National Environmental
Leadership Award
in Asthma Management


Recognition Ceremony
June 9, 201 1


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The National Environmental Leadership Award
in Asthma Management
The U.S. Environmental Protection Agency (EPA) is committed to improving the lives of
people with asthma by integrating sound science into effective public health programs. In
partnership with other federal agencies and nonprofit organizations, EPA delivers a national,
multi-faceted education and outreach initiative to increase public awareness and action
to manage environmental asthma triggers as part of comprehensive asthma management.
An important component of this initiative is the recognition of exemplary programs and
community leaders so that they may serve as national models and mentors for community
asthma care improvement. The National Environmental Leadership Award in Asthma
Management celebrates the outstanding programs and leaders who are improving the lives of
people with asthma by delivering strong environmental asthma management as part of their
comprehensive asthma care services.
201 I Award Winners
Centene Corporation®
Nurtur® MHS (St. Louis, Missouri and Indianapolis, Indiana)
As an experienced, comprehensive service provider,
Managed Health Services, a Centene Corporation
Medicaid health plan, understands the need to customize
asthma solutions for diverse populations. As a result,
in 2007 Managed Health Services and sister company,
Nurtur, Centene life, a health and wellness company,
established a comprehensive asthma program designed
to address the needs of several specific target audiences;
these include persons with asthma in addition to other complex chronic conditions, as well as pregnant
women and children with asthma.
Medical records, pharmacy records and claims data are scanned by predictive modeling software to
identify patients that meet these criteria, who are then referred to the Asthma Team. A case manager
follows up with each patient to assess their level of need and recommends an appropriate asthma
intervention. Educational materials for children and adults, trigger identification training, goal-setting
exercises, home visits and barrier assessments are just some of the many tools used as a part of this
CENTENE'
Corporation
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nurtur
^ ^	MANAGED HEALTH SERVICES
care to be different

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holistic asthma care process. The patient's treatment plan is also updated by the Asthma Team and sent
to the physician for review.
Continuous monitoring and evaluation are integral to this program, and results from 2007 to 2009
indicate an incredible 17.3 percent decrease in emergency department visits for child participants and
a 9.4 percent decrease for adult participants. In addition, visits to primary physicians for children and
adults were up by 11.1 percent and 16.4 percent, respectively, indicating improved preventive care.
South Bronx Asthma Partnership
Bronx-Lebanon Hospital Center (Bronx, New York)
In New York's South Bronx community, one in five school-aged
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children has asthma — one or the highest rates in New York City. - —
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Helping the South Bronx breathe easy.
In response to this staggering statistic, Bronx-Lebanon Hospital
Center's Department of Pediatrics created the Childhood
Asthma Management Program in 2000. Through clinical
pediatric asthma services, community-based activities of the
New York State Department of Health-funded asthma coalition, and hospital-community collaborative
programming, the program promotes asthma-friendly environments and ensures the delivery of
integrated health care services for children with asthma.
Early on, program staff members recognized that to improve asthma outcomes, they must not only
improve provider knowledge and communication, but also strengthen the existing health system in
which providers practice. As a result, the program conducts provider training sessions that translate
asthma management recommendations into quality clinical practice to ensure that patients receive
comprehensive asthma services across the care continuum. Furthermore, the program engages Medicaid
to provide reimbursement incentives for provider participation in asthma education.
As the lead organization of the South Bronx Asthma Partnership, Bronx-Lebanon Hospital Center
also partners with a variety of environmental agencies and community organizations to create
tailored environmental interventions that address both indoor and outdoor asthma triggers. Program
partners provide building walk-throughs, designate asthma-friendly zones at schools, and provide pest
management assistance and air-sampling. In addition, the program distributes culturally appropriate and
literacy-sensitive educational materials throughout the hospital and the community to promote patient
self-management and encourage healthy behaviors in homes.
This multi-faceted approach to asthma care has resulted in tremendous success. Since 2003, Bronx-

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Lebanon Hospital Center has shown a 42 percent decrease in asthma-related hospitalizations, as well as
a decrease in the length of stay of asthma-related hospitalizations. This equates to an annual average cost
savings of about $431 per child. In addition, the National Asthma Control Initiative recently named
the Bronx Lebanon partnership as a clinical champion in recognition of their efforts in promoting the
Expert Panel Report 3 — Guidelines for the Diagnosis and Management of Asthma.
New York State Department of Health
Center for Environmental Health
Healthy Neighborhoods Program (Troy, New York)
In the early 1980s, the New York State Department of Health,
Center for Environmental Health recognized that housing
hazards were often complex and were best addressed by a
neighborhood-level approach. As a result, the Center developed
the Healthy Neighborhoods Program in 1985 — a statewide
program aimed at improving housing conditions in high-risk
communities through a holistic, healthy homes approach.
This program relies on an extensive network of grant-funded, local health department partners and
emphasizes home environmental management as an enhancement to case management and clinical
care. Local health departments initially identify target areas in the community for intervention and
develop work plans to meet the specific needs of that area. These health departments are also encouraged
to leverage local resources and infrastructure to ensure that the services delivered are meaningful and
effective.
During home visits, field staff members assess a wide variety of healthy homes issues, including tobacco
control, fire safety, lead poisoning prevention, indoor air quality, asthma control, injury prevention and
more. Following the assessment, residents are provided with products, referrals and education to help
remediate any potential hazards identified during the assessment. A quarter of homes receive a three-
to-six month follow-up visit to reassess conditions. Any new or ongoing problems identified during the
revisit are addressed.
This program has had incredible success for residents with asthma, with marked improvements in
environmental triggers, including a 14% reduction in environmental tobacco smoke exposure and
improved pest control in at least 44% of homes with pest problems. There have also been significant
improvements in participants' knowledge about asthma triggers and significant decreases in the number
of days with worsening asthma and in the number of work or school days missed due to asthma.

NEW YORK STATE
Healthy
Neighborhoods
Program

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National Environmental Leadership Award
in Asthma Management
Hall of
2010
Children's Hospital Boston
Community Asthma Initiative, Children's Hospital Boston
Boston, Massachusetts
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i > Neighborhood Neighborhood Health Plan of Massachusetts
Boston, Massachusetts
Your health. Our promise.
y	Sinai Urban Health Institute
vml	Chicago, Illinois
SUHI
WIN
WIN for Asthma
New York, New York
Woodhull Medical and Mental Health Center
Brooklyn, New York
2009
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Bethlehem Partnership
f'tn 4 Healthy Community
Bethlehem Partnership for a Healthy Community
The Asthma Initiative
Bethlehem, Pennsylvania
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California Department of Public Health - Center for Chronic
Disease Prevention and Health Promotion
Richmond, California
Seton Asthma Center
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A member o< the Seton ftmUf of Hotpiub
Seton Asthma Center
Austin, Texas

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National Environmental Leadership Award
in Asthma Management
Hall	o (continued)
Boston Medical Center and Boston Public Health Commission
Boston, Massachusetts
Genesee County Asthma Network
Flint, Michigan
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GCAN
Genesee Ctantv Aahma Network
2008
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Asthma
Network
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University of Michigan
Health Syttem
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Monroe Plan
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Asthma Network of West Michigan
Grand Rapids, Michigan
University of Michigan Health
System
Ann Arbor, Michigan
Monroe Plan for Medical Care
Rochester, New York
2007
MaineHealth AH! Program
Portland, Maine
©Priori

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National Environmental Leadership Award
in Asthma Management
Hall of Fame (continued)
2006
IMPACTS
WellPoint.
IMPACT DC—Improving Pediatric Asthma Care in the
District of Columbia
Washington, District of Columbia
Blue Cross of California, State Sponsored Business Unit
Camarillo, California
2005
. Children* Mercy
oeoos? rasim bsbukebs
: www.fhp.org
Children's Mercy Hospitals and Clinics
Kansas City, Missouri
fli Optima Health
OptimaHealth Virginia Beach, Virginia

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Learn more about the National Environmental Leadership
Award in Asthma Management at
http://www.epa.gov/asthma

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