This Startup Raised $45 Million To Build A Community Health Worker Brigade For Medicaid

is managed by private health insurers, who assume the risk of caring for a given group of patients. The idea here is that health insurers will be motivated to take care of patients’ problems before they spiral out of control and drive up costs. But the concept hasn’t matched up to reality yet – even though insurers are on the hook for managing the risk, the majority of Medicaid services are still billed in the old fee-for-service model.

“We've looked at every Medicaid opportunity over the course of the last five plus years, and this was the first time we pulled the trigger.”ver the past few years, venture capital investors have thrown billions of dollars at Medicare Advantage startups, the private insurers that manage the government-funded health program for Americans age 65 and over, including Devoted Health, Bright Health and Clover Health. There are currently around 25 million people in Medicare Advantage plans.

“We've looked at every Medicaid opportunity over the course of the last five plus years, and this was the first time we pulled the trigger,” says Mohamad Makhzoumi, managing general partner at NEA. “Waymark is not looking to build clinics. They're not looking to displace provider relationships. They're really looking to use the infrastructure in place today to stitch together a better member experience and a better set of clinical outcomes.

This means making community health workers salaried employees. When Waymark contracts with a Medicaid managed care organization, the company is betting this new workforce paired with software to better coordinate the patient’s overall journey and connect them with wraparound services will reduce costs.

Source: News Formal (newsformal.com)

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