AI-Supported Care Engagement for Next-step Delivery - Medicare Advantage

An additional ancillary, separately consented consumer-experience sub-study will sample roughly 45 intervention-arm participants for surveys and interviews about the acceptability, burden, and perceived usefulness of the care-navigation workflow.

Inclusion criteria

•.Enrolled in an eligible Medicare Advantage plan and attributed to Intermountain Health in Utah.

• Continuous Medicare Advantage enrollment for at least 6 months before the index date.
• PRM Rising-Risk score (an internally derived prediction model) of at least 0.70 and Current-Risk score below 0.95 at index
• Predicted year-over-year cost increase of at least 30%.
• At least one targeted chronic condition: diabetes mellitus, heart failure, chronic obstructive pulmonary disease, chronic kidney disease, hypertension, or hyperlipidemia.

Exclusion criteria

• Hospice enrollment at index.
• End-stage renal disease requiring chronic dialysis at index.
• Active oncology treatment at index.
• Long-term institutional residence, including skilled-nursing-facility residence, at index.
• Primary language cannot be supported through patient-directed outreach and no feasible alternative care-team communication pathway is available.