A key element of sustainability for the program is funding. Currently LA Cares About Asthma® is funded as part of L.A. Care Health Plan’s budget. The LA Cares About Asthma® budget is assessed annually based on member growth. Funding provided to community based organizations for in-home asthma visits – including all visits, follow-up calls, and environmental management supplies and tools – is reimbursed at an established case rate.
L.A. Care members have an asthma prevalence rates consistent with asthma rates in greater Los Angeles County. After evaluating a variety of factors, such as the effectiveness of self-care, the cost of asthma services and related medication, and health care service utilization and factors affecting it, L.A. Care Health Plan established LA Cares About Asthma® in 2003. LA Cares About Asthma® is a disease management program that seeks to improve asthma outcomes, quality of care and self-management for at risk health plan members. The programs’ objectives include: improving self-management through education, empowerment, monitoring and communication; providing culturally and linguistically appropriate health education materials; and improving treatment of asthma through adoption of evidence-based clinical guidelines and provider feedback.
Ensure Mission-Program Alignment
L.A. Care is committed to promoting health and disease prevention in vulnerable and low-income populations, and the LA Cares About Asthma® program was designed to support this mission. On a monthly basis, LA Cares About Asthma® identifies members with asthma through a variety of sources, including health plan data, hospitalization census data, new member referrals, provider referrals and community referrals. Once identified, individuals with asthma are stratified by severity using claims and other data and are provided educational materials and program information. All identified members are eligible for enrollment into the program and receive a welcome packet with information and asthma health education materials covering environmental asthma triggers, tools for managing asthma and a guide for communicating with their health care provider about asthma. Staff persons ensure that educational materials are culturally and linguistically appropriate, particularly in view of the high percentage (46.2%) of Spanish speaking members within L.A. Care.
Patients with severe asthma receive the most intense interventions, such as telephonic quarterly monitoring, complex case management, in-home visitation and specialist referrals. Asthma in-home visitation programs that LA Cares About Asthma® offers to these high-risk asthma members have the strongest environmental asthma management components. The visits take place in the home and at a time of the family’s choosing, eliminating common barriers that members encounter, such as travel and childcare. During the visits, educational materials are provided and an asthma care plan is created.
The program also offers educational opportunities in a variety of settings with varying methods of delivery to ensure that members can access services that are appropriate for their needs. For example, Certified Health Education Specialists from the Health Education/Cultural and Linguistics department conduct Health in Motion – Asthma 101 classes for L.A. Cares members on a routine basis. Health in Motion is an innovative program that brings asthma education classes directly to physician offices or to accessible community locations. Class instructors administer pre- and post- tests during the class, log the educational session in the patient’s chart, and send a note to the primary care physician (PCP) to ensure continuity of care. In addition, the Regional Community Advisory
Committee (RCAC) community health promoters trained through Esperanza Community Housing Corporation taught asthma management and asthma environmental factors at a variety of locations, including parks, beauty salons, car washes and parent meetings.
Health education materials are also available by mail, online and through monthly health education classes in the community. Asthma nurses are available for consultation with all members and provide more intense quarterly monitoring for members with severe asthma.
ENGAGE YOUR COMMUNITY 'WHERE IT LIVES'
L.A. Care’s Family Resource Centers partnered with BREATHE LA, a non-profit organization that provides community asthma education, to provide free community asthma classes to its members at local resource centers. In particular, level two and three asthma patients who live near the resource centers were encouraged to attend. At the classes, asthma educators offered parents and children information on how the lungs work, asthma basics, triggers, medication utilization, peak flow meter use and what to do during an attack. Educators distributed cost free allergenic pillow cases and mattress covers, peak flow meters and medication spacers during the classes.
COLLABORATE TO BUILD CREDIBILITY
In 2010, LA Cares About Asthma® entered into an innovative partnership with Children’s Hospital of Los Angeles (CHLA) to capture asthma utilization data to help reduce avoidable ED admissions. LA Cares About Asthma® uses the data to support member and clinician education, and to encourage follow up care with primary care physicians following emergency care. Since 2010, the program has distributed reports to clinicians that include a list of their patients who have recently visited the CHLA ED for asthma care, and program nurses receive this information weekly. Nurses then follow up with new and existing patients to assess their status and make referrals, as necessary.
Evaluate Program Implementation and Impact
As of January 2012, enrollment into LA Cares About Asthma® reached 24,000. Tracking all of these patients is an important component of the LA Cares About Asthma® program. It monitors member participation across all business interactions, member satisfaction, member complains and inquiries, as well as clinical data points for impact evaluation. Reports are generated by geographic region, age of member and asthma severity level. Monthly reports, including new members, current members and stratification changes are generated to facilitate member interactions as well.
Using the Healthcare Effectiveness Data and Information Set (HEDIS), LA Cares About Asthma® tracks appropriate medication use. Performance on this measure has improved to 84.58% post intervention in 2011. The program also reported member satisfaction in 2011 to be 97.6%. LA Cares About Asthma® was awarded a Certification for Savings Measurement Validity by the Disease Management Purchasing Consortium Advisory Council for improving members’ asthma management while also lowering healthcare utilization costs.
In addition, LA Cares About Asthma® completes an annual evaluation to enhance the program and target asthma members most in need of intensive asthma management. Findings from these evaluations have resulted in program improvements, such as revising health education materials to reflect the most current health information and meeting readability requirements for the member population. Planned improvements include adding more educational phone consults and distribution of asthma member reports to onsite provider outreach visits.