Asthma management program peaks managed care interest
Company offers unique approach to data collection
Successful disease state management programs are like a breath of fresh air for managed care organizations (MCOs). The Asthma Self-Management Program (ASMP), developed by Research Triangle, NC-based pharmaceutical company Glaxo Wellcome Inc., is an example of just what MCOs want a program that achieves measurable cost reductions while improving member satisfaction and quality of life. Private duty providers looking for a specialty service to add might consider implementing elements of this program, such as patient education. (See story, p. 135.) The program also offers a unique approach to data collection and analysis.
"[To analyze data], you simply look at whether the patient has received a set of interventions [and which ones], look at the outcomes, and then use regression techniques to determine which combinations of interventions had the largest impact on which sets of patients," says Gary Slatko, MD, MBA, vice president of operations in the care management division at Glaxo Wellcome, which administers the program.
The program’s pilot project was implemented at eight sites across the United States, including corporations, managed care organizations, and allergy specialty clinics.
Imagine offering a program to MCOs with these outcomes: Prior to the asthma self-management training, a majority of the program participants (57%) reported feeling anxiety, irritability, or depression as a result of their asthma. Three months after completion of ASMP, 90.3% reported no emotional problems. After six months, 75% had no emotional problems, and only 6.6% reported significant problems. (The average age of the program participants in this survey group was 44. About three-quarters of them were female.)
Prior to ASMP, 68.3% of participants reported some or a lot of difficulty in daily indoor or outdoor work, a figure that dropped to 41.9% in three-month interviews and to 37.7% in the six-month follow-up. Participants also reported fewer limitations in their physical activities. In the four weeks prior to the study, 69.8% of participants reported some or many limitations due to asthma. At three months, that figure fell to 41.9%, and at six months, 47.3%.
ASMP participants also said they experienced less time missed from work, school, or other activities. For the four weeks prior to the program, 27% reported missing more than one day from work, school, or usual activities. In the three-month follow-up interviews, only 3.2% missed more than one day from work, school, or usual activities in the previous four weeks. In the six-month interviews, 16.6% missed more than one day in the prior four weeks.
Since the end of the project, ASMP has been purchased by health plans such as HealthGuard in Lancaster, PA, and employers such as Pitney Bowes in Stamford, CT. Payers say they like the program because it incorporates behavior modification and is easy to implement.
The data collection component
With all of its disease management programs, including asthma, HIV, and gastroesophageal reflux disease, Glaxo’s care managers consult a "wide spectrum of data sources" when collecting data, says John Paul, PhD, director of clinical economics and outcomes assessment at Glaxo Wellcome. Among the most important sources, particularly when working with managed care organizations, is retrospective medical claims data, which Glaxo uses not only for measuring outcomes but to identify prospective patients on the front end.
"We want to work to learn what types of physician guidelines and practice guidelines are in place," Paul says. "We take the claims data and try to assess the current status of the diseases what the needs are, using the data to help identify patients."
Paul adds that, occasionally, when retrospective claims data are deemed inadequate, Glaxo’s care managers supplement them with pharmacy claims data or laboratory data, or use a screening survey to get patient-reported data upfront. "Some plans now have health-risk appraisals or even SF-36s as part of their routine care program," Paul says. "And often these can be linked in with claims experience. You can build a fairly sophisticated algorithm for selecting patients by combining these different data sources."
In addition, having such data upfront allows disease managers to establish a baseline with which they can compare outcomes data to assess a program’s impact, Paul says.
Participants in the program were surveyed about their knowledge of the disease, self-management skills, and attitudes, as well as utilization and impact on health care services. Participants were asked the same series of questions before, three months after, and six months after completing the program. Follow-up is continuing with a nine- and 12-month study.
A third-party source surveys the participants, says Mark Santry, director of the division’s Respiratory Development and Marketing. "[They are asked,] How often do they go to the emergency room? How often do they go to the hospital? If they go the hospital, how many days do they spend there?’" The results of the surveys are reported back to the employer or health plan so [the payer] can gauge the improvements from participants taking the course. (For specific survey questions, see p. 134.)
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