The University of Michigan Health System (UMHS) is a non-profit health care provider serving 12,214 adults and children with asthma in Southeastern Michigan. Since 2005, the UMHS Quality Improvement Steering Committee, a group of multidisciplinary volunteers, has guided improvements in asthma care across the health system. UMHS provides specific, population-based programs for high-risk asthma populations and in-home asthma education through the Michigan Visiting Nurses Asthma Home Environmental Assessment Program. Web-based, standardized NHLBI-compatible guidelines are available to all providers, including standardized asthma action plans and education templates. A comprehensive, validated, all-payer database of asthma patients helps UMHS identify areas of need for targeting interventions and assessing outcomes. As a result of these programs, UMHS achieved a 50 percent decrease in asthma-related hospitalizations among participants in the Children’s Asthma Wellness Program from July 2005 to June 2007. Between June 2006 and June 2007, participants in the home assessment program had a 60 percent decline in ED visits and an 85 percent decrease in hospitalizations.
The Asthma Network of West Michigan (ANWM) is a community coalition that provides comprehensive home-based case management to 82,933 children and adults with asthma in West Michigan. ANWM has demonstrated impressive results including improved health outcomes and cost savings. This success has led to a partnership with Priority Health (a winner of the 2007 National Environmental Leadership Award in Asthma Management) who agreed to reimburse ANWM for its home visit program. This partnership with Priority Health is the nation’s first agreement between a grassroots coalition and a managed care plan. ANWM now has contracts with five local health plans and its asthma management program provides asthma education, coordination with health care providers, development of asthma action plans, home environmental assessments, and social service support. ANWM’s comprehensive care costs $2,500 per person annually and has led to a 64 percent decrease in hospitalizations and a 60 percent decrease in ER visits. These improved health outcomes resulted in approximately $800 in net health care cost savings per child per year.
The Monroe Plan for Medical Care is a managed care organization, located in the Rochester, New York area. The Monroe Plan covers 5,633 children with asthma in Monroe County and 12 neighboring rural counties. With a high asthma burden among children in the area, the Monroe Plan saw trends in pediatric asthma and noticed high admission rates that disproportionately affected minorities. Monroe Plan partnered with ViaHealth, a health care delivery system, to launch a program to shift asthma care toward improved patient self-management. The program now covers all of the plan’s members with moderate to severe pediatric asthma and includes assistance to providers in creating asthma action plans and comprehensive provider and member education. Home assessments are conducted by bilingual asthma outreach workers to identify and reduce environmental triggers. As a result of these interventions, ER visits decreased from 1.1 visits per person to .95 visits per person over the first three years of the program. Inpatient admissions decreased from 98.3 admissions per thousand to 84.15 per thousand in the first three years of the program.