A Survey of Asthma Care in Managed Care Organizations: Discussion
As the results from this survey demonstrate, many of the managed care plans in the Chicago community have an interest in providing comprehensive asthma care and have identified asthma as a priority for quality improvement efforts. According to the survey, benefit coverage for essential items such as asthma medications, peak flowmeters, and spacer devices is generally high. Most of the health plans offer some type of asthma education, and some of the plans appear to be adopting more formal asthma education programs as well as asthma case management plans or more comprehensive disease management programs. However, there are other important issues in asthma care that the MCOs in Chicago have not fully embraced. For example, very few plans cover allergen avoidance materials such as pillow and mattress covers or environmental control measures such as air purifiers or devices for humidity management. Similarly, there is very little coverage for programs or medications targeting smoking cessation. Many of the health plans have not formally adopted any guidelines for asthma care. mycanadianpharmacy.com
There also appear to be differences in some of the asthma-specific services offered in staff model vs nonstaff model capitated health plans. For example, coverage of environmental home assessments was only reported among the nonstaff model plans. All the respondents indicated that they covered some type of asthma education, and all three of the staff model plans offered a formal asthma education program. However, nearly two thirds of the nonstaff model plans did not offer any formal asthma education program to their enrollees.
During 1995 and 1996, HEDIS included an asthma indicator. Although it is unclear how much impact this indicator had on how various plans chose to focus on asthma, this survey found that approximately one third of the plans were conducting some type of asthma quality improvement activity in response to HEDIS and NCQA.
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