Investors have been placing bets into startups that help members of low-income households on Medicaid insurance get care. A paper published Wednesday shows that its model is working.
San Francisco-based Waymark works with health plans and providers by hiring social workers and others in the local community to follow up and guide Medicaid members to the care they need, whether it’s a therapy appointment or finding housing. The company published in the New England Journal of Medicine Catalyst on Wednesday and showed the impact of its first year of serving 64,278 patients.
In 2023, the company’s approach resulted in a 22.9% drop in emergency department and hospital visits, and a 48.3% decrease in non-overnight hospital visits compared to a control group.
The results aren’t that different from other studies that have shown the benefit of managing the health of Medicaid members, co-founder and head of clinical Sanjay Basu told Endpoints News, but Waymark wanted to prove them with a larger population. And it’s the first formal and peer-reviewed study by a startup in the space to his knowledge, Basu said.
It was important for them to see whether the reduction in hospital and ER visits was really due to people getting timely care versus a general trend that happened naturally over time, he said, as some studies put out by health tech companies only show before and after results without a control group, which means the data could very much be the result of a natural phenomenon rather than proof that an intervention is actually effective.
“This space is full of claims,” he said. “It was important to have a matched control group and not sort of cheat in the statistics.”
Waymark, a public benefit corporation, last raised $42 million in October 2023 from investors including Lux Capital, CVS Health Ventures, NEA and Andreessen Horowitz. It’s currently working with Medicaid members in Virginia and Washington with plans to continue building out its algorithms to predict what’s the best way to care for each one of its members.
For example, while a text reminder might be the best way to nudge one person to get a mammogram, others may need someone to accompany them or get access to transportation so that they can travel to the clinic.
Basu said the difference between Waymark and other startups that help guide Medicaid members such as Cityblock or Reema Health is the time Waymark spent on developing its algorithm that draws upon claims data and data about the environment that people live in, which affects their health.
(This story is from our Health Tech newsletter. If you’d like to sign up, just click here.)