Fireside Chat, Interview, Other
Scaling Medicaid Innovation with Rajaie Batniji, Sanjay Basu, and Afia Asamoah
- Afia recruited to Google in 2014 as the first lawyer supporting health tech product development, focusing on extending clinical care to underserved populations outside traditional clinical settings.
- Afia spent nine years at Google testing the thesis that technology can transform care delivery by embedding it within physician and nursing workflows.
- In 2021, Afia joined Waymark via an introduction from an a16z talent team member to co-found the company, driven by a desire to combine technological scalability with direct community engagement.
- Sanjay Rajagopal leads clinical operations at Waymark while maintaining an active primary care practice in community health centers serving mostly Medicaid and Medicare patients.
- Rajay (Co-founder/CEO) founded Waymark based on his background in healthcare payment in low-income settings and a realization during the pandemic that Medicaid, representing 20-25% of Americans, was under-resourced compared to Medicare and employer segments.
- The company operates as a Public Benefit Corporation (PBC) to legally mandate a social charter ensuring financial sustainability is balanced with a mission to improve access and outcomes for Medicaid patients.
- Waymark's 2023 real-world study, published in the New England Journal Catalyst, tracked outcomes for over 60,000 patients across two health plans in Washington State and Virginia.
- The study demonstrated a nearly 25% reduction in emergency room visits and hospitalizations compared to a control group, primarily driven by a 48% reduction in ambulatory care-sensitive hospitalizations.
- Waymark utilized a machine learning model called "Signal," which identifies "rising risk" patients with 90% accuracy (up from 30% accuracy without the tool) by analyzing condition and social risk factors rather than just historical costs.
- The intervention team, comprising community health workers, behavioral health therapists, and pharmacists, achieved a 2/3 patient goal achievement rate and improved HEDIS quality metrics by 11 percentiles.
- Cost reductions were achieved by decreasing unnecessary acute care use, while allowable spending increased in pharmacy and primary care categories to reflect better medication adherence and access.
- Waymark employs "participatory data science," where clinical staff define problems that AI then solves, automating administrative burdens like housing applications and prior authorizations to reduce provider burnout.
- The company faces scaling challenges related to "value veneers," where existing value-based contracts block new care delivery resources; Waymark is developing new contract models to coexist with traditional ACOs.
- Waymark is currently ramping up operations to partner with additional health plans and primary care systems, aiming to replicate its community-based care model which has previously only been funded by grants.
- The organization interfaces with hundreds of community organizations, including food banks and housing authorities, relying on in-person trust-building to navigate social determinants of health.