Presented by: Julie DudleyDate: May 20, 2014

Overview 2  About Asthma  Burden in Florida  National EPR-3 Asthma Guidelines  Collaborating to Improve Asthma Outcomes  Evidence-based successes  Resources

Asthma 3  Asthma is a chronic condition that causes repeated episodes or attacks of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing  The prevalence of asthma is increasing among all populations in Florida and nationally – Medicaid bears a greater burden of uncontrolled asthma  Most people can control their asthma and live active, symptom-free, healthy lives

4  “Asthma is something that we know we can do a better job if we really take the steps that we need to ensure that asthma’s under proper control. When a patient goes to the ED there’s almost always something we could’ve done earlier in the game.”  Dr. Stephen Cha, Chief Medical Officer, Center for Medicare and Medicaid Services

ED Visits and Hospitalizations 5  The following slides will present data for cases with asthma listed as the primary diagnosis  ICD-9 Code: 493  Keep in mind: There are more than twice as many cases with asthma listed as a secondary and tertiary diagnosis

6 Figure 1. Florida Asthma ED Visits, 2008 – 2012 Source: AHCA Emergency Department Discharge Data Set 6

7 Figure 2. Florida Asthma ED Visits by Payer, Source: AHCA Emergency Department Discharge Data Set 7

8 Figure 3. Florida Asthma ED Visit Rates per 10,000 by Age Group, 2012 Source: AHCA Emergency Department Discharge Data Set (All Payers) 8

9 Figure 4. Florida Asthma ED Visit Rates per 10,000 by Race/Ethnicity, 2012 Source: AHCA Emergency Department Discharge Data Set (All Payers) 9

10 Figure 5. Florida Asthma Hospitalizations, 2008 – 2012 Source: AHCA Hospital Inpatient Discharge Data Set 10

11 Figure 6. Florida Asthma Hospitalizations by Payer,

12 Figure 7. Florida Asthma Hospitalization Rates per 10,000 by Age Group, 2012 Source: AHCA Hospital Inpatient Discharge Data Set (All Payers) 12

13 Figure 8. Florida Asthma Hospitalization Rates per 10,000 by Race/Ethnicity,

Figure 9. Repeat ED Visits and Hospitalizations, Source: AHCA Hospital Inpatient Discharge Data Set (All Payers)

National Heart, Lung, and Blood Institute (NHLBI) Expert Panel Review-3 (EPR-3)Guidelines The Four Evidence-Based Components of Asthma Care by Providers: 1. Assessing and Monitoring Asthma Severity and Asthma Control 2. Education for a Partnership in Care (includes Self- Management Education & providing an Asthma Action Plan) 3. Control of Environmental Factors and Co-Morbid Conditions that Affect Asthma 4. Medications 15

Asthma Management in Florida 16 Among Floridians with asthma:  Taken a course or class on how to manage asthma:  One out of 15 adults with asthma (6.6%)  One out of 10 children with asthma or their parents(10.3%)  Received an Asthma Action Plan  One out of four adults with asthma (23.7%)  One out of three parents of children with asthma (33.7%) Source: Florida Adult Asthma Call Back Survey and Florida Child Health Survey

The Asthma Paradox 17 According to the CDC, the continuing high burden of asthma despite the availability of evidence based strategies is attributed to: 1. Gaps in access to care 2. Inconsistent clinician adherence to practice guidelines 3. Poor asthma self-management practices by people with the disease 4. Lack of coordination between health care and public health sectors

Addressing the Asthma Paradox 18 Address from every angle!

Past Efforts of the FDOH Asthma Program & The Florida Asthma Coalition 19  Established the Florida Asthma Surveillance System  Established the Asthma-Friendly School Award  Established the Asthma Friendly Child Care Award  Worked with the Florida Hospital Association to raise awareness about best practices for asthma management from the ED and Hospital Setting 19

20 Florida Asthma Coalition Hospital Partners 20

Individual with Asthma Primary Care Providers Hospital & Emergency Department Community Partners Parents / Caregivers / Peers Addressing the Asthma Paradox Where we’ve been: Community Partners 0-5 yrs: Childcare Centers 5-18 yrs: Schools Where we need to go… 21

22  Maintain the Asthma-Friendly School & Child Care Awards  Promote provider compliance with EPR-3 Guidelines  Establish a Learning and Action Network for Florida MCOs  Facilitate local, multi-sector, collaborative QI projects  Implement a home visiting demonstration project Proposed Efforts of the FDOH Asthma Program & The Florida Asthma Coalition

What can MCOs do? 23  Educate your providers about the EPR-3 Guidelines and incentivize compliance through awards or reimbursement  Assess asthma severity  Provide culturally competent self management education  Provide an Asthma Action Plan  Recommend measures to control exposure to allergens and pollutants  Select medication and delivery devices to meet patients’ needs and circumstances

What can MCOs do? 24  Implement an Asthma PIP  Sample PIP Question: Does outreach to health care providers about the EPR-3 Guidelines (including self-management education and Asthma Action Plans) result in increased medication adherence and reduced emergency department visits and hospitalizations?

STATE / HEALTH PLAN PROGRAM OVERVIEWOUTCOMES Indiana / CENTENE Corporation, Managed Health Services, and NURTUR -Risk-stratified asthma case management -MHS’s Asthma Team -MHS’s Asthma Care Team delivers telephonic and in-home case management, asthma education, and environmental interventions, communication coordination with clinical care providers, and robust outcomes tracking ↓ Reduced ED visits by 17.3% for children, 9.4% for adults ↓ Reduced inpatient admissions by 28.6% for children ↑ Increased vaccination rates by 22.5% in children and 51.3% in adults More Information: High-Performing Asthma Projects 25

STATE / HEALTH PLAN PROGRAM OVERVIEWOUTCOMES Michigan Priority Health -Self-Management Education -Case Management -Review of pharmacy claims -Provider per member per month incentive for medication compliance -Implemented the Pacesetters initiative, a collaborative QI project with providers ↓ Emergency department visits per 1,000 Medicaid members dropped from 250 to 189 from 2002 to 2006 ↓ Hospitalizations per 1,000 Medicaid members decreased from 62 to 36 from 2005 to 2006 High-Performing Asthma Projects More Information:

Community & Partners PROGRAM OVERVIEWOUTCOMES New York City / Washington Heights / Inwood Neighborhood Partners: Merck, New York Presbyterian Hospital & WIN for Asthma Program -Community Health Workers provided the following over a 12 month period: -Self-Management Education -Case Management -Home environmental assessments -Trigger reduction strategies -Clinical and social referrals ↑ Caregiver confidence in ability to control child’s asthma increased by 40% ↓ ED and Hospitalization visit rates decreased by more 50% ↓ Child school absenteeism decreased by 30% High-Performing Asthma Projects More Information:

Resources 28  /asthma/pdfs/Asth ma_Reimburseme nt_Report.pdf /asthma/pdfs/Asth ma_Reimburseme nt_Report.pdf

Resources 29  g/EHEP/Investing%2 0in%20Best%20Pra ctice%20for%20Asth ma.pdf g/EHEP/Investing%2 0in%20Best%20Pra ctice%20for%20Asth ma.pdf

Resources 30  v/asthma/pdfs/sna pshot_ pdf v/asthma/pdfs/sna pshot_ pdf

Resources 31 hma.org/AsthmaR esourceGuide.pdf

Resources 32 Online Network for asthma programs and organizations that sponsor them—including representatives of health plans and providers, government agencies, nonprofits, coalitions, schools and more. Offers real-time access to best practices and cutting-edge Internet tools to facilitate collaboration, problem solving, and learning between leaders. Benefits include: 1.Learning from and networking with asthma programs nationwide 2.Locating and teaming with mentors to assist with program activities 3.Highlighting your program’s activities with your own program profile page 4.Posting and finding local, regional and national events 5.Receiving national asthma awards and recognition

Resources 33 Your Data!  Use your data to understand burden and to design your PIP!  Are you capturing data that allows you to look at the quality of asthma management?  How many of your covered patients have an Asthma Action Plan?  How many are receiving appropriate pharmacotherapy?  How many of your covered patients filled/refilled their prescriptions?

Thank you for your time! Questions & Discussion 34