Transcript Document

Presented by: Julie Dudley
Date: 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
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“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
Figure 1. Florida Asthma ED Visits, 2008 – 2012
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120,000
Number of Visits
103,849
90,000
89,450
90,770
89,181
2009
2010
2011
80,932
60,000
30,000
0
2008
All Payers
6
2012
Medicaid
Source: AHCA Emergency Department Discharge Data Set
Figure 2. Florida Asthma ED Visits by Payer, 2008-2012
50,000
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Number of Visits
40,000
30,000
20,000
10,000
0
2008
Medicare
7
2009
Medicaid
2010
Commercial
2011
Self-Pay
2012
Other
Source: AHCA Emergency Department Discharge Data Set
Figure 3. Florida Asthma ED Visit Rates
per 10,000 by Age Group, 2012
8
200
Rate per 10,000
172.4
150
98.9
100
59.3
50
36.5
13.1
0
0-4
8
5-17
18-34
35-64
65+
Source: AHCA Emergency Department Discharge Data Set (All Payers)
Figure 4. Florida Asthma ED Visit Rates
per 10,000 by Race/Ethnicity, 2012
9
150
Rate per 10,000
129.4
100
55.4
50
34.1
33.5
Non-Hispanic
White
Other
0
Non-Hispanic
Black
9
Hispanic
Source: AHCA Emergency Department Discharge Data Set (All Payers)
Figure 5. Florida Asthma Hospitalizations, 2008 – 2012
Number of Hospitalizations
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40,000
30,000
30,709
30,910
2009
2010
28,532
29,776
29,476
2011
2012
20,000
10,000
0
2008
All Payers
10
Medicaid
Source: AHCA Hospital Inpatient Discharge Data Set
Figure 6. Florida Asthma Hospitalizations
by Payer, 2008-2012
Number of Hospitalizations
11
15,000
10,000
5,000
0
2008
Medicare
11
2009
Medicaid
2010
Commercial
2011
Self-Pay
2012
Other
Source: AHCA Hospital Inpatient Discharge Data Set
Figure 7. Florida Asthma Hospitalization
Rates per 10,000 by Age Group, 2012
12
50
Rate per 10,000
40
35.1
30
23.0
20
15.7
12.9
10
5.5
0
0-4
12
5-17
18 - 34
35 - 64
65+
Source: AHCA Hospital Inpatient Discharge Data Set (All Payers)
Figure 8. Florida Asthma Hospitalization
Rates per 10,000 by Race/Ethnicity, 2012
13
40
Rate per 10,000
30
29.1
20
14.2
12.5
8.8
10
0
Non-Hispanic
Black
13
Hispanic
Non-Hispanic
White
Other
Source: AHCA Hospital Inpatient Discharge Data Set (All Payers)
Figure 9. Repeat ED Visits and Hospitalizations, 2012
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82%
37% of Total
Visits and
Total Charges
18%
Single Visits
Repeat Visits
Source: AHCA Hospital Inpatient Discharge Data Set (All Payers)
National Heart, Lung, and Blood Institute (NHLBI)
Expert Panel Review-3 (EPR-3)Guidelines
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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 SelfManagement Education & providing an Asthma
Action Plan)
3.
Control of Environmental Factors and Co-Morbid
Conditions that Affect Asthma
4.
Medications
Asthma Management in Florida
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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%)

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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
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According to the CDC, the continuing high
burden of asthma despite the availability of
evidence based strategies is attributed to:
1.
2.
3.
4.
Gaps in access to care
Inconsistent clinician adherence to practice
guidelines
Poor asthma self-management practices by
people with the disease
Lack of coordination between health care and
public health sectors
Addressing the Asthma Paradox
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Address
from every
angle!
Past Efforts of the FDOH Asthma Program &
The Florida Asthma Coalition
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 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
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Florida Asthma Coalition
Hospital Partners
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20
Addressing the Asthma Paradox
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Primary
Care
Providers
Parents /
Caregivers /
Peers
Individual
with
Asthma
Where we need to go…
Hospital &
Emergency
Department
Where we’ve been:
Community Partners
Community
Partners
0-5 yrs:
Childcare Centers
5-18 yrs:
Schools21
Proposed Efforts of the FDOH Asthma
Program & The Florida Asthma Coalition
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 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
What can MCOs do?
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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?
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
Implement an Asthma PIP
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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?
High-Performing Asthma Projects
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STATE /
HEALTH PLAN
PROGRAM OVERVIEW
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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
OUTCOMES
↓ 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: http://www.asthmacommunitynetwork.org/node/6161
High-Performing Asthma Projects
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STATE /
HEALTH PLAN
Michigan
Priority Health
PROGRAM OVERVIEW
OUTCOMES
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Self-Management Education
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Case Management
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Review of pharmacy claims
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Provider per member per
month incentive for medication
compliance
↓ Emergency
department visits per
1,000 Medicaid
members dropped
from 250 to 189 from
2002 to 2006
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Implemented the Pacesetters
initiative, a collaborative QI
project with providers
↓ Hospitalizations per
1,000 Medicaid
members decreased
from 62 to 36 from
2005 to 2006
More Information: http://www.epa.gov/asthma/pdfs/priority_health.pdf
High-Performing Asthma Projects
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Community &
Partners
PROGRAM OVERVIEW
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Community Health Workers
provided the following over ↑ Caregiver confidence in
a 12 month period:
ability to control child’s
asthma increased by 40%
Self-Management
Education
↓ ED and Hospitalization
visit rates decreased by
Case Management
more 50%
Home environmental
↓ Child school absenteeism
assessments
decreased by 30%
Trigger reduction strategies
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Clinical and social referrals
New York City /
Washington Heights
/ Inwood
Neighborhood
Partners: Merck,
New York
Presbyterian
Hospital & WIN for
Asthma Program
OUTCOMES
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More Information: http://www.asthmacommunitynetwork.org/node/3331
Resources
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http://www.cdc.gov
/asthma/pdfs/Asth
ma_Reimburseme
nt_Report.pdf
Resources
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http://www.sophe.or
g/EHEP/Investing%2
0in%20Best%20Pra
ctice%20for%20Asth
ma.pdf
Resources
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http://www.epa.go
v/asthma/pdfs/sna
pshot_060111.pdf
Resources
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http://takingonast
hma.org/AsthmaR
esourceGuide.pdf
Resources
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www.AsthmaCommunityNetwork.org
• 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.
2.
3.
4.
5.
Learning from and networking with asthma programs nationwide
Locating and teaming with mentors to assist with program activities
Highlighting your program’s activities with your own program profile page
Posting and finding local, regional and national events
Receiving national asthma awards and recognition
Resources
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Your Data!
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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?
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Thank you for your time!
Questions & Discussion