Control Asthma

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Fast Facts
  • More than 26 million Americans have asthma (1 in 12 children and 1 in 13 adults).1
  • Each year, asthma accounts for more than 439,000 hospitalizations, 1.7 million emergency department (ED) visits, and 13.8 million missed school days.
  • Asthma costs about $50 billion each year in healthcare costs.
  • Every day, about 10 people die of asthma. Black Americans are 2-3 times more likely to die from asthma than any other racial or ethnic group.
Evidence-Based Interventions
  1. Promote evidence-based asthma medical management described in the 2007 National Asthma Education and Prevention Program (NAEPP) guidelinespdf iconexternal icon.
  2. Promote strategies that help people access and continue to use asthma medications and devices.
  3. Expand access to intensive self-management education for people whose asthma is not well controlled with guidelines-based medical management alone.
  4. Make it easier for people with asthma to have home visits by licensed professionals or qualified lay health workers, if their asthma is not under control with medication and education. Home visits help people with asthma learn how to manage asthma and reduce triggers at home.

What You Can Do to Control Asthma

Healthcare Providers

  • Follow NAEPP Guidelines for medical management of asthma, such as assessing asthma severity, regularly monitoring asthma control, and prescribing inhaled corticosteroid when appropriate. Health care providers who follow NAEPP guidelines have seen decreases of up to:
    • 45 % in asthma related ED visits,
    • 56 % in asthma-related hospitalizations,
    • 19 % in asthma-related outpatient visits, and
    • 59 % in asthma symptom days.
  • Investigate and consider using available CPT codes to support your or your team’s delivery of asthma self-management education.
  • Refer patients to asthma-related home visit programs available through local community organizations or patients’ health insurance plans.

Payers

  • Emphasize key components of the NAEPP in clinical practice guidelines.
  • Use claims data to improve asthma disease case management through directed provider trainings, audits, or feedback.
    • Using claims data this way has been shown to reduce asthma-related ED visits up to 55 percent and hospitalizations up to 56 percent. Return on investment of $2.40 to $4.00 return on each $1.00 spent has been reported.
  • Share pharmacy claims data with health care providers to identify patients who frequently use rescue inhalers and do not adhere to controller medication regimens.
  • Let patients get asthma devices (such as spacers) from pharmacies instead of durable medical equipment facilities.
  • Employ certified asthma educators or trained lay health workers for asthma disease management programs.

Selected Studies Behind the Interventions

Payers

Asthma Medical Management

In a study involving more than 4,000 Medicaid recipients (adults and children) in a large metropolitan area, a program:

  • Trained healthcare providers on the NAEPP Guidelines.
  • Used claims data to deliver provider-specific feedback at 6-month intervals.

This program showed a 41% reduction in asthma-related ED visits. Return on investment (ROI) was $3.00 to $4.00 per every $1.00 spent.2

Access to Asthma Medication and Devices

A study reviewed pharmacy claims data from more than 2,000 patients enrolled in a health maintenance organization (HMO). This review showed patients with above-average copays were less likely to fill their first-time prescriptions for asthma medications within 30 days of the prescription date.3

Asthma Home Visits

A review of the health and economic evidence for asthma home visits identified 17 US home visit programs that reported ROI.4 About one-third of these programs involved health plans, and most of those plans were in urban areas. Fifteen of the 17 programs reported a positive ROI for all or some participants, and one program for children less than 6 years old observed a positive ROI. The study estimated that it would take an average of 3 years for programs to have a positive return on investment.

Healthcare Providers

Asthma Medical Management

An insurance company, healthcare provider, and nonprofit organization worked together on a multistate quality improvement project that promoted guidelines-based management for asthma to primary care providers (PCPs).

The effort used data from insurance payers to:

  • Identify clinics serving patients with asthma who are at higher risk for emergency department (ED) visits or hospitalizations.
  • Track health outcomes.

The project reduced asthma-related ED visits by 55% and asthma-related hospitalizations by 56% percent.5,6 Return on investment was $2.40 per every $1.00 spent. 7,8,9

Access to Asthma Medication and Devices

A study reviewed interventions designed to improve healthcare providers’ adherence to asthma treatment guidelines. The review showed prescriptions for controller medications could be increased by supporting healthcare provider decision-making (decision support), providing performance data to healthcare providers about their quality of care, and targeting how pharmacists’ provide care (clinical pharmacy support).10

Asthma Home Visits

A review found that providing clinical decision-making support for healthcare providers or clinical pharmacy support could help increase healthcare providers’ provision of asthma self-management education to patients.11

Employers

In a study using an employer-sponsored health plan, a combination of asthma education and lowering of disease copayments resulted in a 10% increase in the number of people using their asthma medication as prescribed and an overall decrease in medical costs for the employer.12

Resources

EXHALE Technical Package to Control Asthmapdf icon
The EXHALE technical package represents a group of strategies, which, based on the best available evidence, can improve asthma control and reduce health care costs. It is intended as a resource to inform decision-making in communities, organizations, and states.

Learn How To Control Asthma – Asthma FAQs
A summary of short answers to frequently asked questions about asthma.

Asthma in Children – CDC Vital Signs February 2018
A summary of problems related to asthma, important statistics, and information on what one can do to control asthma in children.

Home Characteristics and Asthma Triggers – Checklist for Home Visitorspdf icon
Simple and low cost action items that a trained home visitor can use to help remove asthma triggers in the home.

CDC’s Asthma Reimbursement Report – Self-Management Education and Environmental Managementpdf icon
This document is a resource for asthma program managers and partner organizations who are considering options for implementing or redesigning reimbursement mechanisms to increase access to evidence-based asthma management practices.

National Asthma Education and Prevention Program (NAEPP)external icon
A collection of asthma guidelines, tools and materials to put guidelines into practice.

1Centers for Disease Control and Prevention.  Asthma Data.  Available at https://www.cdc.gov/nch1s/fastats/asthma.htm.  Accessed 1 April 2019

2 Cloutier MM, Grosse SD, Wakefield DB, Nurmagambetov T, Brown CM. The economic impact of an urban asthma management program. American Journal of Managed Care. 2009; 15(6): 345–51.

3Berger Z, Kimbrough W, Gillespie C, Boscarino JA, Wood GC, Qian Z, Jones JB, Shah NR. Lower copay and oral administration: predictors of first-fill adherence to new asthma prescriptions. American Health & Drug Benefits. 2009;2(4):174–80.

4Hsu J, Wilhelm N, Lewis L, Herman E. Economic evidence for U.S. asthma self-management education and home-based interventions. Journal of Allergy and Clinical Immunology: In Practice. 2016. DOI: 10.1016/j. jaip.2016.05.012.

5Asthma Community Network. Collaborating for Better Care: Strategies for Successful Partnerships Between Health Plans and Asthma Programs. Available at Asthma Community Network. Collaborating for Better Care: Strategies for Successful Partnerships Between Health Plans and Asthma Programs.pdf iconexternal icon Accessed 18 January 2017.

6Rossiter LF, Whitehurst-Cook MY, Small RE, et al. The impact of disease management on outcomes and cost of care: a study of low-income asthma patients. Inquiry. 2000;37(2):188-202.

7Rossiter LF, Whitehurst-Cook MY, Small RE, et al. The impact of disease management on outcomes and cost of care: a study of low-income asthma patients. Inquiry. 2000;37(2):188-202.

8Asthma Community Network. Collaborating for Better Care: Strategies for Successful Partnerships Between Health Plans and Asthma Programs. Available at Asthma Community Network. Collaborating for Better Care: Strategies for Successful Partnerships Between Health Plans and Asthma Programs.pdf iconexternal icon Accessed 18 January 2017.

9Cloutier MM, Grosse SD, Wakefield DB, Nurmagambetov T, Brown CM. The economic impact of an urban asthma management program. American Journal of Managed Care. 2009; 15(6): 345–51.

10Okelo SO, Butz AM, Sharma R, et al. Interventions to modify health care provider adherence to asthma guidelines: a systematic review. Pediatrics. 2013; 132(3):517-34

11Okelo SO, Butz AM, Sharma R, et al. Interventions to modify health care provider adherence to asthma guidelines: a systematic review. Pediatrics. 2013;132(3):517-34.

12D’Souza AO, Rahnama R, Regan TS, Common B, Burch S.  The H-E-B Value-Based Management Program:  Impact on Asthma Medication Adherence and Healthcare Cost.   Am Health Drug Benefits. 2010;3(6):394-402. Accessed 1 April 2019.