Investing in Best Practices for Asthma: A Business Case for Environmental Interventions

Size: px

Start display at page:

Download "Investing in Best Practices for Asthma: A Business Case for Environmental Interventions"

Meryl Cain
8 years ago
Views:

1 Investing in Best Practices for Asthma: A Business Case for Environmental Interventions Presented by: Stacey Chacker Director, New England Asthma Regional Council Director, Environmental Health Department, Health Resources in Action

Chacker Director, New England Asthma Regional Council

2 New England Asthma Regional Council A Program of Health Resources in Action ARC works to reduce the impact of asthma across New England, through collaborations of health, housing, education, and environmental organizations, with particular focus on the contribution of schools, homes, and communities to the disease and with attention to its disproportionate impact on populations at greatest risk.

environmental organizations, with particular focus on the contribution of schools, homes, and

3 Asthma Regional Council Contact Information: Stacey Chacker ARC Director ext

4 Key Sources 1. Investing in Best Practices for Asthma: A Business Case for Education and Environmental Interventions (2007) By Polly Hoppin and Molly Jacobs, UMass Lowell, and Laurie Stillman, The Medical Foundation Produced for the Asthma Regional Council in partnership with UMass Lowell and Children s Hospital Boston 2. The Role of Pest Control in Effective Asthma Management: A Business Case (2009) By Molly Brett and Laurie Stillman, The Medical Foundation Produced by ARC for the Boston Public Health Commission s Healthy Pest-Free Housing Initiative

Jacobs, UMass Lowell, and Laurie Stillman, The Medical Foundation Produced for the Asthma Regional Council in partnership with UMass Lowell

5 Asthma s national price tag Economic Cost of Asthma, 2007 (in billions of dollars) Hospital Care Prescription drugs Physician's services Indirect costs $14.7 billion in direct health care costs $6.2 billion for prescription drugs Total cost of asthma in US in 2007: $19.7 billion Source: American Lung Association

7 Hospital Care Prescription drugs Physician's services Indirect costs 3.8 6.

6 Housing Interventions and Health Outcomes: A Review of the Evidence Convened by CDC and NCHH Experts weighed scientific evidence on health impacts of various home interventions Found Sufficient Evidence of Clinical Impact for multi-faceted tailored home interventions for asthma: Education (Social learning theory) Mattress and pillow covers HEPA Vacuum HEPA Air Filter (subset) Smoking Cessation Cockroach Extermination Bedroom cleaning

Impact for multi-faceted tailored home interventions for asthma: Education (Social learning theory) Mattress

7 Environmental interventions recommended among best practices for asthma management The National Asthma Education and Prevention Program 2007 Guidelines for the Diagnosis and Management of Asthma outlines 4 main components of asthma management: 1. Measures of assessment and monitoring 2. Comprehensive pharmacologic therapy 3. Multifaceted environmental control measures to avoid or eliminate factors that contribute to asthma severity 4. Patient education

asthma management: 1. Measures of assessment and monitoring 2. Comprehensive pharmacologic therapy 3.

8 Two ways to establish a business case in the health care sector 1. Does the intervention result in cost savings? (Do savings from reduced health expenditures exceed the cost of the program?) 2. Is the intervention cost-effective? (Is the cost of a new service reasonable relative to costs of standard services, given the health benefits?)

(Do savings from reduced health expenditures exceed the cost of the program?) 2.

9 Primary Findings Investing In Best Practices for Asthma Management: A Business Case for Education and Environmental Interventions (2007) Home-based environmental assessments, services & supplies targeted to high risk patients are cost-effective. Education targeted to high risk patients realize cost-savings The Role of Pest Control in Effective Asthma Management: A Business Case (2009) IPM education and services are cost-effective interventions for certain high-risk asthma patients

10 Environmental Interventions Setting: Home Number of visits: 5-9 Personnel: Community health worker Components of Multifaceted Interventions (Tailored to patients exposures and sensitivities) Home assessment Extensive education regarding trigger avoidance Basic supplies such as mattress/pillow encasements, cleaning supplies, basic IPM supplies, etc. Pest abatement Some provide instruction in IPM methods Some provide professional services Equipment such as a vacuum cleaner w/ HEPA filter Services such as smoking cessation

Basic supplies such as mattress/pillow encasements, cleaning supplies, basic IPM supplies, etc.

11 Multifaceted interventions: The Inner-City Asthma Intervention Conducted multifaceted two-year in-home intervention in homes of inner-city children with persistent asthma Cost: $1,469 per patient per year Results: Reductions in levels of cockroach and dust-mite allergen significantly correlated with reduced complications of asthma. Fewer days with symptoms, fewer school days missed 2.1 fewer unscheduled asthma-related visits to the emergency department (ED) or clinic per child per year The intervention was found to be a cost-effective means of reducing asthma symptom days, relative to costs of standard services.

reduced complications of asthma. Fewer days with symptoms, fewer school days missed 2.

12 Multifaceted Interventions: Seattle-King County Healthy Homes Project 1-year environmental intervention in households of lowincome children with persistent asthma The intervention cost $1124 per patient. Health benefits of the tailored intervention included: Fewer symptom days 17% reduction in the proportion of participants utilizing urgent health services for their asthma Due to the decrease in urgent care utilization, researchers projected 4-year net savings per participant of $189 $721.

Health benefits of the tailored intervention included: Fewer symptom days 17% reduction in the proportion of participants

13 Cost-effectiveness of Environmental Interventions: Are Costs Reasonable? Method: Compared cost per symptom free-day gained as a result of the intervention with costs per symptom free-day gained as a result of standard drugs. Findings: Interventions cost $2-$28 per symptom free-day gained (SFD) Comparison with accepted pharmacotherapy: $7.50 per SFD for inhaled corticosteroid $11.30 per SFD for budesonide $523 per SFD for Xolair Yes, costs are reasonable relative to standard pharmacotherapy

14 Average costs: Health care services for allergic asthma An ED visit for allergic asthma $1,434 A hospital stay for allergic asthma (adult) $9,261 A hospital stay for allergic asthma (children aged 0-17) $7, data from the Agency for Healthcare Reform and Quality s Healthcare Cost and Utilization Project the largest collection of hospital care data in the United States

(children aged 0-17) $7,987 2006 data from the Agency for Healthcare Reform and Quality s

15 Average costs: Medications for allergic asthma Advair (fluticasone & salmeterol) Xolair (omalizumab) up to $2,945 per year up to $15,600 per year Advair cost based on 2006 average wholesale price. Xolair cost based on 2008 average wholesale price.

per year up to $15,600 per year Advair cost based on 2006

16 Environmental Interventions are cost-effective, and could result in cost savings for payers For certain high-risk asthma patients, the costs of environmental interventions are reasonable relative to costs of standard services, given the health benefits realized by the intervention. With hospital visits for allergic asthma often costing from over $1000 to over $9000, an environmental intervention that results in just one fewer hospital visit could realize cost savings for payer organizations.

17 Framework for Implementation Patient characteristics: Asthma diagnosis 1 or more ED visit, hospitalization or unscheduled physician visit in 6 months >3 rescue medications; Classified as moderate or severe persistent Multifaceted, Tailored Environmental Intervention High Risk Asthma Patients Patient characteristics: Sensitized to a particular pest allergen Exposed to that particular allergen Intervention including IPM services

persistent Multifaceted, Tailored Environmental Intervention High Risk Asthma Patients Patient

18 Recommendations Provider Groups Support asthma educators and community health workers Encourage referrals to home-based asthma management programs Employers Request coverage for comprehensive asthma services through health insurance contract negotiations Policymakers Create a sustainable statewide reimbursement mechanism that supports best practices for asthma care

comprehensive asthma services through health insurance contract negotiations Policymakers

19 Recommendations Public and Private Payers: Pay for supplies and services shown to reduce exposures to environmental triggers Structure reimbursement mechanisms for the range of providers of asthma education and environmental services Establish incentives for providers to classify patients and make referrals to clinical and in-home sessions

range of providers of asthma education and environmental services Establish

20 Appendix: Practice Literature as of 2007 Optima Health (Virginia Beach, VA) For severest asthma patients, provides asthma education, environmental home assessments, and supplies to reduce exposures Saved $4.10 for every $1 spent on their high-risk member program Monroe Plan for Medical Care (Rochester, NY) High risk children received services including allergy testing, asthma education, case management, home environmental assessment, and supplies Realized a 20% reduction in total asthma-related medical costs.

10 for every $1 spent on their high-risk member program Monroe Plan for Medical Care (Rochester, NY) High risk children received

21 Appendix: Breaking down the costs of an effective intervention Item Skin test to determine allergies Mattress Encasement (twin) HEPA Air Purifier HEPA Filter HEPA Vacuum Cleaner Terminix (1.5 visits) Cost $50.00 $61.85 $ $28.00 $ $ Costs provided by Jacqueline Pongracic of the Inner City Asthma Intervention (2005)

22 Appendix: Breaking down the costs of an effective intervention Introductory IPM Supply Kit Roller mop $11.00 Rubbermaid storage container w/ lid $3.23 Rubbermaid cereal keeper $7.00 Utility trash can (6-gallon) $5.60 Ocelo sponges (2-pack) $ to 6 cockroach glue traps $ mouse glue traps $1.30 Door sweeps $ feet of copper mesh $2.60 Total cost per supply kit: $34.63 Data supplied by Eugene Barros, Senior Inspector for Asthma/Healthy Homes program, Boston Public Health Commission (2008)

Investing in Best Practices for Asthma:

Asthma Regional Council Investing in Best Practices for Asthma: A BUSINESS CASE August 2010 Update AUTHORS: Polly Hoppin Sc.D and Molly Jacobs, MPH, University of Massachusetts Lowell Laurie Stillman,