Phone Calls for Uninsured

Overseen By Rebecca Myerson, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Wisconsin, Madison

Disqualifiers: Language preference, No working phone

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

425000 Participants Needed

Trial Summary

What is the purpose of this trial?

The goal of this study is to try new outreach methods to improve access to Medicaid for those who lost Medicaid for procedural reasons. The main questions it aims to answer are: 1. How does a live phone call from a Navigator impact Medicaid enrollment among people who lost Medicaid coverage for procedural reasons? 2. What is the effectiveness of outreach using a live call rather than a pre-recorded call?

Will I have to stop taking my current medications?

The trial does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Outbound phone call for uninsured patients?

Research on telephone triage and advice lines shows that they can influence uninsured patients' healthcare actions, potentially leading to better compliance with medical advice and reduced healthcare costs. ^{1 2 3 4 5}

How does the treatment of outbound phone calls for uninsured patients differ from other treatments?

The treatment of outbound phone calls for uninsured patients is unique because it focuses on improving access to primary care by proactively reaching out to patients, which can help reduce unnecessary emergency department visits. Unlike traditional treatments that involve direct medical interventions, this approach aims to connect patients with appropriate healthcare services and support, addressing the root cause of overutilization of emergency care. ^{6 7 8 9 10}

Research Team

Rebecca Myerson, PhD

Principal Investigator

University of Wisconsin, Madison

Eligibility Criteria

This trial is for individuals who were eligible for Medicaid but lost their coverage between June 2024 and November 2025 due to procedural reasons. There are no specific exclusion criteria mentioned.

Inclusion Criteria

I am eligible for Medicaid.

I lost my Medicaid coverage between June 2024 and November 2025.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive either a live outbound call or a pre-recorded call from a Navigator to improve Medicaid enrollment

3 months

Follow-up

Participants are monitored for Medicaid enrollment success and coverage gaps

6 months

Treatment Details

Interventions

• Outbound phone call

Trial Overview The study is testing the effectiveness of live phone calls from a Navigator in helping people re-enroll in Medicaid after losing it. It compares the success rate of these calls with pre-recorded messages.

Participant Groups

Group I: Pre-recorded Outreach Experimental Treatment 1 Intervention

People in this cohort will receive a pre-recorded outbound call providing a hotline number

Group II: Live Outreach Experimental Treatment 1 Intervention

People in this cohort will receive a live outbound call from a Navigator

Group III: No outreach Active Control 1 Intervention

People in this cohort will not receive outreach of any kind

Who Is Running the Clinical Trial?

University of Wisconsin, Madison

Lead Sponsor

Trials

1,249

Recruited

3,255,000+

Covering Wisconsin

Collaborator

Trials

3

Recruited

649,000+

Findings from Research

Nonprofit hospitals significantly reduce the amount of outpatient care provided to uninsured patients when Medicare payment rates are cut, indicating a direct link between payment rates and care availability.

In contrast, for-profit hospitals increase the share of outpatient care for uninsured patients without changing the total number of uninsured discharges, highlighting differing responses to Medicare payment cuts based on hospital ownership.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Medicare Payment and Hospital Provision of Outpatient Care to the Uninsured. He, D., Mellor, JM.[2018]

A study of 710 callers to a nurse advice line found that 70% complied with the recommendations given, leading to a significant change in their healthcare actions, with many opting for lower intensity care.

This shift in patient behavior resulted in a potential annual cost savings of $322,249 for the safety net healthcare system, highlighting the effectiveness of telephone triage in managing care for uninsured and managed care populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluating patient compliance with nurse advice line recommendations and the impact on healthcare costs. Bogdan, GM., Green, JL., Swanson, D., et al.[2019]

In a study of 26 uninsured patients over a 10-month period, a free clinic visit led to significant improvements in health status and provided $6,500 worth of care.

The free clinic resulted in a substantial cost savings of $33,145 by reducing the need for emergency department visits and hospitalizations, highlighting its effectiveness in managing healthcare for low-income individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes and cost savings of free clinic care. Crump, WJ., Fricker, RS., Crump, AM., et al.[2019]

Uninsured patients were significantly more likely to undergo emergent surgeries for biliary, colorectal, and hernia operations, with odds ratios indicating a higher propensity for urgent care needs (ORs ranging from 2.43 to 3.95).

Despite the higher rates of emergent surgeries among the uninsured, patients with government insurance experienced more postoperative complications, highlighting a disparity in outcomes that suggests a need for policy changes to improve healthcare access and quality for all.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Worse outcomes among uninsured general surgery patients: does the need for an emergency operation explain these disparities? Schwartz, DA., Hui, X., Schneider, EB., et al.[2022]

Despite Medicaid expansion leading to a decrease in the uninsured rate, access to outpatient orthopedic care for Medicaid patients in Louisiana remains very limited, with only 18.3% of surveyed practices offering appointments.

Out of 93 orthopedic practices contacted, only 13.3% of orthopedic surgeons were willing to accept new Medicaid patients, and this number dropped to 7.1% when excluding those at safety-net facilities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Access to Orthopedic Care post Medicaid Expansion Through the Affordable Care Act. Marrero, CE., Igbokwe, LI., Leonardi, C.[2019]

The Project Access Dallas (PAD) program significantly reduced emergency department (ED) visits among uninsured patients, with enrollees averaging 0.93 visits compared to 1.44 for controls, indicating improved access to primary care.

Participants in the PAD program also experienced lower hospital costs, with direct costs reduced by approximately 60% and indirect costs by 50%, demonstrating the program's effectiveness in reducing healthcare expenses for uninsured individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of a community-based partnership, Project Access Dallas (PAD), on emergency department utilization and costs among the uninsured. DeHaven, M., Kitzman-Ulrich, H., Gimpel, N., et al.[2019]

A study conducted over five years with 33,602 respondents found that despite the introduction of new unscheduled care services like NHS Direct and walk-in centers, the use of traditional providers, particularly general practitioners (GPs), remained stable.

The research indicated an increase in the use of telephone help lines, but most people still preferred to seek help from GPs, family, and pharmacists, highlighting the continued reliance on traditional healthcare sources for unscheduled care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploring the effect of changes to service provision on the use of unscheduled care in England: population surveys. O'Cathain, A., Knowles, E., Munro, J., et al.[2019]

Project Access-New Haven (PA-NH) has successfully improved access to specialty care for uninsured adults, providing timely medical care with an average wait time of just 17 days for appointments.

The program has engaged over 200 volunteer specialty physicians and has already assisted 78 patients, demonstrating a coordinated-care model that encourages physician participation in caring for vulnerable populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Project Access-New Haven: improving access to specialty care for patients without insurance. Spatz, ES., Phipps, MS., Lagarde, S., et al.[2013]

Emergency physicians in Michigan face significant financial losses due to nonreimbursed care for uninsured patients, estimated at approximately $31.7 million per year based on Medicare fee schedules.

The study analyzed data from 29 hospitals covering over 1.1 million emergency department visits, revealing that uninsured patients accounted for about 11.1% of these visits, with a substantial gap between expected and actual reimbursements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Financial impact on emergency physicians for nonreimbursed care for the uninsured. Irvin, CB., Fox, JM., Pothoven, K.[2019]

In the Nordic countries, out-of-hours medical services vary significantly, with Denmark being the only country offering these services completely free of charge.

In Denmark and most of Norway, patients must first contact a physician-operated call-in service before receiving care, while house calls are infrequent in Sweden and Finland but represent about 20% of out-of-hours care in Norway and Denmark.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[On-duty medical service regulation in Norway, Sweden, Finland and Denmark]. Christensen, MB., Olesen, F.[2006]

References

1. United States pubmed.ncbi.nlm.nih.gov

Medicare Payment and Hospital Provision of Outpatient Care to the Uninsured. [2018]

2. United States pubmed.ncbi.nlm.nih.gov

Evaluating patient compliance with nurse advice line recommendations and the impact on healthcare costs. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

Outcomes and cost savings of free clinic care. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

Worse outcomes among uninsured general surgery patients: does the need for an emergency operation explain these disparities? [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Access to Orthopedic Care post Medicaid Expansion Through the Affordable Care Act. [2019]

6. England pubmed.ncbi.nlm.nih.gov

The effects of a community-based partnership, Project Access Dallas (PAD), on emergency department utilization and costs among the uninsured. [2019]

7. England pubmed.ncbi.nlm.nih.gov

Exploring the effect of changes to service provision on the use of unscheduled care in England: population surveys. [2019]

8. United States pubmed.ncbi.nlm.nih.gov

Project Access-New Haven: improving access to specialty care for patients without insurance. [2013]

9. United States pubmed.ncbi.nlm.nih.gov

Financial impact on emergency physicians for nonreimbursed care for the uninsured. [2019]

10. Sweden pubmed.ncbi.nlm.nih.gov

[On-duty medical service regulation in Norway, Sweden, Finland and Denmark]. [2006]