Managing to Breath
Colette A. Weil, MBA

Even after the release of the American Academy of Allergy, Asthma and Immunology's 1999 guidelines for managing pediatric asthma, the adoption and implementation of asthma management programs by providers moved at a slow pace. While the home medical equipment and pharmacy industries had always felt that the successful implementation of diabetes management programs would pave the way for asthma management programs, the development of asthma programs has progressed much slower than anyone expected.

Providers, however, are now noticing that more parents are willing to pay for the help to get their children's asthma under control. In addition, the number of managed care organizations and other third-party insurers seeking qualified asthma educator partners — and paying for their services — is increasing. And now, three years after AAAAI released its initial guidelines, states are stepping up development of statewide initiatives, grants and coalitions to attack asthma and rein it in under the patient's control.

For providers who are in the process of preparing or expanding asthma disease management programs, take it from your colleagues who've been there: Be the expert, network, be assertive, promote your program and give the patient the option to pay cash. Consider the following stories of three providers who've successfully implemented asthma management programs in their communities.

HOME CARE MEDICAL

Wisconsin has gone on high alert for asthma management. While asthma is the third leading cause of preventable hospitalizations in the United States, it's the No. 1 reason for hospitalization at Children's Hospital of Wisconsin in Wauwatosa, according to a June 7 article in the Milwaukee Journal Sentinel. In response, the state of Wisconsin is developing a comprehensive plan of disease tracking, intervention and occupational components.

“It really isn't just about access to care,” says Beth Fiore, an epidemiologist for Wisconsin-sin's Department of Health and Family Services, who is quoted in the article. “It's also about choosing to use the services that are in place.”

With a successful pediatric asthma management program already in place, Home Care Medical in New Berlin, Wis., is ready to serve.

Donna Smith, RRT, manager of respiratory services and co-developer of Home Care Medical's asthma management program, began developing the program in 1999. “The need in Wisconsin was acute,” she says.

Home Care Medical collaborated with CompcareBlue, the health maintenance organization component of Cobalt Corporation, which is the state's Blue Cross and Blue Shield licensee, and with Innovative Resource Group, Compcare Blue's case management organization, to develop the best possible asthma management program available. Based on the National Institutes of Health Expert Panel Report 2 Clinical Practice Guidelines, Home Care Medical's outcomes-driven program coordinates case management nurses, hospital emergency departments and physicians, and provides asthma training in four to six hands-on sessions.

According to Smith, the Home Care Medical program also can include an in-home assessment. So far, more than 200 pediatric patients have completed Home Care Medical's asthma training program.

Ultimately, “the relationship among referring physicians, case workers, nurses and local schools makes this program work,” she says.

But Smith expresses continued concern. “CompcareBlue has more than 75,500 members. We have barely scratched the surface in reaching those children in need,” she says.

And, Home Care Medical is gearing up to further promote its asthma disease management services outside of the CompcareBlue contract.

“We are now staging to market more assertively to our more than 700-physician database. We have a [asthma disease management] track record and can demonstrate our performance to effectively help patients,” Smith says.

Home Care Medical serves few cash-based patients. And some insurance programs and health maintenance organizations have been slow to non-existent to reimburse for asthma disease management services. However, Wisconsin's Touch Point Health Plan since 2000 has paid pharmacists $60 per hour for asthma training, and Unity Health, Wisconsin Medicaid and Group Health of Eau Claire reimburse pharmacists up $75 per prorated hour for asthma management services, according to the Pharmacy Society of Wisconsin.

Here, Smith sees an opening to aggressively promote Home Care Medical's program. “The state's plan to attack asthma puts disease management on every radar screen,” she says. “And we're ready to help.”

MARSH SUPERMARKETS

Pharmacists often are the first contact after an asthma patient's visit to his or her allergist or pulmonologist. Dispensing metered-dose inhalers, prescriptions and, frequently, nebulizers, pharmacists see asthma patients on a regular basis. For Val Berger, manager of clinical services and outcomes for Muncie, Ind.-based Marsh Supermarkets, disease management programs were a natural fit for the supermarket chain's 40 pharmacy practices and regular clientele.

“Disease management training is important for our business, for our pharmacists' education and interest, and for the long-term value and relationship with our patients,” Berger says.

Marsh Supermarkets has established disease management practices with private consultation and training rooms in most of its pharmacies. The company trained its pharmacists first in diabetes disease management. Then, when Avi Weiss, former director of home care for Bindley Western Distribution, now part of Dublin, Ohio-based Cardinal Health, introduced the pharmacists' certification program for asthma disease management in 2000, Marsh Supermarkets sent 25 pharmacists through the training program.

The training paid off. Marsh Supermarkets employs 16,000 people throughout Ohio and Indiana. In discussion with its third-party administrator, the company launched its asthma management program by offering covered asthma disease management training to its own employees. The goals of this initial step included improving employee health, reducing absenteeism and developing outcomes.

Next, Berger began offering the program to physicians and pharmacy customers. Since Berger launched the program almost two years ago, more than 150 patients have participated.

“The program continues to build,” Berger says. “This is one of the disease management services we provide in an appointment-setting atmosphere with trained pharmacists. We [use] a team approach, involving physician, family and patient, pharmacists and other medical professionals.”

The one remaining obstacle for the Marsh Supermarkets program is reimbursement, according to Berger.

“There is little reimbursement for asthma training and education right now, but that can change,” he says. Marsh Supermarkets offers its training program to patients as an 80-minute program. The first session is 40 minutes; followed by two 20-minute follow-up sessions. Patients are charged $80 and can pay on a flexible basis.

“There has been little hesitation by families to pay for this training,” Berger says. “We state that the patients will learn and see a demonstrable improvement in their management of asthma after the first session. Like everything, patients want to see results.”

CHS FAMILY HEALTHCARE

When pharmacist Amanda Place joined CHS Family Healthcare Pharmacy in Muncie, Ind., part of the Cardinal Health system, she knew she was going to introduce an asthma disease management training and patient education program. CHS Family Healthcare Pharmacy is located within a clinic; the pharmacy is a door away from the allergists and pediatricians.

Training through Bindley Western's certified asthma specialist program provided Place with the tools and education she needed to get started. However, banking on the benefits of being located within a clinical practice, Place went a step further by expanding physician referral to patients with complex long-term asthma. Patient training is completed in the physician's office and billed as a level-one office visit.

Place launched the program with the clinic's physicians in September 2001. The program trains two to three patients each month, and Place anticipates the program will be booked at capacity by the end of its first year. Monthly meetings are held with the physicians on development updates and clinical protocols for complex asthma patients. They also track and document education visits to monitor education milestones achieved.

“We view our services as another resource physicians can use,” Place says.

Helpful Hints

DONNA SMITH, RRT, manager of respiratory services and co-developer of New Berlin, Wis.-based Home Care Medical's asthma management program offers this advice to other HME providers:

• Know the National Institutes of Health guidelines for asthma management programs
• Structure a program that performs
• Be the expert
• Know your market
• Make yourself visible
• Network

VAL BERGER, manager of clinical services and outcomes for Muncie, Ind.-based Marsh Supermarkets has some tips on establishing a successful pharmacy-based asthma management program.

• Focus on getting started
• Network
• Structure the program in such a way that patients can measure their improvement between classes
• Promote your program

PHARMACIST AMANDA PLACE, who works for Cardinal Health's Family Healthcare Pharmacy in Muncie, Ind., offers the following recommendations for implementing a successful asthma management program:

• Establishing good rapport between physicians and other health care providers is critical.
• Be more educated than anyone in the area. Preparation and depth of knowledge in asthma education and training is imperative.

Published in HomeCare Magazine