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

University of California, Los Angeles (UCLA)

Status: Enrolling

Conditions: Chronic Disease

Treatments: Behavioral: Complex care management program

Study type: Interventional

Funder types: Other

Identifiers

NCT06916247

IRB-24-0849

Details and patient eligibility

About

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.

Enrollment: 5,000 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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5,000 participants in 2 patient groups

Complex Care Management

Active Comparator group

Description:

Patients randomized to be contacted for enrollment into the complex care management program called ProActive Care.

Treatment:

Behavioral: Complex care management program

Care as usual

No Intervention group

Description:

Patient randomized to be put on a waitlist for being contacted for enrollment into ProActive Care (ie, not enrolled in ProActive Care).