Blue Cross of California, State Sponsored Business Unit (SSB), has designed a Comprehensive Asthma Intervention Program (CAIP) to improve care for California Medi-Cal and Healthy Families members with asthma. Because standard asthma management programs seldom address the needs of all members in a culturally and linguistically diverse, low-income population, like the Blue Cross SSB membership, who often face environmental health challenges, CAIP encompasses innovative partnerships with members, providers, academic institutions, public health organizations, and communities, to maximize opportunities for improved asthma outcomes. CAIP includes individual member outreach; resources and incentives for physicians and pharmacists to encourage improved asthma care; Plan/Practice Improvement Project (PPIP), a collaboration modeled after the Institute for Healthcare Improvement's Breakthrough Series, to enhance asthma chronic care through practice-specific redesign; Valley Air Quality Project, a county-specific partnership to improve community responses to environmental air pollution affecting the respiratory health of Fresno County, where asthma prevalence is high.
Priority Health is a non-profit health plan that serves more than 19,000 people with asthma in 43 Michigan counties. In the late 1990s, Priority Health recognized the need for home-based asthma care that includes environmental trigger management. To deliver effective home-based care, Priority Health formed a first-of-its-kind partnership with the Asthma Network of West Michigan (ANWM). Priority Health uses ANWM's case managers and social workers to increase its ability to effectively assess and educate its members. ANWM provides home-based education; home environmental assessments; and resources to reduce exposures to environmental asthma triggers. Today, all of the plan's members with moderate or high risk asthma within ANWM's service area receive intensive case management that integrates patient education, home-based environmental interventions, and evidence-based clinical care. Priority Health also reimburses ANWM for meeting with providers to develop individualized care plans. These plans are the cornerstone for determining appropriate interventions, monitoring, and follow-up. Priority Health provides incentives to their providers to ensure that members use asthma medications appropriately and to implement the Planned Care Model for asthma. The results of these programs include improved medication use and significant reduction in the number of emergency room visits and hospitalizations for asthma. Utilization data show that emergency room visits were reduced from 72 visits per thousand patients in 2002 to 40 in 2006 for commercial members, and from 250 to 189 for Medicaid members. Savings over time for members are estimated at $1.7 million, and the long-term return on investment (ROI) for Priority Health is 2.1:1.
The Monroe Plan for Medical Care is a managed care organization, located in the Rochester, New York area. The Monroe Plan covers 5,633 children with asthma in Monroe County and 12 neighboring rural counties. With a high asthma burden among children in the area, the Monroe Plan saw trends in pediatric asthma and noticed high admission rates that disproportionately affected minorities. Monroe Plan partnered with ViaHealth, a health care delivery system, to launch a program to shift asthma care toward improved patient self-management. The program now covers all of the plan’s members with moderate to severe pediatric asthma and includes assistance to providers in creating asthma action plans and comprehensive provider and member education. Home assessments are conducted by bilingual asthma outreach workers to identify and reduce environmental triggers. As a result of these interventions, ER visits decreased from 1.1 visits per person to .95 visits per person over the first three years of the program. Inpatient admissions decreased from 98.3 admissions per thousand to 84.15 per thousand in the first three years of the program.