Health Plan

L.A. Cares About Asthma

Winner Blurb: 

L.A. Care Health Plan established the comprehensive disease management program LA Cares About Asthma® in 2003. L.A. Care selected asthma as a disease management focus because of the large number of members with asthma enrolled in L.A. Care and the success of programs like these in helping patients with chronic illness improve their health status over the course of the disease. LA Cares About Asthma ® is a collaborative program designed to improve member self-management through education, empowerment, monitoring and member input and communication.

On a monthly basis, LA Cares About Asthma® identifies health plan members with asthma and provides them with a variety of educational materials and tools to help them take control and manage their disease. To be inclusive to its community’s needs, the program ensures that linguistically and culturally appropriate materials are available for all potential enrollees.

LA Cares About Asthma® also partners with several community-based organizations to expand its reach and depth to serve individuals most in-need. An in-home visitation program with Long Beach Alliance for Children with Asthma in the Los Angeles South Bay area and specialist referrals with Harbor-UCLA Medical Foundation Inc., throughout Los Angeles County offered to high-risk members with asthma are just two examples of such successful partnerships.

Thanks to these efforts, LA Cares About Asthma® achieved a member satisfaction of 97.6 percent, which exceeded their 2011 goal. In particular, members reported great satisfaction with the program materials and felt the materials educated them on how to control their asthma.

Winnner Photo: 
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Pictured l-r: Johanna Aceves, Johanna Kichaven, Rachel Martinez, Joanne Wei, Melissa Diaz, Hela Mahgerefteh, Laura Linebach, Lisa Diaz, and Devaki Magee

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Centene Corporation ®, Nurtur ®, Managed Health Services

Winner Blurb: 

As an experienced, comprehensive service provider, Managed Health Services, a Centene Corporation Medicaid health plan, understands the need to customize asthma solutions for diverse populations. As a result, in 2007 Managed Health Services and sister company, Nurtur, Centene life, a health and wellness company, established a comprehensive asthma program designed to address the needs of several specific target audiences; these include persons with asthma in addition to other complex chronic conditions, as well as pregnant women and children with asthma.

Medical records, pharmacy records and claims data are scanned by predictive modeling software to identify patients that meet these criteria, who are then referred to the Asthma Team. A case manager follows up with each patient to assess their level of need and recommends an appropriate asthma intervention. Educational materials for children and adults, trigger identification training, goal-setting exercises, home visits and barrier assessments are just some of the many tools used as a part of this holistic asthma care process. The patient’s treatment plan is also updated by the Asthma Team and sent to the physician for review.

Continuous monitoring and evaluation are integral to this program, and results from 2007 to 2009 indicate an incredible 17.3 percent decrease in emergency department visits for child participants and a 9.4 percent decrease for adult participants. In addition, visits to primary physicians for children and adults were up by 11.1 percent and 16.4 percent, respectively, indicating improved preventive care.

Winnner Photo: 
Winner Photo Caption: 

Mike Flynn, Director, Office of Radiation and Indoor Air and Gina McCarthy, then Assistant Administrator, Office of Air and Radiation, U.S. EPA, present Award to Patrick Rooney, Dr. Mary Mason and Dan Cave of Managed Health Services, Centene Corporation ® and Nurtur ®

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Optima Health

Winner Blurb: 

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.

Winnner Photo: 
Winner Photo Caption: 

Elizabeth Cotsworth, then Director, Office of Radiation and Indoor Air, U.S. EPA, presents Award to Optima Health

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