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Completed

NCT Number: NCT06916247

Evaluation of AI Cost Prediction Model to Enroll Patients in Complex Care Management Program

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.

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Key information

Conditions

Chronic Disease Disease Attributes Pathologic Processes Pathological Conditions, Signs and Symptoms

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

UCLA Health

Los Angeles, California, 90095, United States

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • At least 18 years of age
  • Enrolled in a UCLA Managed Care Plan
  • Cost prediction model identifies patient as having high predicted costs over the next 12 months

Exclusion criteria

  • Currently enrolled in any UCLA care management program
  • Enrolled in any UCLA care management program in the last 12 months
  • Already has an active referral to a care management program

Treatment and study plan

Complex care management program

Behavioral

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.

Primary outcomes

  1. Days alive and out of hospital (DAOH) at 120 days from randomization

    Time frame: 120 days after 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.

Secondary outcomes

  1. Days alive and out of hospital (DAOH) at 30 days from randomization

    Time frame: 30 days after 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.

  2. Days alive and out of hospital (DAOH) at 90 days from randomization

    Time frame: 90 days after 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.

  3. Days alive and out of hospital (DAOH) at 10 months from randomization

    Time frame: 10 months post-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.

  4. Total healthcare expenditures at 10 months from randomization

    Time frame: 10 months post-randomization

    The sum of all healthcare expenditures (inpatient, outpatient, prescription, etc.) as determined by claims data.

  5. All-cause hospitalizations at 10 months from randomization

    Time frame: 10 months post-randomization

    The total number of hospitalizations under inpatient or observation status for any cause

  6. All-cause emergency department visits at 10 months from randomization

    Time frame: 10 months post-randomization

    The total number of emergency department visits that did not result in hospitalization, for any cause.

  7. All-cause mortality at 10 months from randomization

    Time frame: 10 months post-randomization

    The total number of deaths from any cause

  8. Ambulator contact days

    Time frame: 10 months post-randomization

    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

Other outcomes

  1. Cost prediction model performance over 22 months, as measured by area under the receiver operating characteristic curve

    Time frame: 12 months after the final cohort enrolls

    Observed healthcare expenditures for each month's control cohort will be measured over the subsequent 12 months after randomization (ie, 10 months of enrollment + 12 months of follow-up= 22 months), and compared to model-predicted healthcare expenditures. This analysis will only be conducted in the control group, as the intervention is designed to affect healthcare expenditures in the treatment group.

  2. Protocol fidelity over the 10 months of enrollment

    Time frame: 14 months post-randomization

    The sum of two metrics:

    • The proportion of patients randomized to the intervention who enroll in the complex care management program
    • The proportion of patients randomized to the control who do not enroll in the complex care management program.

  3. Avoidable hospitalizations

    Time frame: 10 months post-randomization

    The number of hospitalizations that could have been avoided through timely access to ambulatory care

  4. Avoidable emergency department visits

    Time frame: 10 months post-randomization

    The number of emergency department visits that could have been avoided through timely access to ambulatory care

Sponsors and collaborators

Lead sponsor

University of California, Los Angeles

Other

Registry information

Official study title

Evaluation of MA Proactive Care Program Using Cost Prediction Model With Randomized Waitlist

Important dates

Study start
2024
Primary completion
2025
Study completion
2026
First posted
Apr 8, 2025
Registry last updated
Jul 16, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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