Menu

Asthma Member and Physician Interventions

Physicians and members can take proactive steps to manage the complexities of asthma.

Interventions Based on Risk Stratification

The HealthPlus Risk Stratification method is based upon condition eligibility criteria, clinical and financial data, predictive modeling, and self-reported information. Stratification is a dynamic process and the stratification level can change as the member’s condition changes.

Eligible members are categorized into four levels of risk, where Intense represents the highest level of risk and Low represents the lowest level of risk.

Interventions for Patient/Parent and/or Guardians

The asthma patient, parent or guardian may be provided the following resources and/or interventions to help them better manage their health conditions.

Intervention

Risk Level

 

Low

Moderate

High

Intense

Introductory letter and program packet informing how member was identified, how to use the services, how to opt out, and how to contact HealthPlus

Once initially

Once initially

Once initially

Once initially

Health Risk Appraisal

Every two years

Every two years

Every two years

Every two years

Disease-specific newsletter (includes lifestyle issues, smoking cessation, etc.)

Periodically

 

Periodically

Periodically

Periodically

Educational materials

4-6x /year

4-6x /year

4-6x /year

4-6x /year

Special equipment (nebulizer, etc.)

As needed

As needed

As needed

As needed

Web-based support and education (Krames Online /disease-specific videos)

Available

Available

Available

Available

Seminars (e.g., nutrition; healthy lifestyle)

Offered 2x /year

Offered 2x /year

Offered 2x /year

Offered

2x /year

Tobacco cessation

Offered - opt in

basis

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Weight management

Offered - opt in

basis

Offered - opt in

basis

Offered - opt in

basis

Offered - opt in

basis

Behavioral health referral

Offered - opt in

basis

Offered - opt in

basis

Offered - opt in

basis

Offered - opt in

basis

Member satisfaction survey

Annually

Annually

Annually

Annually

General standards of care reminder message (automated phone/mail)

Annually

Annually

Annually

Annually

Missed services reminders (automated phone/mail)

3x/year

3x/year

3x/year

3x/year

Poly pharmacy review

-

Monthly

Monthly

Monthly

Referral to Case Management

-

As needed

As needed

As needed

DM Coordinator telephonic follow-up after 1 ER visit (with PCP or member re: medication therapy/compliance) includes PHQ2

-

-

Per ER Visit/daily

-

Case Management discharge telephonic assessment for standards of care compliance after inpatient admission for asthma

-

-

-

Each Discharge

Enrollment for disease management/case management (post hospitalization)

-

-

-

Each Discharge

Physician Support Resources

Physicians and their staff have access to the following resources, to support them in their approach of treating asthmatic patients.

 

Intervention

Frequency

 

 

Provider manual introduction to programs

Regularly

Notification of Disease Management Program information in Provider Plus newsletter

Annually

Educational tools for offices

As needed

Exception list of primary and secondary services

Monthly

Patient Chronic Care Profiles identifying potential missed services and co-morbid conditions

Semi-annually

HEDIS® compliance reports with academic detailing (with benchmark and peer comparative analysis) to PCPs

Annually

Lunch and Learn by an RN disease management coordinator

Upon Request

Educational review on pharmacy utilization for practitioners with members in Moderate Strata

As needed

Nurse review of records for individualized performance feedback and education for physicians with members in all risk stratifications

As needed

Office staff educational forums provided by HealthPlus

Annually

Office Care Improvement:

  • Audit, feedback
  • Tools, materials
  • Asthma specific education for office staff
 

Offered

HealthPlus.org Web-based support including access to patient education tools, clinical guidelines and forms to promote exchange of information. (Provider can request mail option). (e.g., inhaler instruction sheets, asthma care flow sheet, peak flow meter instruction sheets) and asthma management tools (e.g., action plans, peak flow meters)

 

 

 

Ongoing

Web-based Krames Online Patient Education materials and disease specific videos

Available as needed

Physician/Provider satisfaction survey

Annually

Tobacco cessation program materials/member referral

Telephonic/Fax Referral/Print Materials/Website

Depression screening materials

 

Print Tools/Website

Weight management program

Telephonic/Fax Referral/Print Materials/Website

Asthma Care Awareness Plus Program for office care improvement

Selected offices

Explanation of Member and Physician Interventions

The following interventions/services are available to all eligible member asthma patients:

  1. Introductory Welcome Packet, containing:
    • Welcome letter
    • Toll-free telephone number to HealthPlus and Disease Management Department email address
    • Program opt-out information
    • Information on how to access asthma information on the HealthPlus web site
    • Asthma-specific standards of care and sick day plan
     
  2. Asthma-related standard of care service reminders are provided to adult members and parents/guardians of pediatric members, annually, through a newsletter and via automated telephone message. These reminders urge patients and/or parents/guardians to talk with their doctor about managing the disease and following a treatment plan, updating and following the Asthma Action Plan, using anti-inflammatory medicines for long-term control, monitoring peak flow, using “rescue” medicines, getting an annual flu shot and lung exam, and responding to an emergency.
  3. Automated telephone reminders are sent to members whose claims history suggests the patient is in need of services.

  4. Coordination with tobacco cessation, weight management, and depression screening services, available to members receiving HealthPlus Asthma Disease Management services.

  5. Members with asthma and complex care needs qualify for evaluation to enroll in HealthPlus Case Management . Members of the HealthPlus Asthma Disease Management Program who are discharged from a hospital with a primary diagnosis of asthma are evaluated for case management services.
  6. The case management assessment process includes a thorough co-morbidity evaluation of the patient’s medical conditions and psychosocial issues. The case management program involves ongoing management of the patient’s conditions.
  7. Asthma Chronic Care Profiles are member-specific, Chronic Care Reports  provided to the primary care physician (PCP) detailing recent asthma-related services, including spirometry testing, medication fills, ER visits, inpatient admissions, vaccination status, BMI results, co-morbidities, and medication management. The report also provides a dosage review analysis of potential non-compliance with the medication regimen and a status on pharmacotherapy management, from pharmacy claims data. This report is distributed, annually.
  8. With the permission of the PCP, missed services reminder letters are mailed under the PCP’s name to members who have been identified as not meeting asthma standards of care. The letters encourage members to contact their PCP for services.
  9. The Polypharmacy Program coordinates the activities of Disease Management Coordinators, Pharmacy Department and HealthPlus physicians to assess use, compliance, and adherence to member pharmacotherapy management. Members are contacted via telephone or mail regarding education and importance of pharmacotherapy compliance. Members with contraindications are noted in the Asthma Registry and the CCMS member record.
  10. Disease Management Coordinators identify members without appropriate medications or spirometry testing and notify providers and members through mailings, fax, or telephone.
  11. Asthma Disease Management Program members can obtain special equipment (e.g., nebulizers, spacers, etc.) as medically indicated by their treating health care provider. Peak flow meters are available under the member’s Durable Medical Equipment (DME) benefit.
  12. A periodic asthma-specific newsletter is mailed to members with valuable information related to the self-management of asthma.
  13. Member satisfaction surveys are mailed annually to a sample of the HealthPlus asthma patient population to measure satisfaction with the HealthQuest Disease Management Program, absenteeism, and the patient’s perception of health status.
  14. Physician Surveys are mailed annually to physicians to measure satisfaction with the HealthQuest Disease Management Program.
  15. The HealthPlus website provides information about asthma, including educational materials and links. The website also provides information and links for physicians.

Measures of Effectiveness

HealthPlus employs and tracks performance measures for the Asthma Disease Management Program. Each measurement:

  • Addresses a relevant process or outcome
  • Produces a quantitative result
  • Is population based
  • Uses data and methodology that are valid for the process or outcome measured
  • Has been analyzed in comparison to a benchmark or goal

HEDIS®

 Current measures include the following HEDIS® measure:

  • The percentage of members 5-64 years of age, during the measurement year, who were identified as having persistent asthma and who were appropriately prescribed medication during the measurement year (source: Administrative Data for Commercial, Medicaid):
  • 5–11 years
  • 12–18 years
  • 19–50 years
  • 51–64 years
  • Total (combined rate)

Non-HEDIS® Measures Methodology Descriptions

  • High use of albuterol (ten or more canisters of albuterol dispensed within a twelve-month period)
  • High-risk with high use of albuterol (see above) with either no oral inhaled steroids in the prior twelve months or a medication possession ratio of less than 80% for the time within the prior twelve months on the medication (Days Supply from MedImpact divided by days on the medication) is reported on the PCP Chronic Care Profile.
  • ER visit with asthma diagnosis (CPT of 99281-99285 with a primary diagnosis of 493 within the prior twelve months) is reported on the PCP Care Profile
  • Influenza and pneumococcal vaccination status reported on PCP Care Profile
  • Body Mass Index (BMI) is reported (if known) on PCP Care Profile
  • Office visit for asthma at least once each year:

Denominator – HEDIS® specifications for Use of Appropriate Medications for People with Asthma including age and continuous enrollment criteria.  Members without a pharmacy benefit are excluded.  

Numerator – The count of unique members from the eligible population with at least one (1) preventive/ambulatory health services visit with a PCP (internal medicine, family practice, general practice or pediatrics), pulmonologist or allergist within the reporting year, using HEDIS® specifications for Children’s and Adult’s Access to Preventive/Ambulatory Health Services for the codes to identify Preventive/Ambulatory Health Services.

Additional Measures/Outcomes

  • Member satisfaction:  HealthPlus annually evaluates satisfaction by evaluating member survey results and member inquiries and complaints.
  • Physician satisfaction:  HealthPlus annually evaluates satisfaction by evaluating physician survey results.
  • Health care cost reduction
  • Health care utilization (in-patient, emergency department, pharmacy)
  • Annual member participation rates

For more information about the HealthPlus Disease Management Program, please contact a HealthPlus Disease Management Coordinator at (800) 345-9956, ext. 8050, or by e-mail to dismgmt@healthplus.org.

Additional Resources: