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