Evaluation of AI Cost Prediction Model to Enroll Patients in Complex Care Management Program

Not Applicable

Recruiting

• Conditions: Chronic Disease

• Registration Number: NCT06916247
• Lead Sponsor: University of California, Los Angeles

Brief Summary

Currently, UCLA Health (specifically the Office of Population Health and Accountable Care, or OPHAC) runs a complex care management program called Proactive Care (goal is to reduce care utilization by providing personalized care navigation/case management). Every month, an AI Population Risk tool runs to identify around 250 of the 480,000 or so UCLA primary care patients, and RNs contact these 250 patients to enroll in Proactive Care. Starting in December 2024, OPHAC launched a new method of enrolling UCLA's Medicare Advantage (MA) patients into Proactive Care: an AI Cost Prediction model. The idea is the same-- the top 250 highest predicted cost patients will be enrolled in Proactive Care. The investigators will evaluate this model and subsequent enrollment into the program by randomizing the waitlist of MA patients waiting to enroll in Proactive Care, thereby creating a control group. The top 500 highest predicted cost patients will be identified each month, and following a 1:1 randomization, 250 will be contacted for enrollment and the rest will be put on a wait-list control group for 10 months unless otherwise requested by their provider to be enrolled in the Proactive Care program earlier.

Detailed Description

Not available

Study Timeline

• Study Start: 2024-08-16
• Status Verified: 2025-03
• Study First Submitted: 2025-03-21
• Study First Submitted QC: 2025-03-31
• Last Update Submitted: 2025-03-31
• Study First Posted: 2025-04-08
• Last Update Posted: 2025-04-08
• Primary Completion: 2025-10-31
• Study Completion: 2026-06-30

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 5000

Inclusion Criteria

• At least 18 years of age
• Enrolled in a UCLA Managed Care Plan
• Cost prediction model identifies patient as having high predicted costs over the next 12 months

Exclusion Criteria

• Currently enrolled in any UCLA care management program
• Enrolled in any UCLA care management program in the last 12 months
• Already has an active referral to a care management program

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Days alive and out of hospital (DAOH) at 120 days from randomization	120 days after randomization	The sum of the number of days that a patient is not hospitalized under inpatient or observation status, and alive, out of a maximum of 120 days post-randomization.

Secondary Outcome Measures

Name	Time	Method
Days alive and out of hospital (DAOH) at 30 days from randomization	30 days after randomization	The sum of the number of days that a patient is not hospitalized under inpatient or observation status, and alive, out of a maximum of 30 days post-randomization.
Days alive and out of hospital (DAOH) at 90 days from randomization	90 days after randomization	The sum of the number of days that a patient is not hospitalized under inpatient or observation status, and alive, out of a maximum of 90 days post-randomization.
Days alive and out of hospital (DAOH) at 10 months from randomization	10 months post-randomization	The sum of the number of days that a patient is not hospitalized under inpatient or observation status, and alive, out of a maximum of 300 days post-randomization.
Total healthcare expenditures at 10 months from randomization	10 months post-randomization	The sum of all healthcare expenditures (inpatient, outpatient, prescription, etc.) as determined by claims data.
All-cause hospitalizations at 10 months from randomization	10 months post-randomization	The total number of hospitalizations under inpatient or observation status for any cause
All-cause emergency department visits at 10 months from randomization	10 months post-randomization	The total number of emergency department visits that did not result in hospitalization, for any cause.
All-cause mortality at 10 months from randomization	10 months post-randomization	The total number of deaths from any cause
Ambulator contact days	10 months post-randomization	The number of days a patient spends outside the home receiving health care, defined as the total number of days with a primary care or specialty care office visit, test, imaging, procedure, or treatment

Trial Locations

Locations (1)

UCLA Health; 🇺🇸 Los Angeles, California, United States