A Survey of Asthma Care in Managed Care Organizations: Conclusions
Although it was evident that some plans sought to engage in performance monitoring for purposes of reporting to NCQA and HEDIS, a larger number of plans appeared to be examining health-care utilization for asthma via hospitalization, emergency care, or pharmacy records. However, the plans did not appear to have a uniform approach to identifying persons with asthma, and this survey did not query how the plans were using the information on asthma care utilization to affect quality improvement.
The 1996 National Asthma Education and Prevention Program’s Task Force on Cost-effectiveness, Quality of Care, and Financing of Asthma Care found that whereas MCOs may provide optimal access to most asthma-related services, co-payments and partial coverage of some services often create financial barriers for patients. Several studies have demonstrated how changing the systems for delivering asthma care can lead to better patient out-comes. However, these few studies do not represent a substantive body of literature on this subject to suggest optimal ways by which to improve care in managed care environments. so
There are numerous limitations to this study. Perhaps most apparent is the small number of observations. Only 13 MCOs participated in this survey, and information on the nonrespondents is not available to assess bias. Yet, as noted above, the MCOs that responded to the survey represent most of the managed care services delivered in the Chicago area. A larger study would, perhaps, make these findings more generalizable. Also, the findings of this study are based on self-reported data; respondents may report what they believe to be acceptable instead of actual practice. Therefore, many of the estimates may be optimistically high. The cross-sectional study design also limits interpretation to reflect a single point in time. A repeated cross-sectional or longitudinal cohort design would provide information on the changes in asthma care over time.
Given the many limitations, the information from this survey best serves as a starting point for generating ideas, concepts, and perhaps more formal hypotheses about the asthma care delivered by managed care plans. More important, this study provides some new insights into the variations in asthma care among health plans serving a community known to be at risk for unfavorable asthma outcomes.
Many of the plans offer competing services in the areas of asthma education, case management, and population-based management programs. Each plan sends providers and patients different materials and messages about optimal asthma care strategies, and many of the health plans do not have practice guidelines on which to base these strategies. Perhaps a first step for Chicago-area MCOs would be to design a process by which the health plans would adopt common asthma materials (eg, practice guidelines, patient education) so as to give a consistent message to health-care providers and patients. The Chicago Asthma Consortium would be one possible vehicle for facilitating this process. From this beginning, further efforts could be initiated to improve asthma care performance of individual health plans and the overall quality of managed care for persons with asthma living in Chicago.
Tags: Asthma, asthma care, health