Model predicts asthmatics likely to need interventions
Program tracks medication refills
A keystone of ConnectiCare’s BREATHE asthma management program is a predictive model, based on pharmacy usage, that helps identify members before their asthma gets to the crisis stage.
The predictive model, designed by the multidisciplinary team that developed the asthma management program, is designed to track specific asthma medications and the frequency of refills over a three-month period, according to Dori Peruccio, RN, MPH, asthma nurse case manager.
"It’s coded for overuse and underuse. For instance, if the member is overusing their rescue medication and does not have a corresponding prescription for an anti-inflammatory medication, this is a red flag for an intervention," Peruccio says.
Participants also are identified through claims data from hospitals, emergency rooms, physician office visits, and direct referrals from physicians and members.
"We looked at the population and how we could define it using ICD-9 codes, hospital and emergency room claims, and pharmacy data," says Bonnie Bauer, RN BSN, BREATHE program coordinator for ConnectiCare.
The program was developed by a multidisciplinary team that included the medical director, nursing representatives, a consulting pediatrician and a consulting allergist, and representatives of the HMO’s legal and marketing departments.
The team built its own database, designed by the nurse case managers who would staff the program, with the help of a database designer.
Guidelines from the National Heart, Lung, and Blood Institute of the National Institutes of Health are the cornerstone for the program.
Members are stratified into risk levels, based on an assessment. Those at highest risk are flagged for intensive personalized interventions.
Those who have the diagnosis of asthma but have not been hospitalized or treated in the emergency room receive population-based interventions that include a quarterly newsletter and invitations to attend a free asthma education class, offered in different areas of the state every month.
People who attend the meeting take home an age-appropriate asthma care kit. For instance, the adult kit includes a peak-flow meter and asthma information; adolescents get a kit for their school locker; and the kits for younger children include a puppet. The kits are provided in partnership with a pharmaceutical company.
Last fall, the HMO began offering its BREATHE classes to employer groups at the work site. The classes are for adults with asthma or parents with children who have asthma.
"If members are unable to attend the community meetings, we want to give them an opportunity to attend at their work site," says Peruccio.
The team sends out quarterly reports to physicians, giving them information about hospitalizations and emergency room visits, a profile of the prescriptions that patient has been filling, and the latest National Institutes of Health’s National Heart, Lung, Blood Institute guidelines.
A new feature this year includes information on the predictive model population, alerting the physicians as to whether the patients have been filling their prescriptions as directed.
"When we look at the information in the reports and get feedback, we are able to make changes quickly and continue to have the program grow," Peruccio says.
ConnectiCare has used its health management programs as a marketing tool.
"It differentiates what we do. We have developed strong relationships and support systems with the members. It’s part of the personal touch you can have when you develop your own program," Salvio says.