Background: Soaring health care costs and a rapidly aging population, with multiple comorbidities, necessitates the development of innovative strategies to deliver high-quality, value-based care.
Objective: The goal of this study is to evaluate the impact of a risk assessment system (CareSage) and targeted interventions on health care utilization.
Methods: This is a two-arm randomized controlled trial recruiting 370 participants from a pool of high-risk patients receiving care at a home health agency.