United States
Environmental Protection
Agency
National Environmental Leadership Award
in Asthma Management
Priority Health
PriorityHealth"
Who We Are
Nonprofit health plan serving more than 19,000 people with asthma in 43 Michigan counties.
Partnership with the Asthma Network of West Michigan (ANWM) and reimbursement for home-based education—this relationship, the first
between a health plan and an asthma network in the nation, underscores the value of ANWM's services and Priority Health's commitment to its
members.
Our Asthma Management Program
Priority Health takes a total community approach to managing asthma, partnering with ANWM and working with members, providers, pharmacists,
case managers, employers, and schools and daycare centers. Priority Health has a strong educational program for all its asthma members, with the
addition of case management for moderate and high risk members. Case managers develop individual care plans in concert with the member, primary
care physicians (PCPs), and specialists. The interactive Patient Profile tool allows clinicians to look at the record of an individual member with asthma
or to sort for care opportunities for all their members with asthma. Routine review of pharmacy claims by case managers can also prompt follow-up
with members and PCPs. Priority Health implemented a program that provides an incentive (per member per month) to physicians whose asthma
patients meet a specified ratio of long-term controller medication to short-acting medication. Another innovation is the Pacesetter's initiative in which
Priority Health and provider office staff team to implement the Planned Care Model in support of improving processes for managing asthma patients
and, ultimately, improving health outcomes.
Managing Asthma Triggers
In 1999, Priority Health partnered with ANWM to provide home-based case management for members in their service area with moderate to severe
asthma. Priority Health reimburses ANWM for providing asthma education, conducting home assessments, meeting with providers to develop individual
asthma management plans, working with social workers who provide social service referrals for members, and conducting in-service training for schools
and daycare centers. A particular focus is reducing exposure to secondhand tobacco smoke, and implementing measures to reduce triggers in the home.
Priority Health has teamed with an outside firm to provide 24-hour professional counseling and follow-up for members who want to stop smoking.
Results to Date
^ Emergency room visits per 1,000 members reduced from 72 in 2002 to 40 in 2006 for commercial members and from 250 to 189 for Medicaid
members.
^ Hospital admissions per 1,000 members decreased from 26 in 2005 to 18 in 2006 for commercial members and from 62 to 36 for Medicaid
members.
^ In 1995, the ROI of the asthma disease management program was $ 1.7 million.
^ Relationship with ANWM expanded in both scope and service area.
Lessons Learned
^ Telephone case management, complemented with a home-based asthma program, can yield significant outcomes in the clinical and financial
management of asthma.
^ Provider education is important to ensure that evidence-based practice is incorporated within the physician community in support of asthma.
^ Collect and use data to demonstrate successes and promote sustainability.
Replicating Success
Drive the sustainability of the asthma disease management program through comprehensive population health management, including:
• Case management services such as telephonic outreach and home-based services.
• Partnerships with community providers.
• Physician tools, education, and incentives.
• Outcome metrics.
Reimburse for home-based education, if asthma providers can show ROI and value on investment.
Gather, assess, and evaluate the data, so that the impact of the program's interventions can be demonstrated, both clinically and financially.
Leverage your resources with the resources that exist in your community, to further collaboration and outcomes.
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