2015

The Green & Healthy Homes Initiative (GHHI) serves low-income families living in Baltimore City, Maryland, who face a higher than average rate of asthma prevalence, hospitalizations, emergency visits and deaths compared with other Maryland regions and the nation as a whole. Working through a coalition of 35 federal, state, local, nonprofit, university and philanthropic partners, GHHI uses a transformative asthma management model that combines in-home family asthma education; a comprehensive health, safety and home energy audit; and root cause remediation. Since 2000, GHHI Baltimore has completed housing interventions in 1,118 homes of patients diagnosed with asthma in Baltimore City.

GHHI began in Baltimore, Maryland, as the Coalition to End Childhood Lead Poisoning but the organization’s community-based workers understood that other home-based environmental health hazards—especially asthma triggers—required attention. In 2000, with seed money from the Annie E. Casey Foundation, the Coalition established one of the first Healthy Homes programs in the nation. In 2013, the Coalition changed its name to GHHI to reflect its broadened scope of services and mission impact, with Baltimore as its flagship site.

GHHI’s highly successful integrated approach served as the model for Baltimore City’s Office of Green, Healthy and Sustainable Housing. Unlike other Healthy Homes programs, GHHI integrates “green” weatherization and energy efficiency work with traditional healthy homes services, such as integrated pest management and mold removal, to achieve maximum health benefits for the target population. GHHI Baltimore also builds the community’s human capital by deploying its own team of contractors to conduct multi-faceted home interventions and by hiring residents of at-risk Baltimore communities who receive training and accreditation to conduct interventions. Through its integrated approach, which involves an intake stream from established referral sources and long-term partners, GHHI annually serves 100–200 children diagnosed with asthma.

The Le Bonheur Children’s Hospital’s CHAMP Program (Changing High-Risk Asthma in Memphis through Partnership) is a collaborative that serves children ages 2–18 in Memphis, Shelby County, Tennessee, who are identified as having high-risk asthma.  This program is funded by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services*, as a round 1 innovations project.

Of CHAMP’s patients, 95 percent are African American children who suffer from poorly controlled asthma that results in preventable hospital and emergency room encounters, missed school days, and diminished quality of life. They primarily live in rental properties characterized by environmental hazards—such as mold, mildew and cockroaches—that exacerbate asthma episodes, and many of them move frequently or spend significant periods of time in more than one residence over the course of a week or month. Overall, asthma affects up to 13.5 percent of children in Memphis; in 2010, almost 4,000 children were seen in emergency rooms in Shelby County for asthma-related problems. Pediatric asthma hospitalizations cost the Tennessee Medicaid system (TennCare) $2.1 million in avoidable hospitalizations and an additional $2.6 million for emergency department visits.

To address factors that result in asthma care that is fragmented and typically not well managed, CHAMP created an Asthma Registry, which includes extensive data from enrollees’ electronic medical records. The program deploys a team of sub-specialist medical providers, as well as community-based staff members, who work to educate families and address barriers to self-management. CHAMP’s various program components work in an integrated fashion to achieve its ambitious goals, which include seeking to reduce asthma deaths among its target population to zero by June 15, 2015, and lowering overall health care costs for children served by more than $4 million by June 30, 2015. As of the quarter ending December 31, 2014, CHAMP’s 464 enrollees have seen, among other gains, a 40-percent reduction in the percentage of children hospitalized each quarter for asthma-related diagnoses. Data through December 31, 2014, indicate a 52-percent reduction in cost of care per child per year, in comparison to the baseline cost prior to CHAMP enrollment. CHAMP shows great promise for meeting and exceeding its stated goals.

*CHAMP is supported by Grant number 1C1CMS331046-01-00 from the Department of Health and Human Services, Centers for Medicare and Medicaid Services.  The contents of this document are solely the responsibility of Le Bonheur Children’s Hospital, Division of Community Health and Well Being and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.