The staff at Optima Health Plan — the managed care division of Sentara Health Care that operates in southeastern Virginia — noticed a disturbing trend: despite pharmacological advances in asthma therapy, the number of emergency room visits, hospitalization rates, and medical costs for asthma patients continued to rise. The quality of life for the approximately 8,500 asthma patients enrolled in Optima's plan was not as high as Optima's staff thought it should be and staff was committed to helping their asthma patients understand everything they could do to prevent asthma attacks. Optima's staff also knew that education and management advice were often most effective when delivered at home so they developed an innovative "Asthma Life Coach" program that sends nurses and respiratory therapists to asthma patients' homes where they work with patients and their caregivers to identify environmental triggers, such as secondhand smoke, cockroaches, dust mites, mold, and other sources that can trigger asthma attacks. Optima's staff understood that many asthma patients simply don't know that things in their homes, schools, and other environments can trigger asthma attacks and that many asthma triggers can be eliminated through simple management techniques. The Asthma Life Coach program provided an easy way for Optima's asthma patients to learn about environmental asthma triggers and how to reduce exposure to them. Optima's staff visited patients at home where they surveyed their environments, reviewed their use of medicines, and developed individualized written asthma treatment plans incorporating medical and environmental components. Optima's Asthma Life Coaches serve as coordinators helping patients take action based on disease management suggestions and physician recommendations and ensuring that patients know how to use medical and environmental controls to manage their asthma. Since instituting the Asthma Life Coach program in 1999, Optima has seen a significant decrease in the number of hospitalizations and emergency room visits for their members with asthma.