Medicaid Outcomes Program Reduces Asthma Emergency
Services¹
One of the nation's first Medicaid disease management programs
shows that improving the management of asthma can reduce emergency
and urgent care services used by Medicaid patients and increase
the appropriate use of asthma medications. The rate of emergency
and urgent care service claims for patients of physicians who participated
in a disease management program declined by an average of 41 percent
after the program was implemented. This reduction is substantially
greater than expected based on the experience of physicians who
did not participate in the disease management program. The preliminary
results from this program, the Virginia Health Outcomes Partnership
(VHOP), have been published in the peer-reviewed journal Inquiry.
The findings from VHOP are among the first to demonstrate that disease
management benefits Medicaid patients, many of whom have chronic
illnesses that respond to disease management interventions.
Approximately one third of physicians treating asthma in the pilot
intervention community (eight central Virginia counties) volunteered
to participate and were trained in disease management techniques
and communication skills. Eligible physicians were those that participated
in a primary care case management program (PCCM), a program that
pays physicians on a fee-for-services basis but coordinates care
through primary care physician case managers. In Virginia, approximately
31 percent of Medicaid patients receive care through PCCM and 16
percent of Virginia's asthma patients resided in the intervention
community.
Researchers found an average 41 percent reduction from the previous
year in the rate of asthma emergency and urgent care service claims
for the third and fourth quarters following the introduction of
the disease management pilot program. The rate for the third quarter
alone was 46 percent lower. Although some reduction in emergency
and urgent care rates was observed among physicians in a comparison
community that was not a part of the pilot program, rates of emergency
and urgent care among physicians in the pilot program nevertheless
were as much as 31 percent lower than expected. If VHOP has been
implemented statewide for all PCCM physicians, during the five post-intervention
quarters, it could have saved as much as $1.2 million in spending
for emergency and urgent care claims.
The impact of the disease management interventions was measured
by calculating emergency and urgent care utilization, a proxy indicating
how well the patient's asthma was controlled. Use of certain asthma
medications that control asthma attacks - albuterol metered dose
inhalers and nebulizers - increased by 25 percent or more during
the pilot program when compared to medication used by patients whose
physicians were not trained in the VHOP disease management interventions.
The disease management intervention involved training physicians
in the appropriate use of state-of-the-art asthma therapy and in
proven communication methods for teaching patients effective asthma
control. Physicians learned the clinical indications that should
trigger referral of their patients to a specialist and how to educate
their patients about the use of peak flow meters. They were also
informed when their patients used emergency and urgent care services.
VHOP's goal was to improve treatment outcomes and control costs
of care for Medicaid PCCM patients. This goal was achieved by improving
patient care, resulting in better control of asthma, thereby avoiding
unnecessary use of expensive services such as hospitalizations and
emergency rooms. VHOP was developed by the Virginia Commonwealth
University in cooperation with the Virginia Department of Medical
Assistance, the state medical society, and pharmacy and nurses'
associations, with funding from the National Pharmaceutical Council.
The program was expanded in the fall of 1997 beyond central Virginia
and implemented statewide for asthma among physicians paid under
PCCM. The program was also implemented statewide for congestive
heart failure. Analyses from the expanded program on asthma and
congestive heart failure are expected when data is available. Education
materials have also been developed for physicians on the effective
management of diabetes mellitus and schizophrenia. Following the
favorable experience in Virginia, several states are implementing
disease management programs in cooperation with disease management
organizations or other state agencies. Disease management can improve
care for Medicaid recipients while reducing costs, building partnerships
with physicians, and enhancing the effectiveness of PCCM.
The study "The Virginia Health Outcomes Partnership: A Demonstration
Project, 1997" is available by clicking here.
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¹ The following material is based, in whole or in part upon data
accessed from the Virginia Department of Medical Assistance Services
(DMAS). DMAS retains all rights of ownership to said data. No copies
or reproductions, electronic or otherwise, in whole or in part,
of the following materials may be made without the express written
permission of DMAS.
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