Jeri Peters thought that there had to be something that worked better for asthma patients.
When she joined UCare in 2005, the health plan offered a telephone-based coaching program for people with asthma. UCare primarily serves Medicaid and Medicare enrollees, as well as people from diverse cultures and people with disabilities. Asthma, which afflicts about 10 percent of Minnesotans, predominantly affects women, children and the poor.
Among UCare’s more than 400,000 members who have asthma, it can be an expensive condition, often resulting in hospitalizations and emergency-room visits.
The coaching program was meant to reduce these. But as Peters notes, it was having limited success. That was even the case when the patients seemed to be following doctor’s orders. “We saw that they were taking all their medications and taking them at the right time, but they were still going to the emergency room,” Peters recalls.
Peters and her team saw that they needed another strategy—a team approach that works more actively with the communities UCare serves. In 2012, they introduced a home visiting and case management program for UCare members with asthma.
To be part of the program, a member has to meet one of four criteria: had a recent emergency room visit or hospitalization for asthma; took four or more medications for asthma in the past two years; had an increase in symptoms; or inconsistently used asthma medications. Doctors can refer members to the program; members may also directly enroll themselves.
Because the program can’t provide care for all of UCare’s roughly 40,000 members with asthma, Peters and her team focused on the patients considered to be at the highest risk for hospitalization—100 to 200, primarily children.
The program includes an initial in-home assessment and up to a year of case management. In-home evaluations are essential to determining whether environmental factors are part of the problem. Asthma may be triggered by allergens and irritants found indoors and outdoors. Tobacco smoke can also start an attack. Patients receive a phone call each month, with additional home visits if needed. Peters realized that her nurses, for all of their skills, didn’t have adequate knowledge of asthma’s complexities. So UCare partners with Little Canada-based Regency Home Health Care, which provides respiratory therapists.
The new program introduced another element: To encourage continued participation in the program, UCare provides members, as well as minors’ parents and guardians, gift cards following the initial assessment. The member receives a $10 Target gift card for each completed visit and a $30 gift card when he or she no longer needs case management.
So far, UCare is happy with the new program’s results. In the roughly two years since its launch, UCare says it has seen a 51 percent drop in emergency department visits and a 27 percent reduction in hospitalizations for members with asthma. All of the respondents to a member satisfaction survey agreed that the program helped them better manage their condition. Nearly all (96 percent) said that they get useful information from the respiratory therapist during the home visit and follow-up calls. Eighty-three percent both made an appointment with their doctors for a routine asthma care visit and say they’re having fewer asthma-related breathing problems.
Peters emphasizes that the program has been successful because respiratory therapists inspire trust. “Both patients and their parents are going to perceive a [respiratory therapist] as the expert to help them,” she says. Peters adds that in each case, the therapist shares his or her findings from the in-home assessment with the family’s pediatrician or primary care physician. They then work as a team to make changes to members’ action plans.
She also notes that the Target gift cards provide incentives for the patients and their parents. “They both have to work together to manage the child’s asthma,” Peters says.
UCare is now expanding its asthma program with the help of Wellshare International, a nonprofit that works with the Twin Cities Somali community. “We have a fairly large Somali membership,” Peters notes. “Respiratory problems are common, particularly for those who are refugees.” UCare is bringing together a respiratory therapist with a Wellshare community health care worker for home visits. “The goal is to bridge that cultural gap through that community health care worker, who is Somali,” Peters adds.
Asthma is one of those conditions that crosses cultural boundaries. But thanks to the community-based management that Peters has introduced, many of those suffering from the disease are breathing easier.
How It Helps
There’s more to asthma than the asthma itself. For instance, one of UCare’s members with asthma, an adult male, also has seasonal and environmental allergies that can trigger or dangerously worsen his attacks.
Unhappy with the care he was receiving from his clinic, he signed up for UCare’s asthma home visiting/case management program. The respiratory therapist he worked with helped him schedule an appointment at a different specialty clinic. There he gained a better understanding of how his medications worked, when to use what, and when to start prednisone when his allergies became particularly troublesome.
His breathing scores improved, his visits to the emergency room ceased, and he started immunotherapy for his allergies—all thanks to the guidance of the program’s respiratory therapist.
How They Did It
Launched in 2012, UCare’s home visit and case management program for its members with asthma has scored much stronger results than its previous asthma management program. Here’s why it has worked better:
- In-home visits. Previous programs relied solely on telephone-based coaching. In-home visits allow the program team to evaluate patients’ home environments, which can have a strong impact on managing the disease. Such visits also build a stronger relationship between the patient and the team.
- Respiratory therapists. Instead of nurses and social workers who don’t have expertise with this chronic and often complicated condition, UCare’s program is staffed with respiratory therapists whose knowledge has helped improve outcomes—notably, fewer hospitalizations and ER visits.
- Partnering. UCare taps the knowledge of other organizations to make the program work. Notable among these are Little Canada-based Regency Home Health Care, which provides respiratory therapists, and Minneapolis-based Wellshare International, whose community health workers serve the local Somali community.