United States
            Environmental Protection
           I Agency
                                  National Environmental  Leadership Award
                                  in  Asthma Management
                                  BLUE CROSS OF CALIFORNIA, STATE SPONSORED  BUSINESS (SSB)
                                                                                                             Blue Cross
                                                                                                              of California
Basic Information
Blue Cross of California, State Sponsored Business (SSB), provides coverage to about one third of California's Medicaid and Healthy Families
enrollees, including 45,000 members with asthma (34,000 children and I 1,000 adults).
The Asthma Management Program
SSB's Comprehensive Asthma Intervention Program includes member and provider education and outreach, incentives for physicians and pharmacists
who follow care guidelines, and home visits for members as needed. SSB's Health Services staff provide extensive member and provider outreach
from the main office. SSB also maintains a Community Resource Center (CRC) in managed care counties where it has members. CRC staff work with
local providers and coalitions to tailor SSB's asthma management programs to the local population. For example, the Fresno County program has an
environmental focus and collaborates with Fresno air quality experts, while San Francisco's program focuses on identifying best methods for improving
clinical care for asthma members. CRC staff also assist with member outreach, helping members find and become accustomed to visiting a primary
care physician, setting up appointments, and coordinating transportation.
A unique element of the Comprehensive Asthma Intervention Program is additional support for extended pharmacy consultations.  Pharmacists are
reimbursed for having 10-minute point-of-service consultations as often as twice per year with asthma members whose records suggest inappropriate
medication usage.
Environmental Management of Asthma
All of SSB's programs include member education on environmental triggers and home assessments as indicated through the American Lung
Association (ALA) or other community-based organizations.  In San Francisco County, through the Plan /Practice Improvement Project Collaborative,
CRC staff encourage providers to educate members about the role of asthma triggers.  CRC staff also supply clinical practices with mattress and
pillow casings, and encourage providers to distribute these to members with asthma. In Fresno County, poor air quality and high asthma prevalence
prompted SSB to invest extra resources into air quality research, in partnership with the Valley Air Quality Committee. SSB contributed asthma claims
data for its Fresno members; based on these data, health care leaders have come together to develop community-wide interventions. SSB also
contracts with a Fresno hospital, Community Medical Center (CMC), to offer asthma education through CMC's Asthma Education and Management
Program. In addition, SSB partners with the ALA to send Fresno children to asthma camp.

Results Achieved	

In a study of a subset of California SSB members with asthma between 2001 and 2005, the use of appropriate asthma medication rose from 56.0 % to
66.4 % (HEDIS rates). The additional services provided in Fresno County since 2003 have played a role in the achievement of even higher HEDIS
rates in that county: 75.5 % in 2004 and 72.5 % in 2005.
SSB claims data indicate that from 2004 to 2005, asthma-related hospitalizations for Medicaid members with asthma decreased 60 %, and
asthma-related emergency room visits decreased 46 %. Asthma-related outpatient visits to primary care physicians and specialists decreased 25 %
and 14 %, respectively.

Lessons Learned

With such a large and diverse membership (SSB covers 1.18 million members in California), SSB realized that a one-size-fits-all approach would not be
effective. Local CRCs provide face-to-face service for members and serve as an effective liaison between SSB, providers, and community groups.
Getting Started
   When members enroll, make sure they sign up with a primary care physician and start to recognize that provider as their main resource for health care.
   Look for effective and efficient ways to reimburse pharmacists for providing educational consultations on appropriate asthma medication use.
   Provide members with education about appropriate asthma self- management, and in particular, about ways to avoid unnecessary exposure to
   both indoor and outdoor asthma triggers and pollutants.

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