Prevention and disease management programs are some of the best ways to help keep health care costs low. According to the American Lung Association , about 7.1 million children under the age of 18 were affected by asthma in 2009. The health care cost of the chronic disease is about $50.1 billion annually. Furthermore, asthma is the leading cause of school absences and the third-leading cause of hospitalizations in children under age 15. Health insurance providers are finding that asthma education tools go a long way toward reducing the prevalence of asthma-related emergency room visits, asthma episodes and hospitalizations.
Health Plans for Asthma Condition Management
The U.S. Environmental Protection Agency encourages health insurance providers with established asthma condition management programs to implement home visit programs. Along with medical treatment and the management of environmental triggers in the home, the implementation of a home visit program can help teach skills about asthma condition management, thus reducing health care costs for health plans and enrollees.
The following are the steps the EPA suggests to help health plan providers get started with the development of a home visit program:
1. Identify the benefits of a home visit program as part of a traditional asthma condition management plan. By going into a home and helping identify asthma risk factors and triggers like pests, dust mites, secondhand smoke, pets and molds, enrollees will experience medical benefits as well as financial and economic benefits. Health plans will also experience financial and economic benefits, plus they’ll gain competitive advantages.
2. Get leadership buy-in. Talk to the executives within your health plan about the benefits of asthma education and home visit programs; estimate a budget that includes time and money; and design a pilot program.
3. Create an implementation team. Consider including the company’s asthma case manager, network physicians, analyst, the medical director and the utilization management director, among others.
4. Develop the home visit program’s structure. Define the goals of the program, its components, the number of home visits and the individuals who will conduct the home visits.
5. Decide which enrollees will be part of the program. A plan can include all of the individuals with asthma, or only those with the most severe cases.
6. Develop outreach strategies. Consider who will contact enrollees and how; the features of a good outreach program (such as multi-lingual staff and incentives); and how health care providers will learn about the program.
7. Determine what outcomes and outputs will be measured (and how). Common outcomes measured include asthma-related hospitalizations; missed days of work or school; and the percentage of enrollees using an asthma action plan.
8. Develop tools and forms, and train staff. Forms can include checklists, asthma action plan templates, intake forms and tracking forms.
9. Form partnerships with local asthma organizations. Doing so can provide the company with enrollee referral relationships as well as provide vital collaborative opportunities.
10. Begin the program, and track results. Tracking should measure the efficacy of the program, evaluate areas of improvement and identify areas that could be expanded.