AmeriHealth Caritas

AmeriHealth Caritas, through a local affiliate, implemented a comprehensive asthma management program serving Medicaid recipients in southeastern Pennsylvania’s five counties, including Philadelphia. This multifaceted program applies a sustainable approach based on population health, guiding members through a continuum of care that is built on solid evidence and works within AmeriHealth Caritas’ integrated health care management system. Members and network providers can participate in several unique, award-winning initiatives that support the delivery of asthma medication and supplies, asthma education, and home environmental surveys. Since 2012, AmeriHealth Caritas has incorporated asthma-specific measures into its Annual Operating Plan’s Managed Care and Quality goals.

In 2015, Philadelphia was ranked the third-worst city for asthma in the United States, with 16,000 children visiting emergency rooms each year for asthma-related causes. The asthma management program serves residents of culturally diverse inner-city environments such as west and northwest Philadelphia, where one out of four children has physician-diagnosed asthma or was admitted to the hospital for wheezing.

AmeriHealth Caritas works with local network providers and community-based organizations to deliver a range of services that reach members in their physicians’ offices, homes and communities to enhance existing care management efforts. Simultaneously, AmeriHealth Caritas continuously improves its capability to monitor, assess and refine its offerings based on member, staff and provider feedback.

Care managers and support staff guide members by telephone or in person across the continuum of care to (1) identify members with a primary diagnosis of asthma; (2) perform asthma management assessments; (3) categorize patients into risk strata and high-need population groups; (4) implement tailored interventions based on risk profile and social determinants of health; (5) perform reassessments as needed; and (6) monitor outcomes to quantify program effectiveness and financial sustainability. Low-risk members receive general and asthma-focused education through member mailings and are invited to AmeriHealth Caritas-led programs and events. High-risk members receive individual care management assessments, care planning and interventions focused on priority areas (i.e., asthma control action plan, sick day plan, medication management, behavioral risk management and asthma self-management). The asthma action plan incorporates environmental management protocols and helps members contact public and private entities, supporting members’ overall health. Member material—which can be translated into 200 languages on request—is written at a sixth-grade reading level and keeps patients’ cultural needs in mind to help members with limited English proficiency understand medical content.

AmeriHealth Caritas partners with the local affiliate’s high-volume network providers, which have led to distinct provider-specific community health worker (CHW) models in northeast Philadelphia, west Philadelphia and Chester tailored to the local demographic and fiscal environments. Trained CHWs, supervised by a medical director, cooperate with the practice- and telephone-based care management system to provide face-to-face care coordination, home health and environmental surveys, and asthma-related education for members and their families while addressing the social determinants impacting members’ health. When environmental asthma triggers are identified, the CHW suggests such actions as installing an air conditioner or new windows, removing carpet, and conducting mold remediation; in some instances, they even provide members with an “asthma home kit” (hypoallergenic mattress and pillowcase covers, storage bins, trash bags, cockroach bait stations and cleaning supplies). To help connect to cultural and health literacy barriers faced by members in their communities, CHWs often are hired from those same communities, and several are bilingual, primarily in Spanish and English.

Additional service offerings include provider-led dispensation of asthma medication and supplies and hands-on education during office visits (B.E.S.T. asthma program—Breathe Easy. Start Today.®); school-based clinic partnerships to address member care gaps in asthma medication adherence; and “edutainment” programming (Healthy Hoops®) for children with asthma and their families.

From 2013 through 2015, statistically significant improvements were observed in asthma controller medication adherence rates, acute hospitalizations and hospital readmissions. Increases in pharmacy expenditures for asthma medication were more than offset by significant decreases in hospital admission rates. Dozens of provider practices and thousands of members have participated in these asthma-focused initiatives, leading to 327 CHW-led home visits and environmental surveys, as well as the distribution of more than 13,000 asthma medications and supplies and 875 asthma home kits. During this time, hundreds of children with asthma and their families in the community attended Healthy Hoops® programs in the Philadelphia area, where pediatric participants received health screenings (including spirometry, peak flow and spacer education). Asthma action plan consultation stations provided participants with a clinical summary and a blank asthma action plan template to assist their providers in completing an individualized asthma action plan.