Standard Care Coordination Expansion Pilot

UnitedHealthcare

Status: Terminated

Conditions: Superutilizers, Health Care Utilization

Treatments: Behavioral: Community Health Worker Case Management; Behavioral: RN Standard care coordination and disease management; Behavioral: RN case management

Study type: Interventional

Funder types: Other

Identifiers

NCT04415515

UHC100023A

DP006128 (Other Grant/Funding Number)

Details and patient eligibility

About

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.

Enrollment: 592,023 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

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)

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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592,023 participants in 3 patient groups

Treatment 1

Experimental group

Description:

RN Standard care coordination and disease management + RN Case Management

Treatment:

Behavioral: RN case management

Behavioral: RN Standard care coordination and disease management

Control

Experimental group

Description:

RN Standard care coordination and disease management

Treatment:

Behavioral: RN Standard care coordination and disease management

Treatment 2

Experimental group

Description:

RN Standard care coordination and disease management + Community Health Worker Case Management

Treatment:

Behavioral: RN Standard care coordination and disease management

Behavioral: Community Health Worker Case Management