A Survey of Asthma Care in Managed Care Organizations: Results
Characteristics of Asthma-Specific Services and Covered Benefits
Table 2 provides insights to some key aspects of asthma-related services and covered benefits. All of the staff model plans offered some type of asthma education program. These patient education programs were offered much less frequently in both the nonstaff model plans (36.4%) and noncapitated plans (33.3%). Asthma case management programs were also available in some, but not all of the health plans: 33.3% of the staff model plans, 45.5% of the nonstaff model capitated plans, and 33.3% of the noncapitated plans. Comprehensive, population-based asthma management strategies (eg, asthma disease state management programs) were offered infrequently in all types of plans.
The data revealed some important variations in benefit coverage for asthma-related medications and services. Among the staff model and nonstaff model capitated plans, overall coverage of asthma medications and peak flowmeters was high; these plans covered spacer devices less frequently (Table 2). All plans offered coverage of some type of asthma education, although the exact content of this coverage was not characterized and may have varied from plan to plan. Very few plans covered allergen reduction materials such as pillow and mattress covers. Similarly, very few plans covered smoking cessation programs and smoking cessation medications. Of note, 45.5% of the nonstaff model capitated plans covered environmental home assessment for persons with asthma. In contrast, none of the staff model plans covered environmental home assessments. mycanadianpharmacy
Characteristics of Asthma-Specific Quality Improvement Activities
Monitoring and improving quality of care are important goals of MCO operations. As part of this survey, the MCOs were asked about asthma-specific quality improvement activities within their plans. Only 54.5% of the nonstaff model capitated plans promoted the use of practice guidelines for asthma care (Table 3). Use of asthma guidelines in the staff model plans and noncapitated plans was even less frequent.
Table 2—Characteristics of Asthma-Specific Services and Covered Benefits Among Chicago-Area MCOs
Characteristics | Capitated Care | Noncapitated Care (n = 6) | |
Staff Model(n = 3) | Network (n = 11) | ||
Asthma-specific services | |||
MCOs offering an asthma education program | 100.0 | 36.4 | 33.3 |
MCOs offering an asthma case management program | 33.3 | 45.5 | 33.3 |
MCOs offering an asthma disease management program | 33.3 | 18.2 | 16.7 |
Asthma-specific covered benefits | |||
Medications | 66.7 | 100.0 | 83.3 |
Spacer devices | 66.7 | 72.7 | 83.3 |
Peak flowmeters | 66.7 | 100.0 | 66.7 |
Nebulizers | 66.7 | 90.9 | 66.7 |
Asthma education | 100.0 | 100.0 | 100.0 |
Pillow/mattress covers | — | 9.1 | — |
Smoking cessation programs | 33.3 | 18.2 | — |
Smoking cessation medication | 33.3 | 18.2 | — |
HEPA filter/cleaner | 33.3 | 9.1 | — |
Dehumidifier | — | — | — |
Home assessment | — | 45.5 | 16.7 |
Table 3—Characteristics of Asthma-Specific Quality Improvement Activities Among Chicago-Area MCOs
Characteristics | Capitated Care | Noncapitated Care (n = 6) | |
Staff Model(n = 3) | Network (n = 11) | ||
MCOs that estimated number of covered lives with asthma diagnoses | 66.7 | 54.5 | 33.3 |
MCOs that conducted drug utilization reviews | — | 54.5 | 66.7 |
MCOs that used of asthma care practice guidelines | 33.3 | 54.5 | 33.3 |
MCOs that tracked HEDIS 2.5 asthma measure in 1995 | 33.3 | 27.3 | 33.3 |
MCOs that tracked HEDIS 2.5 asthma measure in 1996 | 33.3 | 36.4 | 33.3 |
MCOs that conducted an asthma quality improvement effort | |||
Related to NCQA accreditation activities in 1995 | — | 9.1 | 16.7 |
Related to NCQA accreditation activities in 1996 | 33.3 | 27.3 | 16.7 |
Category: Asthma
Tags: Asthma, asthma care, health