2015 Asthma Coalition SummitAllergy & Asthma Network

November 6, 2015San Antonio, TX

Innovative Approaches for Asthma Care in Your

Community

Karen Meyerson, MSN, APRN, NP-C, AE-C

Date established: January 1994, as the grassroots asthma coalition serving West Michigan

Location: Grand Rapids, Michigan Population: 82,933 people with asthma - 3 counties Target population: children (<18 years) with uncontrolled

asthma from low-income families (we also serve adults) Population served:

33% African American, 32% Hispanic/Latino, 15% Caucasian

82% children; 78% covered by Medicaid; 20% uninsured/under-insured

Original funding: Local foundations & hospital systems Created direct service arm in 1996; obtained non-profit status in

1997 Contract signed with Priority Health in 1999

Asthma Network ofWest Michigan

Institutionalize the focus on outcomes

Community collaborative guided by a physician champion and partners in key positions of leadership, able to parlay that partnership into action

“Leave your badges at the door” –

Partnered to achieve a shared goal and and not for any organizational advantage

Tried to ensure mission/program alignment and didn’t just “follow the money”

Designed a comprehensive program, which would provide direct service and would target the most at-risk children with asthma in our community

Building a Better Program:Committed Leaders and Champions

Building a Better Program:Strong Community Ties

Included our community in program planning

Engaged our community “Where it Lives”

Situated our offices in target community

Demonstrated broad commitment to our target community by getting involved in community affairs

Recruited asthma champions

Reached out to local foundations and corporations

Collaborated with competing hospital systems

Supported school districts

Focused on health care providers/clinics

Partnered with local universities

Engaged health plans

Building a Better Program:High Performing Collaborations

Collaborated to build credibility – we wanted to become indispensable to our community Patient-centered medical home model in Kent

County Merck Childhood Asthma Network grant/GWU study Women Breathe Free

Engaged health plans Identified key decision-makers, offered a

a “trial” period Helped support a “Payer Summit” for sister

communities replicating our model Responsive and flexible - (e.g., serving an additional

county as well as members with COPD at the request of Priority Health)

Building a Better Program:Key Partnerships

First asthma coalition in the nation to contract with a health plan – now have signed contracts with 4 health plans Reimbursement ($138,000) covers ~1/3 of our operating budget

($400,000)

Collaborations with Health Net of West Michigan (neutral convener) and Healthy Homes Coalition as well as schools, hospital systems, physician practices, community clinics, MDHHS

Partnership with University of Michigan/Center for Managing Chronic Disease to adapt Women Breathe Free for in-home use Transition from a telephonic program to a home-based program, working

with men, women, and parents of children with asthma

Enrolled 60+ individuals/families, still actively enrolling

Requested gender-neutral materials & perhaps a name change?

WBF helped case managers formalize the goal-setting process in homes

Program Description:Integrated Health Care Services

Home-Based Case Management: Home visits – reimbursable visits

AE-Cs, LMSW and CHWs School/daycare visits – reimbursable visits Physician care conferences – reimbursable visits Licensed masters social worker (LMSW who is also

AE-C) assists with psychosocial barriers – reimbursable visits

Health professional education / technical assistance In-services for providers and office staff

o Spirometry, asthma medications & devices, asthma guidelines, Asthma Action Plans, etc.

Case Management Model

5 AE-C* Home Visits in 3 months*RN or RRT - must become a certified asthma educator (AE-C) within 1 year

3 monthly visits thereafter 1 visit to medical home 1 visit to school or daycare 2 LMSW visits Target: 6 - 12 visits over 6 - 12 months CHW visits as needed and follow-up visits after

discharge

Referral Sources

Health Net of West Michigan (local health care HUB)

Inpatient population/ED Physician practices/clinics School nurse Public Health Nurse Self-referral Managed Care Organizations “No wrong door” for referrals!

Current Funding Sources Secured sustainable funding from the local United Way and Community

Benefits/operating funds from 2 competing hospital systems

Reimbursement from contracts with 4 health plans

Foundation /grant funding, including Amway Corp. and United Way

Expanded services to members with COPD at the request of our largest payer

Selected by GHHI for feasibility study, in collaboration with Health Net of West Michigan, Healthy Homes Coalition, Spectrum Health and Priority Health, to prepare for a Pay for Success intervention 7 months of technical assistance from GHHI

Goals: Determine target population, define and scale services, design program evaluation, secure funding from investors and (hopefully) move to intervention phase

Leveraging Assets and Resources

Outcomes:Reduced Hospital Charges

$18,357

$67,972

$86,329

$11,787

$19,277

$31,064

Pre-studyStudy

Total ED Charges

Total Charges Total hospital charges decreased by $55,265 from pre-study year to study year

Total Inpatien

t Charges

Managing Asthma Through Case Management in Homes (MATCH)

Three established Michigan MATCH programs Asthma Network of West Michigan Hurley Medical Center St. Joseph Mercy Health System

Children and adults with asthma MATCH model

≥ 6 visits ≥ 5 months between Intake and Discharge

visits

28.36%

86.57%

45.45%

5.97%

34.33%

7.58%

0%

20%

40%

60%

80%

100%

≥ 3 ED visit: -78.95 %Δ ≥ 1 ED visit : -60.34 %Δ ≥ 1 Hospitalization: -83.33 %Δ

Percentage of Individuals with Asthma related Medical Care Usage in last 6 months By Intake/Discharge

Intake Discharge

MATCH Outcomes:Utilization

Percentage of participants with Asthma Inpatient Visits by intake and discharge for participants who were enrolled for at least 5 months and had at least 6 visits. There was a -78.95% change between Intake and Discharge for participants who had at least 3 ED visits, -60.34% for those who had at least 1 ED visit, and -83.33% change for those who had at least 1 hospitalization.

Major Achievements & ResultsThe results we’re most proud of:Designed and implemented a comprehensive home-

based asthma case management modelFirst asthma coalition in the nation to partner with a

health plan and obtain reimbursement for servicesLong-term partnership with health plans who report

cost savings and positive return on investment (ROI)40% decrease in hospitalizations (Priority Health, 2014)

25% decrease in ED visitsTwo national U.S. EPA awards:

“National Model Asthma Program” (2006) National Environmental Leadership Award in Asthma

Management (2008)

Our Value Proposition:The Business Case for an Asthma

Program

For $400,000, the Asthma Network will improve asthma outcomes for 300 at-risk children with poorly controlled asthma by achieving reductions in ER visits and hospital admissions, through our in-home asthma case management program.

We estimate that our work will deliver $212,000* per year in net cost savings to the healthcare system through 40% fewer hospital admissions and 25% fewer ER visits.

* $1.53 return for every $1 invested (2012) so $612,000 - $400,000 = $212,000 net savings

For more information, please contact:

Karen Meyerson at:

Phone: 616-685-1432

E-mail: meyersok@mercyhealth.com

Website: www.asthmanetworkwm.org