A Survey of Asthma Care in Managed Care Organizations: Characteristics of Asthma-Specific Quality Improvement Activities
The respondents reported conducting asthma drug utilization reviews in a majority of the nonstaff model capitated plans and noncapitated plans, 54.5% and 66.7%, respectively. The most common reviews were for use of inhaled anti-inflammatory medications (85.7% of nonstaff model and noncapitated plans) and short acting p-agonists (71.4% of nonstaff model and noncapitated plans). This type of review was not conducted in the staff model plans.
The respondents indicated that a majority of the capitated health plans had made an effort to estimate the number of covered lives diagnosed with asthma (Table 3). Approximately 83.3% of the capitated plans used asthma hospitalizations as the identifier for these estimates, and 66.7% of the capitated plans used emergency department visits or prescriptions as the identifier. Patient identification via urgent care visits, routine office visits, or patient survey were less common (Table 4).
During both 1995 and 1996, approximately one third of the plans in each category were tracking the Health Employers Data Information Set (HEDIS) measure for asthma. Asthma-related quality improvement efforts in response to National Committee for Quality Assurance (NCQA) accreditation was rare in 1995. However, by 1996, nearly one third of the capitated insurance plans were conducting some type of asthma improvement project. so
The respondents indicated that, for 61.5% of the plans, program development in asthma care improvement was a high-priority goal relative to programs for other conditions. In addition, the respondents indicated all three staff model plans as well as 81.8% of the nonstaff model capitated plans intended to implement an asthma care improvement program in the next year. A majority of the respondents indicated their plans would be interested in participating in a collaborative asthma care improvement activity with other MCOs.
Table 4 —Detailed Information of Asthma-Specific Quality Improvement Activities Among Chicago-Area MCOs
|Quality Improvement Activities||All MCOs With Activity|
|How persons with asthma were identified by MCOs (n = 6)|
|Hospitalizations for asthma||83.3|
|Emergency department visits for asthma||66.7|
|Prescriptions for asthma-related medications||66.7|
|Urgent care visits for asthma||33.3|
|Routine office visits for asthma||33.3|
|Information from patient survey||33.3|
|Drugs routinely monitored for persons with asthma by MCOs (n = 7)|
Tags: Asthma, asthma care, health