Waymark Signal Achieves 85% Accuracy in Predicting Medicaid Care Gaps, Study in npj Digital Medicine Shows

Associated Press

2 days ago

Peer-reviewed research demonstrates dramatic improvement in identifying and closing quality gaps for Medicaid patients, outperforming current methods by 35 percentage points
SAN FRANCISCO, CALIFORNIA / ACCESS Newswire / August 4, 2025 / Healthcare organizations nationwide face a critical challenge: how to effectively deploy limited staff to close quality measure gaps among patients receiving Medicaid. With health plans facing financial penalties for poor quality performance and providers under value-based contracts unable to reach vulnerable patients through traditional methods, many resort to ineffective and untargeted mass outreach campaigns - helping fewer than 8% of eligible patients.
A new peer-reviewed study from Waymark published in Nature's npj Digital Medicine offers a solution. Signal for Quality Improvement, the company's newest predictive analytics technology, identifies with 85% accuracy which Medicaid patients will benefit most from proactive community-based outreach-enabling care teams to prioritize and target patients who need additional support to close gaps in care and improve quality performance.
'Healthcare organizations know that community-based outreach works, but they've been unable to identify and prioritize who will benefit most from these limited resources,' said Dr. Sadiq Y. Patel, lead author of the study and Vice President of Data Science and Artificial Intelligence (AI) for Waymark. 'The challenge isn't just identifying patients with open gaps-it's distinguishing between those who will close gaps on their own versus those who need proactive outreach and support. By incorporating social determinants of health data alongside clinical factors, Signal for Quality Improvement enables care teams to more efficiently prioritize outreach to the patients who need it most.'
The study analyzed data from over 14 million Medicaid beneficiaries across 25 states and Washington D.C.. Researchers found that Signal for Quality Improvement achieved 85% accuracy in predicting which patients would miss nine nationally adopted quality measures, as defined by the Healthcare Effectiveness Data and Information Set (HEDIS) developed by the National Committee for Quality Assurance (NCQA). Model simulations showed that using this predictive prioritization to guide outreach would result in a 35 percentage point improvement in helping patients close care gaps compared to traditional, non-predictive methods used by most healthcare organizations, such as alphabetical calling or birthday reminders.
Signal for Quality Improvement is the latest addition to the company's proprietary Waymark SignalTM platform, which also includes Signal for Rising Risk. A 2024 peer-reviewed study published in Nature Scientific Reports demonstrated that Signal for Rising Risk predicts patients at risk for future avoidable emergency department (ED) and hospital visits with greater than 90% accuracy. Signal for Quality Improvement builds on this technology by enabling health plans and providers to identify which patients will most benefit from proactive outreach to close quality gaps and improve HEDIS performance.
'Healthcare organizations face significant financial penalties when quality metrics are poor, but current outreach methods are remarkably inefficient,' said Dr. Sanjay Basu, Co-founder and Head of Clinical at Waymark and senior author of the study. 'Signal for Quality Improvement represents a fundamental shift toward evidence-based patient outreach that can improve both health outcomes and resource allocation for the 80 million Americans covered by Medicaid.'
The study found that incorporating social determinants of health data not only improved predictive accuracy, but also eliminated pre-existing racial disparities in prediction performance between Black and White patients across four quality measures. 'This paper addresses a persistent challenge in healthcare: efficiently reaching patients who need care most,' said Dr. Michael L. Barnett, study co-author and Professor at Brown School of Public Health. 'The combination of high predictive accuracy with a thoughtful approach that minimized racial bias offers a pathway toward more equitable healthcare delivery.'
Waymark works with health plans and primary care providers to deliver community-based early interventions to patients receiving Medicaid. The company's local care teams use the Waymark Signal platform to identify and support patients who are at risk of avoidable ED and hospital visits or have open gaps in care. A 2024 peer-reviewed study published in NEJM Catalyst found that Waymark reduced all-cause hospital and ED visits by 22.5% for rising risk patients, and improved care quality by an average of 11.8 absolute percentage points across seven quality measures in its first year of service.
The full article titled " Predicting Quality Measure Completion Among 14 Million Low-Income Patients Enrolled in Medicaid " was published in npj Digital Medicine, a peer-reviewed journal published by Nature. The authors were Sadiq Y. Patel MSW PhD of Waymark, Michael L. Barnett MD of Brown School of Public Health, and Sanjay Basu MD PhD of Waymark.
About Waymark
Waymark is a public benefit company dedicated to improving access and quality of care for people receiving Medicaid. We partner with health plans and primary care providers-including health systems, federally qualified health centers (FQHCs), and independent practices-to provide community-based care to people enrolled in Medicaid. Our local teams of community health workers, pharmacists, therapists and care coordinators use proprietary data science technologies to deliver early interventions to hard-to-reach patient populations. Waymark's peer-reviewed research has been published in leading journals including the New England Journal of Medicine (NEJM) Catalyst, Nature Scientific Reports, and Journal of the American Medical Association (JAMA)-demonstrating measurable improvements in health outcomes and cost savings for Medicaid populations. For more information, visit www.waymarkcare.com.
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Iman Rahim
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SOURCE: Waymark
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