Fireside Chat, Interview, Other
Scaling Medicaid Innovation with Rajaie Batniji, Sanjay Basu, and Afia Asamoah
- Afya anticipates that technology will transform care delivery by enabling workflows through direct physician and nurse collaboration, with the company aiming to test this thesis by co-building solutions and expecting peer-reviewed publications to validate that community-based models paired with such technology can bend the cost curve and improve clinical outcomes.
- The Waymark care model is expected to serve communities indefinitely, with future leadership responsible for maintaining financial sustainability alongside a social charter, while Afya plans to productize, scale, and implement an existing evidence base rather than creating new clinical models.
- Afya forecasts that the "Signal" machine learning predictive model will achieve 90% accuracy in identifying future acute care use, a significant improvement over the current 30% accuracy, while the platform intends to automate routine documentation, referrals, and scheduling to make community health workers orders of magnitude more efficient and reproducible.
- Sadek expects machine learning and AI to reduce administrative burdens on staff, allowing them to focus on patients, and plans to iterate on the platform to replicate the decision-making experience of seasoned staff for new hires regarding the order of operations for patient care.
- Rajay intends to transform Medicaid care delivery on a relatively short timeframe by building an end-to-end product that reduces unnecessary acute care use, addresses non-clinical social needs, improves outcomes, and funds operations through a value-based model.
- Rajay anticipates that Medicaid programs are under tremendous financial pressure and identifies the "rising risk" patient category as a key intervention opportunity where costs balloon without engagement compared to the current intervention cohort.
- A primary challenge for the current year is scaling the company while ensuring technology and quality consistency during the creation of a new community health worker workforce.
- Rajay plans to find partners willing to coexist with existing care management programs through new contract evolutions to navigate "value veneers" that currently block non-fee-for-service models, expecting that better communication with community organizations will change appointment dynamics compared to previous failures with faxes and inbox messages.
- Afya expects that moving toward reimbursing Community Health Worker services and pushing care outside clinic walls via telehealth will become standard, noting that in-person appointments by community health workers fundamentally improve navigation and patient understanding.
- The organization expects to continue operating within the current system to decrease costs and improve clinical outcomes, demonstrating the ability to operate effectively without new legislation or fundamental realignment of incentives, while A16C considers investing in a solution aligned with the thesis of technology-enabled care delivery.