Transcript Business Case for Quality Phase II

Business Case for Quality Phase II
(BCQII)
Ingrid Lamirault, CEO
Alameda Alliance for Health
ACAP Presentation – July 2009
About AAH
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Alameda Alliance for Health (AAH) is a local
health plan (a public entity) in Alameda
County, CA
The health plan serves over 102,000
members
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Medi-Cal (Medicaid): 88,000 members
Medicare Special Needs Plan: 1,150 members
Healthy Families (CHIP): 9,200 members
Group plan for State/County In-Home Supportive
Services workers: 4,400 members
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Impact of Asthma
 20% of children in Oakland have asthma - twice
the national average
 Children’s Hospital-Oakland (CHO) is the primary
provider for severe uncontrolled asthma
 Asthma is the primary reason for emergency
room visits
 4,755 asthma emergency room visits/year
 25-30% of these patients had previous ER visit in last year
 Asthma is the primary reason for hospitalization
 1,805 asthma hospitalizations
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Impact of Asthma
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Almost 5,000 children enrolled in the AAH
plans have an asthma diagnosis
One third of these members received ER
services at CHO and were treated multiple
times in the ER for asthma-related events
ER visits in one year among this group
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Range: 2-18 visits
Mean: 3 visits
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AAH and
CHO Collaboration
2003
2005
2008
Develop
asthma
data
warehouse
(CHCS)
In-office training
of PCPs for
patient education
(CHCF)
ER based
intervention called
ATTACK Clinic
(CHCS BCQII)
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About ATTACK Clinic
Program Name
Asthma Tools and Training Advancing Community
Knowledge
Goal
Reduce return ER visits for asthma by 30%
Strategy
Connect
patients to their medical home
Provide families the tools and training to manage their
child’s asthma at home
Previous Success
Similar program in D.C. reduced ER and hospitalizations by
40% *
*Teach, S. J. Improved Asthma Outcomes in a High Morbidity Pediatric Population Results of an Emergency Department-Based Randomized Clinical
Trial. Archives of Pediatric and Adolescent Medicine. 2006;160 535-541.
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ATTACK Clinic
Design and Evaluation
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Randomized control design based on day of
the week
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On treatment days, patients are referred to the
ATTACK clinic for the intervention
On control days, patients are referred to their PCP
CHCS has developed separate contracts for
independent statistical analysis and evaluation
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Mathematica Policy Research, Inc.
University of North Carolina
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ATTACK Intervention
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ER-based educational/medical intervention for families
of children with asthma in separate CHO clinic
One-time visit for children 2-18 years:
Asthma management plan for family and school
 Intensive 1:1 education for child and parent/guardian
1. Pathophysiology of asthma
2. Asthma medications – how to use and why
 Referral to county asthma case management or specialists
 Warm hand-off to PCP (appt/progress note)
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Results
After one year
Data use agreement between AAH,
Mathematica and UNC
 156 number of families seen in the ATTACK
Clinic
 Inconsistent referrals to ATTACK clinic from
ER
 AAH staff taking a more active role in
recruitment through ER face sheets
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