New England Asthma Innovation CollaborativeOverview

Asthma Regional Council – Annual MeetingStacey Chacker, Director of the Asthma Region Council of New England, Co-

PIHeather Nelson, PhD, MPH, Senior Research Scientist, Co-PI

Annie Rushman, MSPH, Program Coordinator

October 16th, 2014

New England Asthma Innovation CollaborativeControlling Asthma, Controlling Costs

NEAIC is a project of the Asthma Regional Council of New England, a program of Health Resources in Action.

“The project (NEAIC) described is supported by Grant Number 1C1CMS331039 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.”

Health Resources in Action

NEAIC Builds on Asthma Regional Council

Working for 13 years, across New England, to improve pediatric asthma outcomes and reduce disparities

through partnerships and policy

Health Resources in Action

New England Asthma Innovation Collaborative

CHW-led Home Visiting for Children with Poorly Controlled Asthma • Improve quality of care• Improve health and quality of life outcomes• Decrease health care utilization costs • Advance sustainable payment systems

MassachusettsChildren’s Hospital BostonBoston Medical CenterBaystate Children’s Hospital Rhode IslandRI/Hasbro HospitalSt. Joseph’s Health Services Thundermist Health CenterConnecticut Middlesex Hospital Children’s Medical GroupVermontRutland Regional Medical Center

NEAIC Partners: 9 Clinical Partners

MassachusettsNeighborhood Health Plan, MABMC HealthNetHealth New EnglandMass Health (application pending)Rhode IslandNeighborhood Health Plan, RIConnecticut CT Department of Social Services/Children’s Health NetworkVermontDepartment of Vermont Health Access

NEAIC Partners: 6 Medicaid Payers

• American Lung Association of the Northeast• Boston Public Health Commission’s Community Health

Education Center• Central MA – Area Health Education Center’s Outreach

Worker Training Institute • MA Association of Community Health Workers • CDC Funded – New England State Asthma Programs

NEAIC Partners: Policy and Training

CHW Training

• CHW Core Competency - 48 hour training provided by Central MA Area Health Education Center.

• CHW Asthma Home Visiting – 24 hour training, product of MA DPH. Developed and delivered by Boston Public Health Commission

Health Resources in Action

Three to four Home Visits to:

• Assess patients’ needs and home environment

• Provide asthma self-management education

• Deliver cost-effective environmental supplies

• Improve quality and experience of care:o Client-centered, use of motivational interviewing o Promote asthma action planso Promote connections to primary care & preventiono Referrals for social serviceso Review of needs and progress

Intervention: CHW-led Home Visiting

• 1136 children

• Aged 2 – 17 years old

• Medicaid or CHIP beneficiary

• A diagnosis of asthma from an authorized clinician

• Evidence of poorly controlled asthma– Asthma-related ER visit– Observation stay– Hospitalization– Oral corticosteroids

Participants

Evaluation

Home visit / follow-up phone call data• Caregiver self-report (44Qs) • Environmental observations (36 items)

Environmental measures Asthma control Health care utilization Pediatric asthma caregiver’s quality of life

Caregiver focus group data

Claims data – Fall 2014 and December 2015

Environmental Factors

Mean Environmental Composite Score (maximum score = 6)Visit 1 2.55 Visit 3 2.03 (p=.000)Environmental Factor

Visit 1 Visit 3

Mold 35.2% 30%

Pests 58.25% 26.6%Smoke 48.9% 41.2%

Pets 29.4% 28.6%

Chemicals 73.4% 64.1%

Dust 45.1% 9.3%

N = 698 (through June 30, 2014)

Asthma Control

Asthma Control Categories

Visit 1 Visit 3Well controlled 15.6% 49.5%Not well controlled 49.1% 42.9%Poorly controlled 35.3% 7.6%

p = .000

Health Care Utilization

N = 295 V1 – V3, N = 138 V3 – 6 mos call, p < .05 except for days in the hospital and urgent care visits between V3 and 6 mos call

TIMES admitted to hospital DAYS in hospital ED visits Urgent care visits0

0.5

1

1.5

2

2.5

Health Care Utilization Pre- and Post- Intervention

Home Visit 1 Home Visit 3 (post intervention) 6 month follow-up call

Health Care Utilization

# of

tim

es, d

ays o

r visi

ts in

the

past

6

mon

ths

Asthma Action Plans & Flu Vaccines

Other CMS Self-Monitoring Measures

Measure Home Visit 1 Home Visit 3

Percentage of patients who have received an asthma action plan 59.0% 79.5%

Percentage of participants who used the asthma action plan the last time their child’s asthma got worse

50.3% 65.9%

Percentage of participants who have received the flu vaccine in the past 12 months

74.4% 80.0%

NEAIC Payer Engagement

• Claims and Encounter Data• Payer/Provider Meetings• Payer Assessment• Paying in Year Three/Four for Patients

(with cost savings)• Policy Change

Next Steps in Promoting Sustainability

• Conduct cost analysis• Payer/Provider Summit

- Share successful payment models- Communicate health outcomes and ROI

• Individual meetings with payers• Solicitations for “short-term” interim payment

structures.• Researching Social Impact Financing

Questions

• Stacey Chacker, Project Director/Co-PI schacker@hria.org

• Heather Nelson, PhD, MPH, Senior Research Scientist/Co-PI hnelson@hria.org

• Annie Rushman, MSPH, Program Coordinator arushman@hria.org

www.asthmaregionalcouncil.org

“The project described is supported by Grant Number 1C1CMS331039 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.”

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