Expansion of care coordination for high-risk patients
Standard Care Coordination Expansion Pilot - A Quality Improvement Study
This study is testing if expanding a care program for high-risk patients can help them avoid hospital stays by providing support from nurses and community health workers.
Quick facts
| Phase | Not applicable |
|---|---|
| Study type | Interventional |
| Enrollment | 592023 (estimated) |
| Ages | 18 Years and up |
| Sex | All |
| Sponsor | UnitedHealthcare Academic / other |
| Locations | 1 site (Minnetonka, Minnesota) |
| Trial ID | NCT04415515 on ClinicalTrials.gov |
What this trial studies
This study evaluates the effectiveness of the Standard Care Coordination (SCC) program, which integrates case management and care coordination for high-cost, complex patients. It aims to expand the SCC program to commercially insured members identified as high risk for persistent superutilizer status through proprietary algorithms. The study will utilize a randomized controlled trial design to assess whether this expansion significantly reduces rates of acute inpatient admissions. Participants will receive support from registered nurses and community health workers to facilitate better health care access and decision-making.
Who should consider this trial
Good fit: Ideal candidates are UnitedHealthcare commercial members aged 18 and older identified as high risk for persistent superutilizer status.
Not a fit: Patients who are pregnant, have certain medical conditions, or are part of specific excluded health plans will not benefit from this study.
Why it matters
Potential benefit: If successful, this program could significantly improve health outcomes and reduce hospital admissions for high-risk patients.
How similar studies have performed: Previous studies have shown positive outcomes with care coordination programs for high-risk patients, indicating potential success for this approach.
Eligibility criteria
Show full inclusion / exclusion 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)
Where this trial is running
Minnetonka, Minnesota
- UnitedHealthcare — Minnetonka, Minnesota, United States (Recruiting)
Study contacts
- Principal investigator: Anthony V Pirrello, MS — UnitedHealthcare
- Study coordinator: Eileen Birmingham
- Phone: 800-842-3225
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.