Standard Care Coordination Expansion Pilot
- Conditions
- Superutilizers, Health Care Utilization
- Interventions
- Behavioral: RN case managementBehavioral: Community Health Worker Case ManagementBehavioral: RN Standard care coordination and disease management
- Registration Number
- NCT04415515
- Lead Sponsor
- UnitedHealthcare
- 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.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 592023
- 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.
-
: 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)
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Treatment 1 RN case management RN Standard care coordination and disease management + RN Case Management Treatment 1 RN Standard care coordination and disease management RN Standard care coordination and disease management + RN Case Management Treatment 2 Community Health Worker Case Management RN Standard care coordination and disease management + Community Health Worker Case Management Treatment 2 RN Standard care coordination and disease management RN Standard care coordination and disease management + Community Health Worker Case Management Control RN Standard care coordination and disease management RN Standard care coordination and disease management
- Primary Outcome Measures
Name Time Method Total Cost 24 months Defined as total plan cost (medical and pharmacy) per member
Acute Inpatient Admission Rate 24 months Defined as acute inpatient admissions per 1,000 qualified members
Emergency Room Visit Rate 24 months Defined as the number of emergency room visits per 1,000 qualified members
Diabetes-Related Complications 24 months Defined as the Diabetes Complications Severity Index (DCSI) composite score. The composite DCSI score ranges between 0 to 13 (sum of scores from 7 diabetes complication categories \[cardiovascular disease, cerebrovascular disease/stroke, peripheral vascular disease, nephropathy, retinopathy, neuropathy, and metabolic complications such as ketoacidosis, hyperosmolar, or other coma\] which are each scored from 0 to 2 \[0=no complication, 1=non-severe complication, 2=severe complication\], except for neuropathy which is scored from 0 to 1)
- Secondary Outcome Measures
Name Time Method Nephropathy 12, 18, 24, 36, 48 months Defined as percentage of members with Nephropathy
Outpatient Emergency Room Visit Rate 12, 18, 24, 36, 48 months Defined as emergency room visits per 1,000 qualified members per year
Specialist Physician Visit Rate 12, 18, 24, 36, 48 months Defined as specialist physician visits per qualified member
Risk of Acute Inpatient Admission 12, 18, 24, 36, 48 months Defined as time to first acute inpatient admission
Risk of Emergency Room Visit 12, 18, 24, 36, 48 months Defined as time to first emergency room visit
Cardiovascular Disease 12, 18, 24, 36, 48 months Defined as percentage of members with cardiovascular disease
Diabetes-related complications (DCSI) 12, 18, 24, 36, 48 months Adherence to Diabetes-Related Processes of Care 12, 18, 24, 36, 48 months Defined as rates of microalbuminuria screening, retinal/eye exams, A1c test frequency, LDL test frequency, Statin use, ACE/ARB use
Total Plan and Member Cost 12, 18, 24, 36, 48 months Defined as total (plan+member) cost per member
Any Acute Inpatient Admission 12, 18, 24, 36, 48 months Defined as the number of members with any Acute Inpatient Admission per 1,000 qualified members
Metabolic complications such as ketoacidosis, hyperosmolar, or other coma 12, 18, 24, 36, 48 months Defined as percentage of members with metabolic complications
Amputations 12, 18, 24, 36, 48 months Defined as lower extremity amputations per 1,000 qualified members
Glycemic Control 12, 18, 24, 36, 48 months Defined as number of members with A1c below 7%, below 8%, and/or above 9%, per 100 qualified members with diabetes
Any Emergency Room Visit 12, 18, 24, 36, 48 months Defined as the number of members with any emergency room visit per 1,000 qualified members
Cerebrovascular disease/stroke 12, 18, 24, 36, 48 months Defined as percentage of members with Cerebrovascular disease/stroke
Retinopathy 12, 18, 24, 36, 48 months Defined as percentage of members with Retinopathy
Neuropathy 12, 18, 24, 36, 48 months Defined as percentage of members with Neuropathy
All-Cause 30-Day Readmission Risk 12, 18, 24, 36, 48 months Defined as first acute inpatient readmission for all-causes within 30 days of index acute inpatient discharge
Primary Care Physician Visit Rate 12, 18, 24, 36, 48 months Defined as primary care physician visits per qualified member
Chronic Kidney Disease 12, 18, 24, 36, 48 months Defined as attenuated decline of eGFR, for members with baseline eGFR below 60mL/min
Adherence to Diabetes-Related Medications 12, 18, 24, 36, 48 months Defined as number of members with medication possession ratio (MPR) values of 80% or higher, per 100 qualified members with diabetes
Diabetes Complications Count 12, 18, 24, 36, 48 months Defined as the Diabetes Complications Severity Index (DCSI) count. The DCSI count ranges from 0 to 7 (count of the 7 diabetes complication categories \[cardiovascular disease, cerebrovascular disease/stroke, peripheral vascular disease, nephropathy, retinopathy, neuropathy, and metabolic complications such as ketoacidosis, hyperosmolar, or other coma\]).
Peripheral vascular disease 12, 18, 24, 36, 48 months Defined as percentage of members with Peripheral vascular disease
Trial Locations
- Locations (1)
UnitedHealthcare
🇺🇸Minnetonka, Minnesota, United States