Clinical trial NCT04415515: Standard Care Coordination Expansion Pilot
Official title: Standard Care Coordination Expansion Pilot - A Quality Improvement Study
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Superutilizers, Health Care Utilization
Keywords: Care coordination, case management, superutilizers, health care utilization
Lead sponsor: UnitedHealthcare
Sponsor class: OTHER
Collaborators: name: University of California, Los Angeles
First posted: 2020-06-04
Enrollment: 592023
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: OTHER

Brief summary: The Standard Care Coordination (SCC) solution integrates aspects of case management \& care coordination \& was designed by UnitedHealth Group for high-cost, complex, at-risk consumers to facilitate health care access and decisions that can have a dramatic impact on the quality and affordability of the consumer's health care. Currently members only receive the SCC if they are: 1) identified as high risk for readmission upon discharge from the hospital, 2) are self-referred, or 3) are directly referred to the program by their physician. The current quality improvement study was designed as a randomized controlled trial to determine if the expansion of the SCC program to commercially insured members identified via a proprietary administrative algorithms as being at high risk would significantly impact rates of acute inpatient admissions.


Eligibility criteria: Inclusion Criteria:

* UnitedHealthcare commercial Fully Insured members; all states; 18+ years old; actively enrolled in the health plan as of randomization identified via proprietary administrative algorithm as being at high risk for persistent super utilizer status.

Exclusion Criteria:

* : pregnant women, individuals prescribed medications for infertility, members with evidence of dementing disorders, members indicated as "do not contact " for program outreach, and Members in the following products and plans:

  * legacy UHC ASO groups (populations for which UHC provides administrative services only),
  * legacy Oxford health plan members (all members receive the SCC program),
  * legacy PacifiCare members,
  * legacy River Valley/NHP members, and
  * Public Sector clients
  * the PHS 2.0 intervention (a small population within Fully Insured)
  * assignment to a clinically activated Accountable Care Organization (ACO)

Primary outcomes:
measure: Total Cost
timeFrame: 24 months
measure: Acute Inpatient Admission Rate
timeFrame: 24 months
measure: Emergency Room Visit Rate
timeFrame: 24 months
measure: Diabetes-Related Complications
timeFrame: 24 months
Secondary outcomes:
measure: Risk of Acute Inpatient Admission
timeFrame: 12, 18, 24, 36, 48 months
measure: All-Cause 30-Day Readmission Risk
timeFrame: 12, 18, 24, 36, 48 months
measure: Outpatient Emergency Room Visit Rate
timeFrame: 12, 18, 24, 36, 48 months
measure: Risk of Emergency Room Visit
timeFrame: 12, 18, 24, 36, 48 months
measure: Primary Care Physician Visit Rate
timeFrame: 12, 18, 24, 36, 48 months
measure: Specialist Physician Visit Rate
timeFrame: 12, 18, 24, 36, 48 months
measure: Cardiovascular Disease
timeFrame: 12, 18, 24, 36, 48 months
measure: Diabetes-related complications (DCSI)
timeFrame: 12, 18, 24, 36, 48 months
measure: Amputations
timeFrame: 12, 18, 24, 36, 48 months
measure: Chronic Kidney Disease
timeFrame: 12, 18, 24, 36, 48 months
measure: Glycemic Control
timeFrame: 12, 18, 24, 36, 48 months
measure: Adherence to Diabetes-Related Medications
timeFrame: 12, 18, 24, 36, 48 months
measure: Adherence to Diabetes-Related Processes of Care
timeFrame: 12, 18, 24, 36, 48 months
measure: Total Plan and Member Cost
timeFrame: 12, 18, 24, 36, 48 months
measure: Diabetes Complications Count
timeFrame: 12, 18, 24, 36, 48 months
measure: Any Acute Inpatient Admission
timeFrame: 12, 18, 24, 36, 48 months
measure: Any Emergency Room Visit
timeFrame: 12, 18, 24, 36, 48 months
measure: Cerebrovascular disease/stroke
timeFrame: 12, 18, 24, 36, 48 months
measure: Peripheral vascular disease
timeFrame: 12, 18, 24, 36, 48 months
measure: Nephropathy
timeFrame: 12, 18, 24, 36, 48 months
measure: Retinopathy
timeFrame: 12, 18, 24, 36, 48 months
measure: Neuropathy
timeFrame: 12, 18, 24, 36, 48 months
measure: Metabolic complications such as ketoacidosis, hyperosmolar, or other coma
timeFrame: 12, 18, 24, 36, 48 months
Other outcomes:
Locations:
city: Minnetonka
country: United States
facility: UnitedHealthcare
state: Minnesota
Study officials:
affiliation: UnitedHealthcare
name: Anthony V Pirrello, MS
role: PRINCIPAL_INVESTIGATOR
References: