Caret Health: Utilization Management Case Study

In 2024, Caret Health deployed its clinical tasking platform at a large health plan in Nevada.  The health plan desired to bring diabetes and hypertension to control among its high risk patient population.

The Platform

Caret Health’s platform cohorted patients based on the following criteria:

  • Identify each patient’s technology literacy

  • Create path-of-least resistance clinical pathways for each patient

  • Optimize outreach based on each patient’s individual communication preferences

Afterwards, Caret Health launched a program that included:

  • Chronic care management

  • Remote patient monitoring (biometric monitoring devices)

  • Patient consent, enrollment, education, and outreach

  • Alerting criteria

  • Triage and escalation pathways

The clinical staff utilized Caret’s executive management and clinical tasking systems - powered by the caretEngine.

The Results

Triage and escalation pathways

The study cohort comprised 954 patients who were enrolled in the utilization management program. These patients consistently provided their vital signs via remote patient monitoring and engaged in chronic care management for 6+ months. They were also subject to alerting, triage, and escalations as appropriate.

Results

Over the course of 6 months, an observable enhancement in the management of blood pressure and glucose levels has been noted. Specifically, there has been a more than twofold decrease in the frequency of elevated vital sign submissions on a monthly basis. The decline in adherence to monthly submission was found to be statistically insignificant.

Diabetes Control

Among the entire population cohort of 954 patients in a 6-month period.

Hypertension Control

Among the entire population cohort of 954 patients in a 6-month period.

The Results

Based on claims data processed for the patient cohort so far, there has been a >35% reduction in all-cause hospitalizations and ER visits.

Detailed clinical information and process summaries are available upon request – please contact info@carethealth.com

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