Health Plan

Health Care Service Corporation

Are you the primary contact for this program?: 
No
Program Contact First Name: 
Erika
Program Contact Last Name: 
Callahan
Phone: 
(312) 653-1607
Website URL: 
hcsc.com
What year was your program established?: 
2011
What community do you primarily serve?: 
White
African American
Hispanic
Native American
Other
What type of area do you serve?: 
Urban
Suburban
Rural
Low-Income
Minority
Health Care Service Corporation (HCSC), the nation’s largest customer-owned health insurer, in partnership with the American Lung Association of the Upper Midwest (ALAUM), has implemented comprehensive, community-based asthma quality improvement programs in more than 120 health care clinics in Illinois, Montana, New Mexico, Oklahoma and Texas.

The program have served an estimated 435,545 individuals across these states, including low-income, Latino, and Native American populations. The ongoing effort works directly with providers to improve the quality of care being delivered to patients with asthma, in addition to direct engagement with individuals through home environmental assessments that include asthma education and providing allergen-reducing and remediation products. The company leverages its own medical claims data to identify providers serving the highest-risk children with asthma and the ALAUM invites these clinics to take part in a year-long learning collaborative and training program based on the National Asthma Education Prevention Program developed by the National Heart, Lung, and Blood Institute. Overall, hospitalizations for children years 18 and younger have reduced by 59 percent and emergency department (ED) visits have been reduced by 54 percent. For individuals older than 18 years, results showed a 52 percent reduction in hospital stays and a 56 percent reduction in ED visits for this population. The program has also realized a positive return on investment – a savings of $2.40 per dollar spent. Not only are patients able to better manage their asthma, but significant reductions in avoidable medical utilization drives down the cost of care for all and allows the company to play a vital role in making the health care system work.   

What type of program do you have?: 

Molina Healthcare

Are you the primary contact for this program?: 
Yes
Program Contact First Name: 
Shauna
Program Contact Last Name: 
Shiflett
Phone: 
(801) 542-7917
Website URL: 
Molinahealthcare.com
What year was your program established?: 
1980
What community do you primarily serve?: 
Other
What type of area do you serve?: 
Urban
Suburban
Rural
Low-Income
Minority
Medicare, Medicaid and Marketplace - Government sponsored healthcare to low-income individuals.including kids, seniors, families and people with disabilities.
What type of program do you have?: 

AmeriHealth Caritas

Are you the primary contact for this program?: 
Yes
Program Contact First Name: 
David
Program Contact Last Name: 
Keleti, PhD
Phone: 
(215) 937 - 7357
Website URL: 
http://www.amerihealthcaritas.com/
What community do you primarily serve?: 
White
African American
Hispanic
Native American
Other
What type of area do you serve?: 
Urban

AmeriHealth Caritas, through its local affiliate, has implemented a comprehensive asthma management program to serve Medicaid recipients and their families living in southeastern Pennsylvania. Care managers and support staff apply a sustainable approach based on population health, guiding members through a continuum of care that is built on solid evidence and works within AmeriHealth Caritas’ integrated health care management system. High-risk members are identified for individual care management assessment, care planning and interventions focusing on priority areas (i.e., asthma control action plan, sick day plan, medication management, behavioral risk management and asthma self-management).

 

Members and network providers can participate in several unique, award-winning initiatives that support the delivery of asthma medication and supplies, asthma education, and home environmental surveys. AmeriHealth Caritas partnered with the local affiliate’s network providers to adopt unique community health worker (CHW) models in northeast Philadelphia, west Philadelphia and Chester tailored to the local demographic and fiscal environment. Trained CHWs, supervised by a medical director, cooperate with the practice- and telephone-based care management system to provide face-to-face care coordination, home health and environmental surveys, and asthma-related education for members and their families while addressing the social determinants impacting members’ health. When environmental asthma triggers are identified, the CHW may deliver “asthma home kits” (including hypoallergenic mattress and pillowcase covers) and suggest such actions as conducting mold remediation. Additional service offerings include provider-led dispensation of asthma medication and supplies and hands-on education during office visits (B.E.S.T. asthma program—Breathe Easy. Start Today.®); school-based clinic partnerships to address member care gaps in asthma medication adherence; and “edutainment” programming (Healthy Hoops®) for children with asthma and their families.

 

From 2013 through 2015, statistically significant improvements were observed in asthma controller medication adherence rates, acute hospitalizations and hospital readmissions. Dozens of provider practices and thousands of members have participated in these asthma-focused initiatives. This resulted in the distribution of more than 13,000 asthma medications and supplies, as well as 875 asthma home kit materials. CHWs led 327 visits and environmental surveys, and hundreds of health screenings were performed on community members attending Healthy Hoops® sessions.

What type of program do you have?: 

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