Special Report: Disease Management
Asthma program reduces costs, improves health
Health plan sponsors see a 4-to-1 return
A study of 1,811 people who participated in Scottsdale, AZ-based PCS Health Systems’ Healthy Results asthma disease management (DM) program for one year showed that the program reduced emergency room visits by 17%, hospital admissions by 14%, hospital days by 21%, and the number of doctors’ office visits associated with asthma by 22%.
PCS is one of the nation’s largest pharmacy benefit managers, and provides the program on behalf of its health plan clients. Some plans put their name and PCS’s on the program, while others just put PCS on the introductory letters.
The reduction of medical expenses represented more than a 4-to-1 return on investment for the health plans that sponsored the program, or a net savings of nearly $150 per enrollee.
In addition to decreasing overall asthma-related costs, program goals include helping patients control asthma symptoms and encouraging the appropriate use of over-the-counter and prescription medication. "The program clearly shows that medical cost savings and improved quality can go hand in hand," notes Marsha Moore, MD, PCS’ senior vice president and chief medical officer.
A series of educational booklets and other written materials are at the heart of the Healthy Results program, explains Dan Sullivan, MD, assistant vice president and health management services for PCS.
"Taken together, they represent the core patient education materials that people with asthma should have," he says. The information is distributed throughout the year in several separate booklets "so participants can get small, digestible pieces that they complete in each time period," he explains. Those pieces, which can be read in one sitting, are divided in a manner similar to that found in other PCS DM programs:
• Explaining the disorder. The important aspects of asthma are outlined, not only for adults but also for children. In addition to explaining what can be expected if asthma is managed correctly, it explains to children that asthma is nothing to be ashamed of, and that it’s not anybody’s fault.
• Medication. What medications you may be taking, how to use them and when, and common side effects.
• Other actions you can take. Discusses things the patient can control, such as avoiding allergens, what to do on high-pollution days, and information about flu shots.
• How to identify when you may be getting into trouble. How to handle the problem on your own, and when you should call a doctor.
The organization of the information is one of the strengths of the program, says Sullivan. "You’re not confronted with 80 pages at a time, but 12 or 16," he notes. "The folks who helped us design these booklets — who are experts in adult ed — have advised us as to just how much people will absorb in one chunk."
Not exactly self-care
It would not be accurate to call the program "self-care," says Sullivan, because of the heavy physician involvement.
After asthmatics are identified primarily through pharmacy claims data, the physician who manages the patient receives information from PCS. This includes general information about current guidelines for management, as well as tools to help them help their patient.
"For example, we provide a blank form they can copy to fill out each patient’s asthma action plan," says Sullivan.
This written plan will be constructed according to guidelines established by the National Institutes of Health; those guidelines vary with the severity of the case. PCS also provides patient-specific drug histories for the last six months. "This will let the doctor see if the patient has been filling the prescriptions he should, as often as he should," says Sullivan. "Or, perhaps he may be using his rescue meds’ too often."
The fact that both the patient and the doctor are intimately involved with the program is one of the keys to its effectiveness, Sullivan asserts. "The doctor gets our feedback and feedback from the patient, and the patient knows the doctor will be keeping track of his progress," he explains.
He also notes the importance of "the efforts we made to make the materials truly understandable, and understanding how patients react to the disease." The printed materials also repeat basic messages, such as: "Remember to take your long-term medications, even if you feel well. The experts agree that if they could just get the patients to take their long-term control meds, to take precautions on foggy days and to call their physician if the peak flow meter is off, they’d be 100% better," Sullivan says. "We just take those small messages and try to communicate them throughout the program."
PCS appears to be on the right track: Nearly 70% of the survey participants said they would use the information they received from PCS.
• Dan Sullivan, PCS, 9501 E. Shea Blvd., Scottsdale, AZ 85260. Telephone: (480) 314-8870. Web site: www. pcshs.com.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content