By Karen Meyerson, MSN, APRN, NP-C, AE-C, Manager, Asthma Network of West Michigan
In 1994, a group of concerned health professionals in West Michigan recognized the alarming rise in pediatric asthma morbidity and mortality, locally as well as nationally. Significant disparities are also associated with asthma. For example, asthma deaths in Michigan occur six times more frequently in Black children than in White children. In response, the Asthma Network of West Michigan (ANWM) was formed as a grass-roots coalition with initial funding from the (then) three acute care hospitals and two local foundations.
To reach and improve the lives of the nearly 100,000 people in Western Michigan—24 percent of whom are children—who have asthma, ANWM created a direct service arm of its coalition and implemented a home-based asthma case management program for school-aged children who had uncontrolled asthma. ANWM, believed to be the first grassroots asthma coalition in the nation to receive reimbursement for asthma education and case management services from health insurance plans, has since expanded its services to adults as well as children under the age of 5.
Our model relies on a few core components: home visits, care conferences and school/daycare visits and social worker services.
Home Visits
Research and common sense says that the environment around a child, particularly the home, is an important factor in preventing and controlling asthma. Consequently, a home visit provides the ideal setting to educate, review medication plans, and help families identify environmental factors that may contribute to the severity of asthma. If there are issues in the home that are triggering asthma attacks, we connect the family to our partner, the Healthy Homes Coalition, that provides environmental remediation.
To help educate families, we send a certified asthma educator—a nurse (at the RN level) or respiratory therapist (at the RRT level)—into the homes of patients for up to a year to perform environmental assessments and teach them about asthma attack trigger identification and avoidance/reduction, medications, proper use of devices and other self-management techniques. The asthma educator’s home visits are typically biweekly for the first three months and then monthly thereafter, as necessary, to provide a continuum of care.
Care Conferences and School/Daycare Visits
Care conferences—which are reimbursable visits—are held with the primary care physician and, if indicated, the asthma specialist soon after a new patient enters the program. These conferences tackle issues surrounding adherence, including psychosocial barriers to asthma management and access to care, and elicit a written asthma action plan, if none exists. If necessary, we provide spacers, a device to use with inhalers, to all patients who do not have them.
School/daycare visits – also reimbursable visits – are conducted in order to educate those caring for the children throughout the day about asthma and the child’s asthma in particular. We share the asthma action plan with staff and discuss asthma triggers in those settings.
Social Work Services
Lastly, we connect patients to our Licensed Masters-level Social Worker’s services (LMSW), which help families link the clinical recommendations they receive in the hospital or at the doctor’s office with the social services in their community. This is a vital service because many of our patients and families typically have multiple stressors, ranging from environmental to financial to socio-legal and LMSWs are uniquely capable of identifying and assisting with this range of problems. By blending social support with clinical support, ANWM makes the appropriate referrals or contacts to financial resources, mental health agencies, food banks, hospitals, landlords and others.
Successes
With this type of intensive, personal care, we have had demonstrated success in controlling asthma and reducing healthcare utilization (including emergency department visits and hospital admissions due to asthma). Patients often “graduate” from our program after just 6 to 12 months when their asthma control has improved.
When reviewing data over the past 19 years, we find that there have been significant reductions (64 percent) in the number of hospitalizations, days hospitalized for children and emergency department visits (from 60 percent to 35 percent). And, for low-income children with moderate to severe asthma who remained in the original case management study for at least 1 year, we saw an estimated average savings of $1,625 in hospital charges per patient. In total, we estimate the program results in approximately $800 in net healthcare savings per child per year, with a return to society—over two years—of $1.53 for every $1 invested.
We also hear from those we serve. The mother of a 5-year old boy with asthma told us that, “working with the Asthma Network has really made a big difference – his asthma is controlled now. They gave me education and made sure that I understood what asthma meant…they made me feel like no one was judging me.” Mom added, “I thought he had asthma ONLY when he got sick so I didn’t give him his inhaler until he had symptoms. If I had never had that education, who knows how many more asthma attacks or emergency room visits he would have?”
Another important, but perhaps overlooked success, is merely being paid for our services by health insurance plans. Most similar programs aren’t so lucky to receive reimbursement for their hard work. We get reimbursed by Medicaid managed care plans, Medicare and other commercial insurers. We have also been successful in raising grant funds and community benefit funds from local hospitals. It takes a lot of different funding streams, braided and blended together, to support our program, even with the insurance reimbursement. The funding is out there, you just need to spend the time to find it and combine the various streams to succeed.
ANWM owes our success to intentional collaborations with local health insurance plans, hospitals and schools, the people and entities helping patients (public health nurses, physician practices, community clinics, and our local healthcare HUB, Health Net of West Michigan) and our unique ability to blend different funding sources
Because of our success, other Michigan coalitions have formed and begun replicating our model—and they have also been successful in securing payment for similar services in their respective communities.
For more than 20 years we’ve worked hard to prevent adverse asthma events among our most vulnerable populations. We wouldn’t have been successful without the network of community resources and funding we’ve been able to marshal – and the ability, through home visits and social work services, to connect families to those services. Asthma cannot be cured, but it can be controlled. Individuals with asthma should expect nothing less.
