Central California Asthma Collaborative’s (CCAC) Asthma Impact Model (AIM) Program is aimed at improving the lives of low-income, predominately Hispanic and African American Medi-Cal and uninsured patients suffering from asthma by reducing in-home environmental triggers, ensuring access to and proper use of asthma medications, and facilitating regular visits to health care providers. Asthma prevalence across the eight counties of the San Joaquin Valley served by CCAC reach as high as 20 percent in school-age children. The Valley’s aging housing stock and high rents are significant contributors to home environmental asthma triggers. These factors, combined with outdoor air quality that is the poorest in the nation, create a “perfect storm” for high rates of poorly controlled asthma. CCAC was established as a 501.c(3) in 2011 to develop an in-home asthma program for children residing in low-income and communities of color. Over time, CCAC has partnered with health plans to receive direct patient referrals for high-risk asthmatic patients with high health care utilization. In response to COVID-19, CCAC has adapted the AIM Program to a virtual-visit model to continue to provide participants with personalized asthma education and home remediation services. As a result of CCAC’s work, asthma-related hospitalizations decreased by 70 percent, asthma-related emergency department usage decreased by 81 percent, and asthma-related outpatient visits decreased by 53 percent. Medi-Cal claims data were used to measure net savings from reduced health care utilization. The estimated per-member savings for the participant group during the 24 months after the intervention began is $3,056. Per the cost-benefit analysis, investment in the in-home asthma management generated $3.63 in value for every $1 invested.
Established in 1954, Rady Children’s Hospital–San Diego (RCHSD) has evolved from a 59-bed hospital for child polio victims to a 524-bed pediatric medical center servicing San Diego, Imperial and southern Riverside counties. Rady Children’s Health Network (RCHN) is a Clinically Integrated Network that combines primary care, specialty care and hospital-based services. In fiscal year 2019, more than 247,000 children relied on the hospital for care. Of this number, more than 55 percent of patients had Medi-Cal or no insurance. In 2019, RCHN had an asthma prevalence of 8.6 percent, while the Centers for Disease Control and Prevention’s 2018 asthma prevalence for children 18 and younger was reported at 7.5 percent and the California Department of Public Health’s 2014 prevalence was reported at 8.1 percent. Of the asthma population seen in the emergency department, the children are primarily Latinx (65%) and African American (12%). Many of the children live in neighborhoods commonly associated with inequalities related to poverty, air quality, and other socioeconomic and cultural factors. For the past 5 years, RCHSD has implemented a Community Approach to Severe Asthma Program, an innovative initiative utilizing a community health worker (CHW) model with the goal of improving management and outcomes for children with severe childhood asthma. CHWs contact the families and perform in-home visits to conduct environmental assessments, reinforce health care provider instructions, assess asthma control, and set behavioral and environmental change goals. Because of COVID -19, the team moved the home visit program to a completely virtual format with great success. Natural cleaning kits are distributed to all participants in the program, and home remediation supplies—such as dust mite encasings for beds, HEPA filters and closed lid garbage cans—are distributed as needed. The program has seen up to a 75 percent reduction in emergency department return rates for Medi-Cal patients and those with commercial insurance. Sustainability is achieved through a variety of mixed funding sources including grants, donations and a line item in the annual RCHSD budget. RCHSD also is advocating with legislators in the state of California to drive expanded reimbursement for in-home environmental care services, specifically for Medi-Cal health plans.