Homegrown asthma program cuts hospitalization, ER visits for HMO
Case managers take a personal approach
A personal approach to asthma management has paid off for ConnectiCare, a small, regional health maintenance organization based in Farmington, CT.
In the first five years of the BREATHE (Better Respiration Equals Asthma Treatment and Health Education) disease management program, ConnectiCare members with asthma had a 29% decrease in asthma-related hospital length of stay and a 70% decrease in asthma-related emergency room visits, according to Steve Delaronde, MPH, MSW, an epidemiologist and research analyst with ConnectiCare’s Health Management Programs.
The findings are from a pre/post-analysis used to measure differences 12 months before and 12 months after members received at least two case management contacts and/or attended a two-hour asthma education class. Statistics compare the 12-month period before the member received case management contact to the 12-month period after the first contact. There was a 54% increase in anti-inflammatory medication during the same period.
More than 96% of respondents to a member satisfaction survey rated the BREATHE program good, very good, or excellent and reported that their quality of life had improved since they started participating in the program.
The program was this year’s winner of The National Exemplary Practice Award by the American Association of Health Plans (AAHP) and the Washington Business Group on Health (WBGH).
ConnectiCare started its BREATHE asthma program in 1996 because of the prevalence of the disease — around 8% of membership.
"It was a chronic condition where we felt we could make a difference. If patients are taught the importance of self-management, how to work with their physicians, and how to take care of their condition, you can see quick results," says Bonnie Bauer, RN, BSN, BREATHE program coordinator for ConnectiCare.
The program was developed by a multidisciplinary team at ConnectiCare and is managed by Bauer and Dori Peruccio, RN, MPH, asthma nurse case manager.
The key to the program’s success is that it was developed and is handled in-house, which provides a personal touch for the members and makes it easier to make changes, says Jay Salvio, BSN, MBA, director of ConnectiCare’s Health Management Programs.
"When you own it and develop it yourself, you have a lot of pride and commitment. We work with our customers every day. Someone across the country wouldn’t have the same feelings for the well-being of our customers," Bauer adds.
Each year when they analyze the data, members of the asthma team are able to quickly make changes to better respond to the clients.
For instance, in the early years, the program included large seminars for physician groups, school nurses, and pharmacists, but physician attendance rates were low.
In 1998, the team decided to shift the focus to educating members and giving them the resources they needed to have more productive visits with their physicians.
"We haven’t stopped educating the physicians. We’ve just taken a shift in our focus. When you own the program, you can adapt it as the program needs dictate," Salvio adds.
The program is designed to give the case managers the flexibility to do whatever it takes to meet the needs of the members.
For instance, one member with asthma asked Peruccio to talk to her relatives, who were concerned about the anti-inflammatory medicine she was taking.
"Because we’re a homegrown program, we can give them this kind of personal attention," Bauer says.
Bauer and Peruccio each handle about 200 active members at one time. Members identified for the most intense personal management are those who have been hospitalized, followed by those who have visited the emergency room for asthma treatment.
Since the program began, more than 3,000 members have received personal interventions from the case managers.
Patients are stratified into three categories of severity. When a member is identified for the BREATHE program, Bauer and Peruccio conduct a telephone assessment that includes knowledge of the disease, compliance with their medication treatment plan, and knowledge of their allergies and triggers.
The nurses develop a plan of action as to how aggressively they will manage the patient.
Patients may receive a call as often as once a week or as infrequently as once a quarter.
Based on each call, the case managers decide when the member needs another phone call and enter it into the built-in call reminder field in the database. They run weekly reports to set up their schedule.
"It’s a moving target. Some get discharged quickly, and I’m still calling some members that I first contacted in 1996," Bauer says.
These long-standing members in the program have resisted being discharged from the program because they like the contact with someone, she adds.
The case managers may call a physician directly following a phone call if they think the patient needs medical care. For instance, Bauer recently asked a physician to send in a home health nurse because the patient wasn’t doing well.
The case managers work with school nurses and other personnel and have coached them on how to use a peak-flow meter for the younger children.
Since the program began, the case managers have managed about 3,500 members. Almost 1,000 members have gone through classes provided by ConnectiCare either at their place of work or in the community.
The HMO started out in a partnership with a pharmacy company that had an asthma health management program.
"We had some ideas of our own that we felt strongly about, so we decided to design our own program," Bauer says.
Asthma management can pay off
If you’re looking for a disease management program that can pay off quickly, you might think about an asthma management program. Consider these statistics from the National Institutes of Health: The direct and indirect costs of asthma were $12.7 billion in 2000. The disease was responsible for 1.8 million emergency room visits, 460,000 hospitalizations, and 5,000 deaths, further statistics show. In this issue of Case Management Advisor, we’ll take a close look at asthma management programs, how they work, and how they pay off. You’ll learn how a homegrown program allows personalized interventions, and how one organization achieved a 4.5-to-1 return on investment with its asthma management program. We’ll give you tips on starting a program and show you how case managers educate physicians and teach asthmatics to recognize what triggers the disease.
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