www.ghhi.org [ 1 ] ©2015 green & healthy homes initiative. all rights reserved. healthy homes:...

www.ghhi.org [ 1 ]©2015 Green & Healthy Homes Initiative. All rights reserved.

Healthy Homes: Indoor-Outdoor Environmental Interventions to

Improve Asthma Outcomes

Michael McKnight11/6/15


A GHHI Family Story

https://youtu.be/rbF71lDmt4k





Recommendations from NAEPP

It is essential to identify and reduce exposures to allergens and irritants and to control other factors that have been shown to increase asthma symptoms in your patient.

Effective allergen avoidance requires a multifaceted, comprehensive approach; individual steps alone are generally ineffective.

Focus on allergen-control education for cockroach, dust mite and rodent allergens for patients sensitive to these allergens as these have proven interventions.


Healthy homes part of effective asthma management• Surgeon General’s Call to Action to Promote Healthy Homes (2009)

• The Community Preventive Services Task force recommends the use of home-based, multi-trigger interventions with an environmental focus for children and adolescents

• Cost-benefit studies show a return of $5.3 to $14.0 for each dollar invested

• Home-based triggers cause 40% of asthma episodes1

1Robert Wood Johnson Foundation Commission to Build a Healthier America. Beyond Health Care: New Directions to a Healthier America Report. April 2009


Address Root Causes at Home

Unhealthy Home

AsthmaEpisode

Hospital Visit

Treatment/ Inhaler


Common Home Asthma Triggers

Dust Mites

Cockroaches

PestsMold

VOCs

Tobacco Smoke

Animal Allergens

Smoke/Gas


Environmental Assessment & Education Together

Environmental Assessor-Energy Auditor (HHS/BPI)• Conduct pre-intervention environmental assessments /

audits• Develop comprehensive scopes of work for properties • Conduct post intervention assessments and audits

Community Environmental Health Educator (CHES/AE-C)

• Conduct asthma/HH resident education during assessment

• Coordinate client health surveys and data collection• Distribute HEPA-Vacuum and indoor allergen reduction

kit• Referrals and follow-up client services• Review asthma action plan• Medication adherence• Ongoing education, behavioral reinforcement, and band follow-up with PCP / care managers


Healthy Homes Interventions• Installation of mattress and pillow covers• Integrated pest management: gel baits, boric acid, glue traps,

reducing entry points, cleaning/behavioral change (clutter)• Mold remediation• Venting kitchen, bathroom and dryer; filter replacements• Removal or steam cleaning of carpets• Air filtering system installed in child’s bedroom• Air conditioners and dehumidifiers• Provision of a HEPA-vacuum and indoor allergen reduction

cleaning kit• Other Healthy Homes Interventions with leveraged funding (lead, radon, asbestos)


GHHI Baltimore Healthy Homes Program

• Direct Healthy Homes Program services began in 2000

• Program targets asthma diagnosed children in Baltimore; priority on children with prior ED visit or hospitalization; family income ≤ 80% AMI

• Primary Referral Sources - MCOs, health care providers, Health Department, GHHI Baltimore partners

• Units Completed - 1,660 families enrolled and 1,480 Healthy Homes interventions completed by the program to date using tiered intervention strategy and in-house GHHI Baltimore Hazard Reduction Team


Healthy Homes Demonstration Project

Mean Change and Percent Reduction of Key Outcomes

In the past 6 months (N=139)

Intake Mean (StdDev)

6 Month Mean (StdDev)

Pre Post Mean Change

(StdDev) One-sided t test Percent

Reduction

Hospitalizations 0.364288 (0.923013)

0.141791 (0.53667)

0.238806(0.824248) 0.0008 65.5%

ER Visits 0.942857 (1.22193)

0.701493 (1.097022)

0.261194(1.250137) 0.015 27.7%

Physician Visits 1.76258 (1.462491)

1.340909 (1.413293)

0.389313(1.460098) 0.002 22%

Calls to Physicians 2 (1.498792)

1.481203 (1.490381)

0.515152(1.565296) 0.0002 26%

Work days missed 2.76259 (1.954492)

1.736842 (1.85413)

1.037879(2.057959) 0.0000 37%

School/ daycare missed

2.372093 (2.008069)

1.787402 (2.091669)

0.647059(1.998254) 0.0002 27%

200 units completed with 139 respondents completing 6 month post intervention health surveys

Environmental Justice, Vol 7. Number 6, 2014


Outcomes and ImpactA look at GHHI Philadelphia’s impact:

• 70% fewer asthma-related client hospitalizations • 76% fewer asthma-related client ED visits• 62% fewer asthma-related client doctor’s office visits • 53% fewer asthma-related client missed days of school

or daycare • 55% fewer uses of Albuterol Pump

A look at GHHI Cleveland’s impact:

• 58% reduction in asthma-related client hospitalizations • 63% reduction in asthma-related client ED visits


Reduced Costs = Cashable Savings

• 1 asthma-related hospitalization on average costs $7506 in Baltimore

• 1 asthma-related emergency room visit on average costs $820 in Baltimore

Asthma hospitalizations

and ED visits

Cashable Savings

[2009-10 data]


Challenges• Funding sources: HUD, DOE, CDBG, philanthropy, utilities,

state and local housing funds. Healthcare investment for home remediation services has not been significant.

• Currently no standard set of codes for Healthy Homes measures and approved costs for services – Now working on a guidance manual and reimbursement recommendations including payment models

• Reimbursement traditionally only for licensed clinical providers – Medicaid Rule Change adjusted “Who” is available to be reimbursed, not “What” services are reimbursable

• Coordination of care between medical providers and community based services is still improving


A Fractured Delivery System


GHHI - A Model That Benefits Families


Opportunities

• Medicaid Rule change for reimbursable professionals

• Waivers and State Plan Amendments

• Hospital community benefit investments - can encompass “physical improvements and housing” and “environmental improvements”

• Community health worker certifications and expanding role; new home performance professional certifications for health

• Education Funding Connections - Costs school districts $29 per child per school absence

• Pay for Success / Social Impact Bonds


& Other Guarantors

(Baltimore foundations)

GHHI Baltimore Asthma PFS Model

Upfront

capital

Success payment

s

Re-payment

Target setting

Evaluation

Risk mitigatio

n

&Other Investors

Service delivery funding

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCNvMupv2ssgCFYWmHgodiyUD_w&url=http://www.gbms.org/partners.html&psig=AFQjCNE1Nu0i5FGiKwAPG_gcWr_yyH4NpQ&ust=1444395367274679


Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7

Draws

Intervention

Evaluation

Savings & Success

Payments

$ $ $

Guarantee Payments Guarantee

Timeline


Location Healthcare Org Service Provider

Springfield, MA Baystate Health Partners for a Healthier Community

Memphis, TN Le Bonheur Children’s Hospital Habitat for Humanity of Greater Memphis

Buffalo, NY Monroe Plan for Medical Care

Community Foundation of Greater Buffalo& Heart of the City Neighborhoods, Inc.

Grand Rapids, MI Spectrum Health Health Net, Healthy Homes Coalition, & Asthma Network of West Michigan

Salt Lake City, UT University of Utah Health Plans

Salt Lake County Office of Regional Development

• GHHI selected to participate in Social Innovation Fund’s first PFS cohort with asthma PFS feasibility studies in 5 locations:


GHHI National Scaling


Our National Partners

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&docid=ksX73a3Y9vQzNM&tbnid=HXu4n5IlBYEzQM:&ved=0CAcQjRw&url=http://non-profit-organizations.findthebest.com/l/1844241/The-Jpb-Foundation&ei=mIoYVJL9I8ypyATA_IBI&bvm=bv.75097201,d.aWw&psig=AFQjCNF0nBIbac4-OJRU0TIMR6LeF_1OeQ&ust=1410980878780309

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&docid=ksX73a3Y9vQzNM&tbnid=HXu4n5IlBYEzQM:&ved=0CAcQjRw&url=http://non-profit-organizations.findthebest.com/l/1844241/The-Jpb-Foundation&ei=mIoYVJL9I8ypyATA_IBI&bvm=bv.75097201,d.aWw&psig=AFQjCNF0nBIbac4-OJRU0TIMR6LeF_1OeQ&ust=1410980878780309


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Questions?

Michael McKnightVice President of Policy and Innovation

[email protected]

@McKnight_GHHI

https://twitter.com/HealthyHousing

https://www.facebook.com/GHHInational

https://www.youtube.com/user/GHHIVideos

http://www.linkedin.com/green-and-healthy-homes-initiative

www.ghhi.org [ 1 ] ©2015 green & healthy homes initiative. all rights reserved. healthy homes:...

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