Children’s Hospital Boston Community Asthma Initiative: Partnerships and Outcomes Advance Policy Change

Abstract

A community coalition that successfully addresses asthma health disparities with a strong business case and program outcomes can be leveraged to persuade policy makers of the value of innovative financing strategies for asthma care.

Community Asthma Initiative to Improve Health Outcomes and Reduce Disparities Among Children with Asthma

“…This included collaboration among local and regional asthma healthy housing and healthy schools coalitions to address indoor air quality in schools and homes (31) and among regional and national agencies to develop a business case and educate legislators and insurers about outcomes and costs for this enhanced approach to care. CAI has active community and family advisory boards, which contributed recommendations that have been incorporated into the program.…”

“…In addition, CAI is a member of the Boston Asthma Home Visit Collaborative, convened by the Boston Public Health Commission, which receives funding from EPA and others to share best practices among public health, hospital, health center, payer, and community-based organizations of a nursesupervised CHW model of home visits using a standardized, evidence-based protocol. CAI provided outcome and cost data to the Boston Children's Office of Government Relations and community partners to educate decision-makers and make a case for the potential benefits of a bundled payment pilot project for patients with high-risk asthma within the Massachusetts Medicaid program (31,36). Boston Children's was recently designated as one of three sites in Massachusetts approved to participate in this pilot; implementation will begin pending an agreement with The Commonwealth of Massachusetts Executive Office of Health and Human Services.…”

Economic Evidence for US Asthma Self-Management Education and Home-Based Interventions

“…8, 21, 33–84 Approximately half (9/17) were identified in peer-reviewed literature. 36, 46–48, 54, 60, 63, 64, 76, 77, 80, 81, 83, 84 An additional 25 U.S. programs providing ≥1 asthma-related home visit reported cost savings without ROI data (Table E3). …”

“…Most programs (12/17) operated in urban settings 33–36, 42–44, 46–49, 60, 62, 65–67, 70, 71, 73–75, 80, 81, 83, 84 , and information was not available for the remaining 5 programs. 37–41, 54, 59, 76–79, 85 Program descriptions indicated health insurance plans operated or served as partners in over one-third (6/17) of programs.…”

Considerations and challenges for eliminating asthma disparities in children

“…Return on investment was calculated as the difference in baseline hospital costs from year 1 to year 2 for CAI patients divided by the cost of the program. Program successes contributed to the Massachusetts legislature approving a pilot project that allows providers to submit a bundled payment for Medicaid-enrolled children that includes evidence-based asthma interventions not currently reimbursed by Medicaid, such as home visiting by community health workers [2]. The Community Asthma Initiative is an evidence-based asthma intervention that is effective in improving quality of life for inner-city African-American and Latino children, while showing a return on investment of US$1.46, due to lower asthma-related hospital costs.…”