IT to Support Integration of Social Determinant of Health Services to Reduce Avoidable Emergency Department Visits

NCT04125433 | Unknown DMC

• 1 other identifier: NCBHNPIC
• Study Type: interventional
• Target: 400
• Locations: 1 country
• Sites: 1

Brief Summary

Working through regional Accountable Care Organizations (ACO) the sponsor will establish a 2-year pilot project to demonstrate that early recognition and intervention in the various Social Determinant of Health (SDoH) domains can reduce avoidable Emergency Department (ED) visits by high utilizers. The regional ACO's will contract with Medicaid Managed Care Plans to assign traditional high ED utilizing members to the pilot project. Members will be offered enhanced peer facilitated care management services connecting members with available SDoH community based services. Members fitting our eligibility criteria will self-select by way of completing a pilot project consent form.

Conditions

Mental Health Issue; Substance Use Disorders

Outcome Measures

Primary Outcomes (3)

• Change in Adoption and Use of IT Platform

  Change in Number of Participating Agencies That Contribute Data to the IT System

  Months 6, 12, 18, 24

• Change in Engagement of Medicaid Member Participants with Peer Integration Care Services

  The change in acceptance by Medicaid Members of Peer Integrated Care Services

  Months 0, 3, 6, 9, 12, 15, 18, 21, 24

• Change in Total Cost of Care for Participating Members

  Change in cost trend for participating members. Pre-study vs. study period.

  Month 0, Month 24

Secondary Outcomes (1)

• Change in Emergency Room Visits by Participating Members

  Month 0, 6, 12,18,24

Study Arms (1)

Medicaid Emergency Department High Utilizers

EXPERIMENTAL

This Arm will include the following individuals * Up to 400 Adults age 18 to 65 * New York State Medicaid Managed Care Members * Have utilized emergency department services 6 or more times in a 12-month period * Have been assigned to the Pilot Project by their Medicaid Managed Care Plan

Behavioral: Peer Integrated Care Services

Interventions

Peer Integrated Care Services BEHAVIORAL

The project employs a two level intervention to include Peer Support Specialist (PSS) and Community Health Advocate (CHA). Contact and engagement with participating members will be through both direct intervention in the emergency department as well as in the community for prevention visits and follow up. Peers and Community Health Advocates will address Behavioral and Social Determinants of Health (SDoH) concerns through a coordinated intervention supported by a common IT Medicaid member tracking platform. This research project will determine the feasibility of deploying a single shared IT platform that will include referral, appointment completion, and intervention outcome data. Project staff will develop a relationship with the members improving member access and engagement with community-based services. The project will determine the impact on total cost of care through redirecting study participants to community resources rather than return visits to the emergency department.

Medicaid Emergency Department High Utilizers

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adults age 18 to 65
• New York State Medicaid Managed Care Members
• Have utilized emergency department services 6 or more times in a 12-month period
• Have been assigned to the Pilot Project by their Medicaid Managed Care Plan

You may not qualify if:

• Individuals not assigned by a Managed Care Organization meeting the above criteria

Sponsors & Collaborators

• Northern New York Rural Behavioral Health Institute: lead

Study Sites (1)

Northern New York Rural Behavioral Health Institute

Saranac Lake, New York, 12983, United States

Location

MeSH Terms

Conditions

Substance-Related Disorders

Condition Hierarchy (Ancestors)

Chemically-Induced Disorders; Mental Disorders

Study Officials

• Robert Cawley, BBA

  Northern NY Rural Behavioral Health Institute

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Barry Brogan, MAPP

CONTACT

518-891-9460; barry@behaviorhealthnet.orh

Robert Cawley, BBA

CONTACT

518-891-9460; robert@behaviorhealthnet.org

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: In this study a Medicaid Managed Care Plan will identify up to 400 plan members who have visited an emergency department greater than 6 time in a 12-month period. These individuals will receive enhanced integrated peer care services and will be tracked across health and social service venues using a single IT platform. This study will examine the impact of this intervention on total cost of care.

Study Record Dates

• First Submitted: October 10, 2019
• First Posted: October 14, 2019
• Study Start: August 1, 2020
• Primary Completion: June 30, 2022
• Study Completion: August 30, 2022
• Last Updated: October 14, 2019

Record last verified: 2019-10

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)