Asthma Consensus Statement

1
Asthma Consensus Statement

• A Health Care Provider Perspective on Working
  with Payers, Health Organizations, and Government
  to Improve Asthma Outcomes
• Coordinated by
• Polly Hoppin, UMass Lowell
• Laurie Stillman, Asthma Regional Council
• Presented by Shari Nethersole, MD and Matthew
  Sadof, MD

2
Problem Statement

• Too many children with asthma still using urgent
  care, unable to play or attend school
• Too many adults with asthma unable to work,
  exposed to asthmagens, and limited in activities
  of daily life
• Disproportionate burden on low income
  communities. Lack of targeted resources to
  address burden.
• Too many providers not delivering best practices
• Too many families unable to pay for, or
  self-manage, their care. Low patient
  expectations.

• Asthma a disease that can be nearly fully
  controlled, yet

3
Purpose of Consensus Statement

• We can do better we must do better.
• The research on best practices is clear the
  translation into the real world is challenging.
• Current policies and programs not aligned with
  best practices.
• Payers and Policy Makers listen to Providers of
  care who do the work everyday.
• Payers and Policy Makers need and want to hear
  their priorities so they can effectively target
  limited resources.
• The priorities have to be clear and realistic.

4
What will the Consensus Statement Look Like?

• Will be short and to the pointfocus on
  recommendations
• Will provide provider-offered solutions to
  barriers and problems in the field and in the
  literature
• Will tailor solutions to payers, health care
  providers, policy makers and govt. officials all
  have a role to play
• Will be signed by providers across the
  Commonwealth

5
Who Crafted It?

• Organized by UMass Lowell and Asthma Regional
  Council Polly Hoppin, ScD Laurie Stillman, MM
• Drafting Committee Polly Hoppin and Laurie
  Stillman, Stephanie Chalupka, Francis Duda, Lisa
  Mannix, Shari Nethersole, Margaret Reid, Elaine
  Rosenberg, Matthew Sadof, Megan Sandel.
• Input Solicited From 18 adult and child
  physicians and nurses in Framingham meeting
  governmental and NGO reps. included. Payer
  reactions sought.

6
Overall Recommendations

• We call on payers, health systems, our provider
  colleagues and public health agencies to take the
  following steps to improve asthma outcomes in
  Massachusetts
• Align policies and programs with best practices
  (NAEPP EPR3)
• Target and deliver appropriate care and services
  to those most in need
• Address and integrate 3 areas
• -Clinical Care
• -Patient and Provider Education
• -Work, home, community environments

7
What are the Recommendations?

• Payers
• Align Reimbursements/Provide Incentives for
  providers and patients to follow Best Practices
  promoted by NAEPP EPR3

8
Payers

• Pharmacologic therapy. To enable people with
  asthma to secure needed medications, payers
  should
• Reduce or eliminate co-pays, and/or redesign drug
  formularies, to ensure that brand name drugs for
  which there are no generic alternatives are
  placed in a lower-cost category.
• Reimburse for multiple prescriptions for
  inhalers, so patients can have them at school, at
  work, and at more than one homeif thats their
  situation.

9
Payers

• Measures of assessment and monitoring. To
  ensure correct diagnosis and monitoring of
  symptoms, payers should reimburse sufficiently
  for
• Pulmonary function testing, conducted in
  laboratories and/or in clinical office setting
• - Peak flow meters for patients for whom this
  is a reliable indicator of asthma control.

10
Payers

• Education for a partnership in asthma care.
  Payers should provide and/or reimburse for asthma
  education, including
• - Longer office visits with primary care
  providers
• - Reinforcement Sessions with asthma educators
  in the clinic, home and/or community, as
  appropriate and needed.

11
Payers

• Control of environmental factors and co-morbid
  conditions that affect asthma.
• - Payers should reimburse for environmental
  services and supplies for the home, as
  appropriate and needed
• - Payers should promote coordination and
  collaboration among providers caring for patients
  with asthma and other conditions that affect
  asthma, such as obesity and sinusitis.
• e.g., smoking cessation programs and
  associated pharmacotherapy mattress/pillow
  covers HEPA air and vaccum TYPO filters home
  assessments integrated pest management supplies
  and, where needed, professional services.

12
Payers

• Reimburse and facilitate billing for multiple
  kinds of providers most appropriate for a given
  setting.
• Work with health systems to establish robust
  disease management programs that may include
• - Asthma Registries
• - Electronic Provider Decision Support
  (feedback) Mechanisms for benchmarking care
• - Case Managers that coordinate and follow
  care.

13
Payers

• Help finance and support organizations that
  provide comprehensive asthma management services
  to ensure sufficient supply.
• As first step
• Support and participate in pilot projects (NGOs
  or health agencies) that deliver comprehensive
  asthma management track costs and health
  benefits to inform decision-making about
  longer-term investments.

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What are the Recommendations?

• Providers/Health Systems
• Providers health systems need to work
  collaboratively to ensure that high quality
  services are being offered in their communities

15
Providers/Systems

• Ensure full understanding among providers of the
  NAEPP Guidelines and the literature on promising
  interventions.
• Primary care and other providers should take
  advantage of CME/CEU opportunities for keeping
  current on the latest science on best practices

16
Providers/Systems

• Promote quality improvement, in particular
• Establish and/or link with disease management
  tools including asthma registries and provider
  feedback/decision support mechanisms
• Via referrals, connect patients with case
  managers and community services
• Use written asthma action plans
• Ensure that staff or referrals are appropriately
  trained and culturally competent
• Communicate with school nurses and employers
  about your patients asthmas and their needs
• Seek patient and family input on quality
  improvement initiatives

17
Providers/Systems

• Facilitate patients access to asthma education
  and environmental intervention services and
  supplies as appropriate and needed.
• On behalf of patients who could benefit, request
  insurance coverage of services, materials and
  supplies that are not routinely reimbursed by
  payers.
• Inquire about workplace explosures, help workers
  minimize these exposures, and report them to the
  MDPH as required.

18
What are the Recommendations?

• Public Agencies
• State Public Agencies are uniquely capable of
  supporting systems change, increasing capacity
  for service delivery, and delivering safety net
  interventions. The recommendations that follow
  envision partnerships between public agencies,
  payers, providers/health systems and community
  organizations.

19
Public Agencies

• Build capacity for focused and coordinated
  chronic disease prevention and management.
• Utilize data in asthma registries, claims data
  and surveillance systems to inform program
  planning and monitor trends in quality of
  services provided.
• Institutionalize communication between public
  health and coordinators of care.
• Work with MassHealth and Legislators to
  articulate minimum services needed to provide
  effective asthma management, and minimum
  insurance benefits necessary to access these
  services.
• Work with legislature to resource school nurses
  to maximize their role in controlling students
  asthma and provide guidelines on asthma
  management in schools.
• Empower and resource local public health depts.,
  through promoting regionalization and training,
  to track and fill gaps in services.
• Help establish capacity for delivering asthma
  education and environmental interventions and
  providing appropriate materials and supplies.
• Increase awareness of work-related asthma among
  providers, employees and employers
• - Develop agenda for primary prevention of
  asthma through research and policy, and promoting
  alternatives to identifiable asthmagens.

20
Public Agencies

• Identify, strengthen and enforce laws and
  regulations aimed at preventing exposures and
  improving social and environmental conditions.
• - State agencies should provide guidance to
  cities and towns in enforcing sanitary codes in
  housing to address triggers
• - OSHA should ensure workers receive info. on
  asthmagens in workplace and employers should
  address them in the workplace. Public workers
  should be covered by OSHA rules as well.
• - EPA should ensure that all communities in
  MA. meet national ambient air quality standards,
  and enhance clean transportation programs, such
  as diesel prevention/anti-idling

21
What Do You Think?

• Do these suggestions ring true to you?
• Is there anything important that were missing?
• Is there anything inaccurate in these
  observations and suggestions?

22
What Do You Think?

• From your experience, which of these
  recommendations would be most helpful or
  important to you?
• Would you be willing to support their
  implementation?