Asthma Management

and the Allergist: Better Outcomes

at Lower Cost

Asthma Management

and the Allergist: Better Outcomes

at Lower Cost

Asthma Patients Cared for by Allergists Have:Asthma Patients Cared for by Allergists Have:

•Fewer emergency care visits

•Fewer hospitalizations

•Reduced length of hospital stays

•Fewer emergency care visits

•Fewer hospitalizations

•Reduced length of hospital stays

Asthma Patients Cared for by Allergists Have:Asthma Patients Cared for by Allergists Have:

•Fewer sick care office visits•Fewer days missed –

school and work

•Fewer sick care office visits•Fewer days missed –

school and workIncreased productivity in work and personal lives

Increased productivity in work and personal lives

Fewer sick days =

Fewer sick days =

Asthma Patients Cared for by Allergists Have:Asthma Patients Cared for by Allergists Have:

•Greater satisfaction with their care

• Improved quality of life

•Better overall outcomes that lower costs

•Greater satisfaction with their care

• Improved quality of life

•Better overall outcomes that lower costs

Asthma in the United StatesAsthma in the United States• 22 million Americans

• 6.5 million children

• 14.7 million physician visits

• 1.8 million ER visits

• 497,000 hospitalizations

• 22 million Americans

• 6.5 million children

• 14.7 million physician visits

• 1.8 million ER visits

• 497,000 hospitalizations

Direct and IndirectCosts of Asthma CareDirect and IndirectCosts of Asthma CareDirect Medical Costs Hospital Care: Inpatient and ER Physician Services Pharmaceuticals

$4.7 B$3.8 B$6.2 B

Indirect Medical Costs Decreased worker productivity (lost work and school days)

$5.0 B

Total Direct and Indirect Costs

$19.7 B

Setting Standards of CareSetting Standards of Care

According to Guidelines, people with asthma should expect:

•No or few asthma symptoms

•Prevention of all or most asthma attacks

•Participation in all activities

•No ER visits or hospital stays

•Less need for quick-relief meds

•No or few side effects from asthma meds

According to Guidelines, people with asthma should expect:

•No or few asthma symptoms

•Prevention of all or most asthma attacks

•Participation in all activities

•No ER visits or hospital stays

•Less need for quick-relief meds

•No or few side effects from asthma meds

Compliance with Guidelines is PoorCompliance with Guidelines is Poor

One multicenter study of 4,000 patients found:

•83% had uncontrolled asthma

•16% had inconsistent control

•1.3% were controlled

One multicenter study of 4,000 patients found:

•83% had uncontrolled asthma

•16% had inconsistent control

•1.3% were controlled

Compliance with Guidelines is PoorCompliance with Guidelines is Poor

Compliance with Guidelines is PoorCompliance with Guidelines is Poor

Asthma uncontrolled in 85% of inner-city students with asthma

•50% had been treated in ER at least twice in previous two years

•52% often had to limit activities

•29% had nighttime symptoms once or more per week

•17% missed five or more days of school per year because of asthma

Asthma uncontrolled in 85% of inner-city students with asthma

•50% had been treated in ER at least twice in previous two years

•52% often had to limit activities

•29% had nighttime symptoms once or more per week

•17% missed five or more days of school per year because of asthma

Compliance with Guidelines is PoorCompliance with Guidelines is Poor

Analysis of 24,000 Medicaid patients found non-adherence to NIH Guidelines :

•Fewer than 40% received rescue medication

•Fewer than 10% were regular users of inhaled corticosteroids

Analysis of 24,000 Medicaid patients found non-adherence to NIH Guidelines :

•Fewer than 40% received rescue medication

•Fewer than 10% were regular users of inhaled corticosteroids

When to Refer to An AllergistWhen to Refer to An AllergistPatients should be referred to a specialist if they:

•Have symptoms every day and often at night

•Have had life-threatening attack

•Do not meet treatment goals in 3-6 months

•Have unusual/hard-to-diagnose symptoms

•Have co-existing conditions

•Need additional tests

•Need more help and instruction

Patients should be referred to a specialist if they:

•Have symptoms every day and often at night

•Have had life-threatening attack

•Do not meet treatment goals in 3-6 months

•Have unusual/hard-to-diagnose symptoms

•Have co-existing conditions

•Need additional tests

•Need more help and instruction

When to Refer to An AllergistWhen to Refer to An AllergistPatients should be referred to a specialist if they:

•Might be helped by allergy shots

•Need oral or high-dose inhaled corticosteroids

•Use oral corticosteroids 2+ times/year

•Have been hospitalized for asthma

•Need help to identify asthma triggers

•Are children age 0-4 with frequent symptoms

Patients should be referred to a specialist if they:

•Might be helped by allergy shots

•Need oral or high-dose inhaled corticosteroids

•Use oral corticosteroids 2+ times/year

•Have been hospitalized for asthma

•Need help to identify asthma triggers

•Are children age 0-4 with frequent symptoms

PCP Referral Patterns Often Differ from GuidelinesPCP Referral Patterns Often Differ from Guidelines

• Survey of pediatricians and family physicians found criteria for referral did not conform to Guidelines

• Study of PCPs found those who had training in allergic diseases were more likely to refer than those who were not as educated (78% vs. 46%)

• Survey of pediatricians and family physicians found criteria for referral did not conform to Guidelines

• Study of PCPs found those who had training in allergic diseases were more likely to refer than those who were not as educated (78% vs. 46%)

Allergists and NIH GuidelinesAllergists and NIH GuidelinesIn a survey of 1,954 patients in 12 MCOs, patients cared for by allergists reported:

•Fewer hospitalizations and ER visits

•Higher ratings for quality of care

•Fewer activity restrictions

•Improved physical functioning

In a survey of 1,954 patients in 12 MCOs, patients cared for by allergists reported:

•Fewer hospitalizations and ER visits

•Higher ratings for quality of care

•Fewer activity restrictions

•Improved physical functioning

Asthma Treatment OutcomesAsthma Treatment Outcomes• Fewer hospitalizations

• Fewer ER visits and sick care office visits

• Improved patient satisfaction and QOL

• Fewer hospitalizations

• Fewer ER visits and sick care office visits

• Improved patient satisfaction and QOL

Asthma Treatment Outcomes – 497,000 Hospitalizations

Asthma Treatment Outcomes – 497,000 Hospitalizations

Asthma Treatment Outcomes – 1.8 Million ER Visits

Asthma Treatment Outcomes – 1.8 Million ER Visits• Study of 9,500+ HMO patients documented

lower risk of emergency asthma care with specialty care

• Randomized study of 2,000 children found patients seeing allergist were only 54% as likely to require ER services

• Comprehensive treatment in specialty allergy center reduced ER visits 76%

• Study of 9,500+ HMO patients documented lower risk of emergency asthma care with specialty care

• Randomized study of 2,000 children found patients seeing allergist were only 54% as likely to require ER services

• Comprehensive treatment in specialty allergy center reduced ER visits 76%

Asthma Treatment Outcomes – 14.7 Million Sick Care Visits

Asthma Treatment Outcomes – 14.7 Million Sick Care Visits

Asthma Treatment Outcomes – 10 Million Lost Work Days13 Million Lost School Days

Asthma Treatment Outcomes – 10 Million Lost Work Days13 Million Lost School Days

Asthma Treatment Outcomes – Patient Satisfaction and QOL

Asthma Treatment Outcomes – Patient Satisfaction and QOL• Patients who receive care from allergist

are more satisfied and experience improved emotional and physician well-being

• Study of 400 HMO patients saw improvements in physical function, emotion, pain relief and general health

• Patients in private practice reported improvements in ability to participate in activities, emotional well-being and asthma control

• Patients who receive care from allergist are more satisfied and experience improved emotional and physician well-being

• Study of 400 HMO patients saw improvements in physical function, emotion, pain relief and general health

• Patients in private practice reported improvements in ability to participate in activities, emotional well-being and asthma control

Asthma Treatment CostsAsthma Treatment Costs

• Studies show aggressive allergist management produces better outcomes AND reduces costs

• Specialty center experienced a 45% to 80% reduction in insurance claims

• AAFA study found 54% increase in cost of care when guidelines are not followed

• Failure to control asthma carries high price with 80% of all resources expended used by 20% of patients with uncontrolled disease

• Studies show aggressive allergist management produces better outcomes AND reduces costs

• Specialty center experienced a 45% to 80% reduction in insurance claims

• AAFA study found 54% increase in cost of care when guidelines are not followed

• Failure to control asthma carries high price with 80% of all resources expended used by 20% of patients with uncontrolled disease

Asthma Treatment Costs – $4.7 Billion in Hospitalizations

Asthma Treatment Costs – $4.7 Billion in Hospitalizations

Asthma Treatment Costs – $546 Million in ER VisitsAsthma Treatment Costs – $546 Million in ER Visits

How Allergists Improve Outcomes, Lower CostsHow Allergists Improve Outcomes, Lower Costs• Accurately diagnose disease types and

severity

• Identify external triggers including allergens and advise on avoidance

• Administer immunotherapy (allergy shots) to decrease sensitivity to allergic triggers

• Develop and implement aggressive treatment plans

• Maintain disease control

• Prevent serious consequences

• Accurately diagnose disease types and severity

• Identify external triggers including allergens and advise on avoidance

• Administer immunotherapy (allergy shots) to decrease sensitivity to allergic triggers

• Develop and implement aggressive treatment plans

• Maintain disease control

• Prevent serious consequences

Aggressive Asthma Management – The Standard of Care

Aggressive Asthma Management – The Standard of Care• Guidelines recommend early diagnosis and

aggressive treatment

• Treatment to control symptoms – initiate at onset and step down with improvement

• Significant long-term benefits and cost savings outweigh high costs of initial therapy

• Guidelines recommend early diagnosis and aggressive treatment

• Treatment to control symptoms – initiate at onset and step down with improvement

• Significant long-term benefits and cost savings outweigh high costs of initial therapy

Emerging Role of New Treatments and PreventionEmerging Role of New Treatments and Prevention• Allergists aware of latest treatment and

control strategies

o Environmental pollutant and allergens

o Self-management and trigger avoidance

o Partnerships with health care providers, families and other caregivers

o Immunotherapy specialists

o Clinical trial participants

• Allergists aware of latest treatment and control strategies

o Environmental pollutant and allergens

o Self-management and trigger avoidance

o Partnerships with health care providers, families and other caregivers

o Immunotherapy specialists

o Clinical trial participants

Specialty Care of Asthma in Health PlansSpecialty Care of Asthma in Health Plans• Asthma management a model for the

new strategy of managed care

• NCQA has made appropriate management of asthma a key indicator in evaluating the quality of health plans

• PCPs are demanding greater say in referring patients to specialists

• Asthma management a model for the new strategy of managed care

• NCQA has made appropriate management of asthma a key indicator in evaluating the quality of health plans

• PCPs are demanding greater say in referring patients to specialists

Specialty Care of Asthma in Health PlansSpecialty Care of Asthma in Health PlansACAAI provides health plan

checklist:

• Access to specialists

• Ongoing management for specialist care

• Unlimited visits

• Access to tests

• Access to medications and shots

• Management by specialist without high co-payments

ACAAI provides health plan checklist:

• Access to specialists

• Ongoing management for specialist care

• Unlimited visits

• Access to tests

• Access to medications and shots

• Management by specialist without high co-payments

Asthma Management and Asthma Management and the Allergist:the Allergist:

Better Outcomes at Better Outcomes at Lower CostLower Cost

Asthma Management and Asthma Management and the Allergist:the Allergist:

Better Outcomes at Better Outcomes at Lower CostLower Cost

Documented by an evidence-based review of the literature

For a copy of the review, including an annotated bibliography, go to:

www.acaai.org

Documented by an evidence-based review of the literature

For a copy of the review, including an annotated bibliography, go to:

www.acaai.org