Intermountain Health Care, Inc.
ASCEND-MA is an embedded, health-services study of at-risk Medicare Advantage members attributed to Intermountain Health in Utah. Participants are quasi-randomized based on their medical-record-number parity to either AI-supported, nurse-reviewed proactive care navigation or usual care. The study will evaluate whether the program changes cumulative payor-paid healthcare spending over 12 months.
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 enro…
AI-supported proactive care navigation involves the generation of guideline-informed candidate care-navigation actions from protocol-authorized structured data, human-in-the-loop review by a nurse, and then delivery of the approved suggestion through existing care-management or clinical workflows. The nurse may accept, modify, reroute, or reject each candidate before participant outreach or care-team routing. Reassessment is planned approximately every 90 days and may change intervention delivery, but not assigned-group membership.
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