By Melinda Young, Author
EXECUTIVE SUMMARY
A Memphis-based pediatric asthma program quickly produced positive results for patients and Tennessee’s Medicaid program due to its community, healthcare provider, and payer collaboration.
• The program cut ED visits by 60%.
• An independent evaluation showed that the program saved more than $2,000 per enrolled child.
• The program addresses social determinants of health, including housing and legal issues that patients’ families face.
The Changing High-risk Asthma in Memphis through Partnership (CHAMP) asthma program worked so well during its three-year Medicaid Innovations grant pilot period that Tennessee payers and providers collaborated to continue its work after the grant money ended in 2015.
The purpose of the innovation grant project, which was launched by the Centers for Medicare & Medicaid Services (CMS), was to address a problem in the health system’s area, says Susan Steppe, LAPSW, director of CHAMP and 38109 Population Health at Le Bonheur Children’s Hospital in Memphis, TN.
“The main focus for us is children with high-risk asthma,” Steppe says. “It’s the most prominent chronic disease of childhood for most cities across the country.”
Data from 586 CHAMP patients, who were enrolled for 12 months beginning in July 2016, showed the following positive outcomes:
• ED visits were reduced by 60%;
• inpatient admissions/observations reduced by 71%;
• urgent care visits cut by 56%;
• 53% decrease in total asthma exacerbations;
• 52% reduction in asthma-related ambulance calls.
A recent independent evaluation of CHAMP and other pediatric asthma programs nationwide found that Le Bonheur’s relationship with TennCare in targeting high-risk asthma patients was a success. The program reduced ED visits and all-cause asthma hospitalizations, and helped produce a savings of more than $2,000 per year per child, Steppe says.
CHAMP also won the 2015 National Environmental Leader Award in Asthma Management from the U.S. Environmental Protection Agency.
In Shelby County, where Memphis is located, there are tens of thousands of children on TennCare, Tennessee’s Medicaid program, and many of them have asthma. Statewide, an estimated 12% of children have the chronic illness.
Asthma is a big focus for BlueCare of Chattanooga. A managed care company, BlueCare has a contract with TennCare to handle Tennessee’s Medicaid population.
“We have 600,000 members and multiple contracts with the state,” says Frances Martini, BSN, MBA, vice president of population health at BlueCare.
Steppe and Martini met at a 2014 CMS panel on asthma in Atlanta, and that meeting sparked collaboration.
“Once I saw what an impact Le Bonheur’s asthma program had on our population, Susan and I became connected at the hip to see what we could do to impact this population together,” Martini says. “We realized the program was so successful with asthma that the outcomes were positively impacting the state, numbers, and the quality numbers were better than any other program in Tennessee.”
Le Bonheur’s CMS innovation grant expired on June 30, 2015, so Martini worked with Steppe to design a similar asthma program that could help the Memphis area and serve as a model for the entire state. (See story on how CHAMP works in this issue.)
CHAMP focuses on clinical aspects, social determinants of health, and the administrative aspect to case management.
“We saw the outstanding results, but knew it was important to remember the administrative opportunities for similar provider-payer partnerships across Tennessee,” Martini says.
BlueCare partners with primary care provider groups that have strong asthma knowledge and an ability to coordinate, she says.
One aspect of the asthma program that might be challenging to replicate in some areas of the state, such as more rural regions, is its focus on ending barriers caused by social determinants of health.
In the Memphis area, there are several community agencies and resources that case managers can use when trying to find solutions for patients’ nonmedical problems, such as housing insecurity and transportation.
“Memphis and Shelby County are rich with interested community agencies and resources,” Martini says. “Not being originally from the South, I am so impressed as to how robust community commitments are helping their populations become healthy and how strong the faith-based community is.”
Shelby County community programs include early childhood intervention, nurse-family partnerships, legal aid, and programs that deal with the link between childhood traumatic events and health, Steppe says.
“The program is dealing with patients’ housing issues, and we are trying to expand the housing portion of what we do,” she says. “Sometimes people need help with landlords.”
Le Bonheur Children’s Hospital has a medical-legal partnership with the University of Memphis Law School and Memphis Area Legal Services. Together, the organizations help patients deal with housing problems and other legal issues, Steppe says.
It helps if case managers can use a multipronged approach to tackle patients’ barriers.
“What we find as case managers is it’s a case manager’s dream to find community agencies to help,” Martini says. “These agencies are needed when you work with a population where there are challenges, and families are often more concerned about how they can eat and pay rent and pay utilities and get to school.”
Community support is key to having case managers address patients’ social determinants of health, she adds.
“You identify a family that has a child with asthma, and the home might have carpet with dust mites, so the first step is to get the home healthy,” Martini says. “These solutions are not usually covered by insurance companies, but if you have community resources to tap into for the benefit of the child, that’s what Susan’s team offers.”
A Medicaid-funded program trying to model CHAMP would be challenged to succeed as well as CHAMP has without access to community resources, she notes.
“You have to work within the Medicaid benefit and there are exclusions of services not permitted by the contract, so that’s why case management is so important,” Martini says. “The idea of case management is not to find out what the member needs and pay for it — the idea is to look between that gap and see where there is support available within the community.”
In addition to their work in Memphis, BlueCare’s case managers regularly work with partners to ensure members receive services to close the gap between the benefit and the member’s need, such as nebulizers in one school district.
A Memphis-based pediatric asthma program quickly produced positive results for patients and Tennessee’s Medicaid program due to its community, healthcare provider, and payer collaboration.
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