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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
4,962
Intensive outpatient care management program that includes contact from nurses and case managers to help coordinate care, detect clinical red flags, and reduce overall unplanned acute care utilization.
UCLA Health
Los Angeles, California, United States
Days alive and out of hospital (DAOH) at 120 days from 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.
Time frame: 120 days after randomization
Days alive and out of hospital (DAOH) at 30 days from 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.
Time frame: 30 days after randomization
Days alive and out of hospital (DAOH) at 90 days from 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.
Time frame: 90 days after randomization
Days alive and out of hospital (DAOH) at 10 months from 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.
Time frame: 10 months post-randomization
Total healthcare expenditures at 10 months from randomization
The sum of all healthcare expenditures (inpatient, outpatient, prescription, etc.) as determined by claims data.
Time frame: 10 months post-randomization
All-cause hospitalizations at 10 months from randomization
The total number of hospitalizations under inpatient or observation status for any cause
Time frame: 10 months post-randomization
All-cause emergency department visits at 10 months from randomization
The total number of emergency department visits that did not result in hospitalization, for any cause.
Time frame: 10 months post-randomization
All-cause mortality at 10 months from randomization
The total number of deaths from any cause
Time frame: 10 months post-randomization
Ambulator contact days
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
Time frame: 10 months post-randomization
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