A Pragmatic Nationwide RCT of Coordinated Medical, Behavioral, and Social Services to Improve Care and Utilization among High-Cost, High-Need Insured Patients with Diabetes

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PROJECT SUMMARY/ABSTRACT Our UCLA team, in partnership with United Healthcare (UHC), proposes to form a cooperative agreement with the CDC to evaluate the impact of a UHC national care coordination (NCC) program with innovative care models designed to simultaneously address the medical, behavioral and social determinants of health among the most severely ill and costly commercially insured persons in the US. The NCC is a real-world care coordination program that aims to provide “whole-person care,” integrating intensive medical, behavioral and social support at a community level to address access barriers in addition to social determinants of health, including food and housing insecurity. The overall goal of the research is to employ rigorous empirical evaluation of the impact of this innovative program on the delivery, outcomes, and cost of care for adult commercial enrollees with diabetes. This proposed evaluation is unique because UHC implemented a pragmatic, randomized control trial of the NCC program in 2015 to the present. The specific aims for this project are as follows: Aim 1 will evaluate whether UHC's NCC program to reduce utilization among high-cost, high-need commercially insured beneficiaries with diabetes will lead to reduced diabetes complications. These include major cardiovascular events, fewer emergency room visits and hospitalizations, lower overall costs of care (primary endpoints), reduced amputations, slower progression of chronic kidney disease and improvements in A1c control and improvements in adherence to medications and diabetes processes of care (secondary endpoints). Aim 2 will evaluate whether the influence of the NCC on the three primary endpoints for beneficiaries with diabetes varies by race or ethnicity. Aim 3 will compare the relative effectiveness of the NCC on reducing costs of care and utilization, specific emergency room visits and hospitalizations, among beneficiaries with and without diabetes. Aim 4 is to participate in a collaborative multi- institution network designed to strengthen the research methods for evaluating natural experiments across all sites, and to advance the best analytic methods for natural experiments in the US research community. Our 15 year, highly productive collaboration with UHC makes it very likely that the proposed research analyzing this pragmatic RCT will be successful and will provide critically needed evidence about whether intensive, whole-person care management programs can reduce diabetes related complications, resource utilization, and costs for some of the most vulnerable commercially insured persons with diabetes in the US.