to-face and in-person interactions with patients, meeting them where they are, at community sites, such as at homes, shelters, and food pantries. We also deploy proprietary technology to assist our community based teams coordinate patient care proactively rather than waiting for patients to become "high risk" or have inpatient and/or emergency department visits.

5. Is Waymark licensed?

Yes, all of our providers are licensed in the states in which we operate.

6. Does Waymark review or oversee claims payment decisions?

No, Waymark does not review or oversee any claims payment decisions.

7. What if I already have care coordinators, community health workers, social workers, and pharmacists in my clinic?

Wonderful! We seek to fill in gaps, not step on toes. Our services are not "one size fits all"; if you feel you could benefit from additional staffing, we can help fill in the gaps or reduce heavy patient loads. Additionally, many clinics who have multidisciplinary staffing still benefit from our data science--such as by obtaining lists of patients to outreach for targeted campaigns.