Improving Asthma Outcomes
Presented by: Julie Dudley Date: May 20, 2014
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Overview
About Asthma Burden in Florida National EPR-3 Asthma Guidelines Collaborating to Improve Asthma Outcomes Evidence-based successes Resources
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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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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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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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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
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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
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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
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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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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
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Florida Asthma CoalitionHospital Partners
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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…
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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://www.cdc.gov/asthma/pdfs/Asthma_Reimbursement_Report.pdf
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Resources
http://www.sophe.org/EHEP/Investing%20in%20Best%20Practice%20for%20Asthma.pdf
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Resources
http://www.epa.gov/asthma/pdfs/snapshot_060111.pdf
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Resources
http://takingonasthma.org/AsthmaResourceGuide.pdf
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Resources
www.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