Predictors of contact and engagement in a national care coordination intervention for high-need, high-cost beneficiaries

Abstract Background High-need, high-cost (HNHC) patients often have multiple chronic medical conditions along with behavioral and social needs, making it more difficult for them to engage in care coordination interventions or programs. We examined patient characteristics associated with successful contact and intervention engagement among HNHC beneficiaries within a randomized controlled trial of a telephone-based national care coordination intervention. Methods We conducted a retrospective analysis of 2014–2022 administrative claims data from a large commercial insurer among treatment arm beneficiaries. We used multivariate linear and lasso regression models to predict the likelihood of contact and engagement among eligible HNHC patients (beneficiaries in the top 5% of healthcare cost in the prior year and projected to remain there in the following year). Predictors included age, sex, geographic region, plan type, time enrolled in plan, comorbidities, and any inpatient admissions and emergency department visits within 3 months pre-randomization. Results Among 46,483 randomized beneficiaries eligible for the intervention, 27,444 (59%) were successfully contacted. Among them, 12,954 (47%) engaged (i.e., completed ≥ 1 care coordination activity). Beneficiaries who were younger, had inpatient admissions within 3 months pre-randomization, and had a longer duration of plan enrollment were more difficult to contact and engage. Contact and engagement rates varied by comorbidities; arthritis, HIV, and osteoporosis were associated with successful contact, and arthritis, chronic obstructive pulmonary disease, and liver disease were associated with successful engagement. Living in the northeast United States, congestive heart failure, and substance abuse were associated with less successful contact. Some two-way variable-level combinations also predicted engagement, as per the lasso regression. Conclusions Recruitment and engagement of HNHC patients in a national care coordination intervention varied by patient characteristics. Tailored recruitment and engagement efforts may be warranted to better reach HNHC beneficiaries. Trial registration Our study was approved as exempt by IRB No. #20-001952, and the protocol can be accessed at ClinicalTrials.gov—NCT04415515, Registration Date: January 2020.