AmeriHealth Caritas, through its local affiliate, has implemented a comprehensive asthma management program to serve Medicaid recipients and their families living in southeastern Pennsylvania. Care managers and support staff apply a sustainable approach based on population health, guiding members through a continuum of care that is built on solid evidence and works within AmeriHealth Caritas’ integrated health care management system. High-risk members are identified for individual care management assessment, care planning and interventions focusing on priority areas (i.e., asthma control action plan, sick day plan, medication management, behavioral risk management and asthma self-management).
Members and network providers can participate in several unique, award-winning initiatives that support the delivery of asthma medication and supplies, asthma education, and home environmental surveys. AmeriHealth Caritas partnered with the local affiliate’s network providers to adopt unique community health worker (CHW) models in northeast Philadelphia, west Philadelphia and Chester tailored to the local demographic and fiscal environment. Trained CHWs, supervised by a medical director, cooperate with the practice- and telephone-based care management system to provide face-to-face care coordination, home health and environmental surveys, and asthma-related education for members and their families while addressing the social determinants impacting members’ health. When environmental asthma triggers are identified, the CHW may deliver “asthma home kits” (including hypoallergenic mattress and pillowcase covers) and suggest such actions as conducting mold remediation. Additional service offerings include provider-led dispensation of asthma medication and supplies and hands-on education during office visits (B.E.S.T. asthma program—Breathe Easy. Start Today.®); school-based clinic partnerships to address member care gaps in asthma medication adherence; and “edutainment” programming (Healthy Hoops®) for children with asthma and their families.
From 2013 through 2015, statistically significant improvements were observed in asthma controller medication adherence rates, acute hospitalizations and hospital readmissions. Dozens of provider practices and thousands of members have participated in these asthma-focused initiatives. This resulted in the distribution of more than 13,000 asthma medications and supplies, as well as 875 asthma home kit materials. CHWs led 327 visits and environmental surveys, and hundreds of health screenings were performed on community members attending Healthy Hoops® sessions.