Standard Care Coordination Expansion Pilot

Description

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.

Conditions

Superutilizers, Health Care Utilization

Study Overview

Study Details

Study overview

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.

Standard Care Coordination Expansion Pilot - A Quality Improvement Study

Standard Care Coordination Expansion Pilot

Condition
Superutilizers, Health Care Utilization
Intervention / Treatment

-

Contacts and Locations

Minnetonka

UnitedHealthcare, Minnetonka, Minnesota, United States, 55343

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

For general information about clinical research, read Learn About Studies.

Eligibility 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.
  • * : 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)

Ages Eligible for Study

18 Years to

Sexes Eligible for Study

ALL

Accepts Healthy Volunteers

No

Collaborators and Investigators

UnitedHealthcare,

Anthony V Pirrello, MS, PRINCIPAL_INVESTIGATOR, UnitedHealthcare

Study Record Dates

2025-06