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Improving Asthma Outcomes

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Improving Asthma Outcomes. Presented by: Julie DudleyDate: May 20, 2014. Overview. About Asthma Burden in Florida National EPR-3 Asthma Guidelines Collaborating to Improve Asthma Outcomes Evidence-based s uccesses Resources . Asthma. - PowerPoint PPT Presentation
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Improving Asthma Outcomes Presented by: Julie Dudley Date: May 20, 2014
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Page 1: Improving Asthma Outcomes

Improving Asthma Outcomes

Presented by: Julie Dudley Date: May 20, 2014

Page 2: Improving Asthma Outcomes

2

Overview

About Asthma Burden in Florida National EPR-3 Asthma Guidelines Collaborating to Improve Asthma Outcomes Evidence-based successes Resources

Page 3: Improving Asthma Outcomes

3

Asthma

Asthma is a chronic condition that causes repeated episodes or attacks of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing

The prevalence of asthma is increasing among all populations in Florida and nationally – Medicaid bears a greater burden of uncontrolled asthma

Most people can control their asthma and live active, symptom-free, healthy lives

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“Asthma is something that we know we can do a better job if we really take the steps that we need to ensure that asthma’s under proper control. When a patient goes to the ED there’s almost always something we could’ve done earlier in the game.”

Dr. Stephen Cha, Chief Medical Officer, Center for Medicare and Medicaid Services

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ED Visits and Hospitalizations

The following slides will present data for cases with asthma listed as the primary diagnosis ICD-9 Code: 493

Keep in mind: There are more than twice as many cases with asthma listed as a secondary and tertiary diagnosis

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2008 2009 2010 2011 20120

30,000

60,000

90,000

120,000

80,93289,450 90,770 89,181

103,849

All Payers Medicaid

Num

ber o

f Vis

its

Figure 1. Florida Asthma ED Visits, 2008 – 2012

Source: AHCA Emergency Department Discharge Data Set6

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7

2008 2009 2010 2011 20120

10,000

20,000

30,000

40,000

50,000

Medicare Medicaid Commercial Self-Pay Other

Num

ber o

f Vis

itsFigure 2. Florida Asthma ED Visits by Payer, 2008-2012

Source: AHCA Emergency Department Discharge Data Set7

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8

0-4 5-17 18-34 35-64 65+0

50

100

150

200

172.4

98.9

59.3

36.5

13.1

Rate

per

10,

000

Figure 3. Florida Asthma ED Visit Rates per 10,000 by Age Group, 2012

Source: AHCA Emergency Department Discharge Data Set (All Payers)8

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Non-Hispanic Black

Hispanic Non-Hispanic White

Other0

50

100

150

129.4

55.4

34.1 33.5

Rate

per

10,

000

Figure 4. Florida Asthma ED Visit Rates per 10,000 by Race/Ethnicity, 2012

Source: AHCA Emergency Department Discharge Data Set (All Payers)9

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2008 2009 2010 2011 20120

10,000

20,000

30,000

40,000

28,53230,709 30,910 29,776 29,476

All Payers Medicaid

Num

ber o

f Hos

pita

lizati

ons

Figure 5. Florida Asthma Hospitalizations, 2008 – 2012

Source: AHCA Hospital Inpatient Discharge Data Set10

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11

2008 2009 2010 2011 20120

5,000

10,000

15,000

Medicare Medicaid Commercial Self-Pay Other

Num

ber o

f Hos

pita

lizati

ons

Source: AHCA Hospital Inpatient Discharge Data Set

Figure 6. Florida Asthma Hospitalizations by Payer, 2008-2012

11

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0-4 5-17 18 - 34 35 - 64 65+0

10

20

30

40

50

35.1

12.9

5.5

15.7

23.0

Rate

per

10,

000

Figure 7. Florida Asthma Hospitalization Rates per 10,000 by Age Group, 2012

Source: AHCA Hospital Inpatient Discharge Data Set (All Payers)12

Page 13: Improving Asthma Outcomes

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Non-Hispanic Black

Hispanic Non-Hispanic White

Other0

10

20

30

40

29.1

14.212.5

8.8

Rate

per

10,

000

Source: AHCA Hospital Inpatient Discharge Data Set (All Payers)

Figure 8. Florida Asthma Hospitalization Rates per 10,000 by Race/Ethnicity, 2012

13

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Figure 9. Repeat ED Visits and Hospitalizations, 2012

82%

37% of Total Visits and

Total Charges

Single Visits Repeat Visits

Source: AHCA Hospital Inpatient Discharge Data Set (All Payers)

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15

National Heart, Lung, and Blood Institute (NHLBI)Expert Panel Review-3 (EPR-3)Guidelines

The Four Evidence-Based Components of Asthma Care by Providers:

1. Assessing and Monitoring Asthma Severity and Asthma Control

2. Education for a Partnership in Care (includes Self-Management Education & providing an Asthma Action Plan)

3. Control of Environmental Factors and Co-Morbid Conditions that Affect Asthma

4. Medications

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Asthma Management in Florida

Among Floridians with asthma: Taken a course or class on how to manage asthma:

One out of 15 adults with asthma (6.6%) One out of 10 children with asthma or their

parents(10.3%)

Received an Asthma Action Plan One out of four adults with asthma (23.7%) One out of three parents of children with asthma (33.7%)

Source: Florida Adult Asthma Call Back Survey and Florida Child Health Survey

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The Asthma Paradox

According to the CDC, the continuing high burden of asthma despite the availability of evidence based strategies is attributed to:

1. Gaps in access to care2. Inconsistent clinician adherence to practice

guidelines3. Poor asthma self-management practices by people

with the disease 4. Lack of coordination between health care and

public health sectors

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Addressing the Asthma Paradox

Address from every

angle!

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Past Efforts of the FDOH Asthma Program & The Florida Asthma Coalition

Established the Florida Asthma Surveillance System

Established the Asthma-Friendly School Award

Established the Asthma Friendly Child Care Award Worked with the Florida Hospital Association to raise

awareness about best practices for asthma management from the ED and Hospital Setting

19

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Individual with

Asthma

Primary Care

Providers

Hospital & Emergency

Department

Community Partners

Parents / Caregivers /

Peers

Addressing the Asthma Paradox

Where we’ve been:Community Partners

0-5 yrs: Childcare Centers

5-18 yrs: Schools

Where we need to go…

21

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Maintain the Asthma-Friendly School & Child Care Awards

Promote provider compliance with EPR-3 Guidelines

Establish a Learning and Action Network for Florida MCOs

Facilitate local, multi-sector, collaborative QI projects

Implement a home visiting demonstration project

Proposed Efforts of the FDOH Asthma Program & The Florida Asthma Coalition

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What can MCOs do?

Educate your providers about the EPR-3 Guidelines and incentivize compliance through awards or reimbursement

Assess asthma severity Provide culturally competent self management education Provide an Asthma Action Plan Recommend measures to control exposure to allergens

and pollutants Select medication and delivery devices to meet patients’

needs and circumstances

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What can MCOs do?

Implement an Asthma PIP

Sample PIP Question: Does outreach to health care providers about the EPR-3 Guidelines (including self-management education and Asthma Action Plans) result in increased medication adherence and reduced emergency department visits and hospitalizations?

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STATE / HEALTH PLAN

PROGRAM OVERVIEW OUTCOMES

Indiana / CENTENE Corporation, Managed Health Services,and NURTUR

- Risk-stratified asthma case management

- MHS’s Asthma Team

- MHS’s Asthma Care Team delivers telephonic and in-home case management, asthma education, and environmental interventions, communication coordination with clinical care providers, and robust outcomes tracking

↓ Reduced ED visits by 17.3% for children, 9.4% for adults

↓ Reduced inpatient admissions by 28.6% for children

↑ Increased vaccination rates by 22.5% in children and 51.3% in adults

More Information: http://www.asthmacommunitynetwork.org/node/6161

High-Performing Asthma Projects

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STATE / HEALTH PLAN

PROGRAM OVERVIEW OUTCOMES

MichiganPriority Health

- Self-Management Education

- Case Management

- Review of pharmacy claims

- Provider per member per month incentive for medication compliance

- Implemented the Pacesetters initiative, a collaborative QI project with providers

↓ Emergency department visits per 1,000 Medicaid members dropped from 250 to 189 from 2002 to 2006

↓ Hospitalizations per 1,000 Medicaid members decreased from 62 to 36 from 2005 to 2006

High-Performing Asthma Projects

More Information: http://www.epa.gov/asthma/pdfs/priority_health.pdf

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Community & Partners

PROGRAM OVERVIEW OUTCOMES

New York City / Washington Heights / Inwood Neighborhood

Partners: Merck, New York Presbyterian Hospital & WIN for Asthma Program

- Community Health Workers provided the following over a 12 month period:

- Self-Management Education

- Case Management

- Home environmental assessments

- Trigger reduction strategies

- Clinical and social referrals

↑ Caregiver confidence in ability to control child’s asthma increased by 40%

↓ ED and Hospitalization visit rates decreased by more 50%

↓ Child school absenteeism decreased by 30%

High-Performing Asthma Projects

More Information: http://www.asthmacommunitynetwork.org/node/3331

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Resources

http://takingonasthma.org/AsthmaResourceGuide.pdf

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Resourceswww.AsthmaCommunityNetwork.org

• Online Network for asthma programs and organizations that sponsor them—including representatives of health plans and providers, government agencies, nonprofits, coalitions, schools and more.

• Offers real-time access to best practices and cutting-edge Internet tools to facilitate collaboration, problem solving, and learning between leaders.

• Benefits include:1. Learning from and networking with asthma programs nationwide2. Locating and teaming with mentors to assist with program activities3. Highlighting your program’s activities with your own program profile page4. Posting and finding local, regional and national events5. Receiving national asthma awards and recognition

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Resources

Your Data! Use your data to understand burden and to design your PIP! Are you capturing data that allows you to look at the quality

of asthma management? How many of your covered patients have an Asthma

Action Plan? How many are receiving appropriate pharmacotherapy? How many of your covered patients filled/refilled their

prescriptions?

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Thank you for your time!

Questions & Discussion


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