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 [email protected]
• Heather Nelson, PhD, MPH, Senior Research Scientist/Co-PI [email protected]
• Annie Rushman, MSPH, Program Coordinator [email protected]
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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