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| ID | Type | Description | Link |
|---|---|---|---|
| DP006128 | Other Grant/Funding Number | CDC |
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Academic partnership between UHC and UCLA was terminated effective December 31, 2023
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| Name | Class |
|---|---|
| University of California, Los Angeles | OTHER |
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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Treatment 1 | Experimental | RN Standard care coordination and disease management + RN Case Management |
|
| Control | Experimental | RN Standard care coordination and disease management |
|
| Treatment 2 | Experimental | RN Standard care coordination and disease management + Community Health Worker Case Management |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| RN case management | Behavioral | A Registered Nurse (RN) case manager makes phone contact with the member to review medications, health risks, care gaps/barriers, & to develop a case management plan that focuses on improving medication adherence & reconciliation, condition-based measures & outcomes, addressing psycho-social needs, & intensive post-admission care transition. RNs may refer the member to social workers,specialist providers, & support programs (including to more intense case management where the primary care physician is notified that RNs may contact them to support treatment & coordinate services). |
| Measure | Description | Time Frame |
|---|---|---|
| Total Cost | Defined as total plan cost (medical and pharmacy) per member | 24 months |
| Acute Inpatient Admission Rate | Defined as acute inpatient admissions per 1,000 qualified members | 24 months |
| Emergency Room Visit Rate | Defined as the number of emergency room visits per 1,000 qualified members | 24 months |
| Diabetes-Related Complications | 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) | 24 months |
| Measure | Description | Time Frame |
|---|---|---|
| Risk of Acute Inpatient Admission | Defined as time to first acute inpatient admission | 12, 18, 24, 36, 48 months |
| All-Cause 30-Day Readmission Risk | Defined as first acute inpatient readmission for all-causes within 30 days of index acute inpatient discharge |
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Inclusion Criteria:
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:
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| Name | Affiliation | Role |
|---|---|---|
| Anthony V Pirrello, MS | UnitedHealthcare | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| UnitedHealthcare | Minnetonka | Minnesota | 55343 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42043924 | Derived | Saju R, Harwood JM, Tseng CH, Moin T, Mangione C, Duru OK, Takada S, Onufrak S. The effectiveness of care coordination on medication adherence among high-need, high-cost commercially insured beneficiaries: A randomized controlled trial. J Manag Care Spec Pharm. 2026 May;32(5):540-550. doi: 10.18553/jmcp.2026.32.5.540. | |
| 40553475 |
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| ID | Term |
|---|---|
| D010342 | Patient Acceptance of Health Care |
| ID | Term |
|---|---|
| D000074822 | Treatment Adherence and Compliance |
| D015438 | Health Behavior |
| D001519 | Behavior |
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| ID | Term |
|---|---|
| D019468 | Disease Management |
| ID | Term |
|---|---|
| D010346 | Patient Care Management |
| D006298 | Health Services Administration |
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| Community Health Worker Case Management | Behavioral | In selected UHC markets for defined time periods, members randomized to the treatment arm also received an enhanced version of the SCC that included in-home case management support from non-clinical Community Health Workers (CHW). |
|
| RN Standard care coordination and disease management | Behavioral | RN Standard care coordination and disease management |
|
| 12, 18, 24, 36, 48 months |
| Outpatient Emergency Room Visit Rate | Defined as emergency room visits per 1,000 qualified members per year | 12, 18, 24, 36, 48 months |
| Risk of Emergency Room Visit | Defined as time to first emergency room visit | 12, 18, 24, 36, 48 months |
| Primary Care Physician Visit Rate | Defined as primary care physician visits per qualified member | 12, 18, 24, 36, 48 months |
| Specialist Physician Visit Rate | Defined as specialist physician visits per qualified member | 12, 18, 24, 36, 48 months |
| Cardiovascular Disease | Defined as percentage of members with cardiovascular disease | 12, 18, 24, 36, 48 months |
| Diabetes-related complications (DCSI) | 12, 18, 24, 36, 48 months |
| Amputations | Defined as lower extremity amputations per 1,000 qualified members | 12, 18, 24, 36, 48 months |
| Chronic Kidney Disease | Defined as attenuated decline of eGFR, for members with baseline eGFR below 60mL/min | 12, 18, 24, 36, 48 months |
| Glycemic Control | Defined as number of members with A1c below 7%, below 8%, and/or above 9%, per 100 qualified members with diabetes | 12, 18, 24, 36, 48 months |
| Adherence to Diabetes-Related Medications | Defined as number of members with medication possession ratio (MPR) values of 80% or higher, per 100 qualified members with diabetes | 12, 18, 24, 36, 48 months |
| Adherence to Diabetes-Related Processes of Care | Defined as rates of microalbuminuria screening, retinal/eye exams, A1c test frequency, LDL test frequency, Statin use, ACE/ARB use | 12, 18, 24, 36, 48 months |
| Total Plan and Member Cost | Defined as total (plan+member) cost per member | 12, 18, 24, 36, 48 months |
| Diabetes Complications Count | 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]). | 12, 18, 24, 36, 48 months |
| Any Acute Inpatient Admission | Defined as the number of members with any Acute Inpatient Admission per 1,000 qualified members | 12, 18, 24, 36, 48 months |
| Any Emergency Room Visit | Defined as the number of members with any emergency room visit per 1,000 qualified members | 12, 18, 24, 36, 48 months |
| Cerebrovascular disease/stroke | Defined as percentage of members with Cerebrovascular disease/stroke | 12, 18, 24, 36, 48 months |
| Peripheral vascular disease | Defined as percentage of members with Peripheral vascular disease | 12, 18, 24, 36, 48 months |
| Nephropathy | Defined as percentage of members with Nephropathy | 12, 18, 24, 36, 48 months |
| Retinopathy | Defined as percentage of members with Retinopathy | 12, 18, 24, 36, 48 months |
| Neuropathy | Defined as percentage of members with Neuropathy | 12, 18, 24, 36, 48 months |
| Metabolic complications such as ketoacidosis, hyperosmolar, or other coma | Defined as percentage of members with metabolic complications | 12, 18, 24, 36, 48 months |
| Duru OK, Harwood J, Moin T, Takada S, Tseng CH, Saju R, Lee E, Fatehpuria A, Mangione CM. Care Coordination for High-Need, High-Cost Commercially Insured Patients: A Randomized Clinical Trial. JAMA Netw Open. 2025 Jun 2;8(6):e2511804. doi: 10.1001/jamanetworkopen.2025.11804. |