Standard Care Coordination Expansion Pilot

Standard Care Coordination Expansion Pilot - A Quality Improvement Study

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.

Study Overview

• Status: Terminated
• Conditions: Superutilizers, Health Care Utilization
• Intervention / Treatment: Behavioral: RN case management; Behavioral: RN Standard care coordination and disease management; Behavioral: Community Health Worker Case Management

• Study Type: Interventional
• Enrollment (Actual): 592023
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Minnesota
    • Minnetonka, Minnesota, United States, 55343
      • UnitedHealthcare

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

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)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Treatment 1; RN Standard care coordination and disease management + RN Case Management	Behavioral: RN case management; 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).; Behavioral: RN Standard care coordination and disease management; RN Standard care coordination and disease management
Experimental: Control; RN Standard care coordination and disease management	Behavioral: RN Standard care coordination and disease management; RN Standard care coordination and disease management
Experimental: Treatment 2; RN Standard care coordination and disease management + Community Health Worker Case Management	Behavioral: RN Standard care coordination and disease management; RN Standard care coordination and disease management; Behavioral: Community Health Worker Case Management; 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).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	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

Secondary Outcome Measures

Outcome Measure	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	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

Collaborators and Investigators

• Sponsor: UnitedHealthcare
• Collaborators: University of California, Los Angeles
• Investigators: Principal Investigator: Anthony V Pirrello, MS, UnitedHealthcare

Publications and helpful links

General Publications

• 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.

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2015
• Primary Completion (Actual): December 1, 2023
• Study Completion (Actual): December 1, 2023

Study Registration Dates

• First Submitted: January 28, 2020
• First Submitted That Met QC Criteria: June 1, 2020
• First Posted (Actual): June 4, 2020

Study Record Updates

• Last Update Posted (Actual): November 12, 2025
• Last Update Submitted That Met QC Criteria: November 10, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: Care coordination, case management, superutilizers, health care utilization
• Additional Relevant MeSH Terms: Behavior; Treatment Adherence and Compliance; Health Behavior; Patient Acceptance of Health Care; Health Services Administration; Patient Care Management; Disease Management
• Other Study ID Numbers: UHC100023A; DP006128 (Other Grant/Funding Number: CDC)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No