Recipient of the 2012 U.S. Environmental Protection Agency National Environmental Leadership Award in Asthma Management
“Winning the 2012 EPA Leadership in Asthma Management Award validated the strength of not only our asthma management program but also our community collaborative approach”
As a 2012 U.S. EPA award recipient, L.A. Care has had the opportunity to provide mentorship and guidance to other states and programs looking to improve the health of its members with chronic conditions.
L.A. Care uses various strategies to touch and equip more than 90,000 members with asthma with the tools necessary to better manage their asthma. Their disease management program uses encounter, pharmacy and claims data as well as member and physician referrals to identify new members for the programs. Newly identified members are stratified based on these determinants and targeted outreach is conducted according to the member’s severity level.
Interventions include outreach calls by L.A. Care’s staff of registered nurses, educational mailings, access to a 24 hour nurse advice line, and an asthma resource line for members to call. Newly identified members receive a new member welcome packet with information on educational resources available to them. Resources include tips on what to discuss with their physician, information on asthma triggers, steps for dealing with asthma flare-ups and easy and safe cleaning products to use.
Culturally, Linguistically and Age Appropriate Educational Resources
L.A. Care uses age specific asthma control tests and action plans to provide culturally, linguistically and age appropriate information to its members with asthma. Materials are made available in English and Spanish and can be translated into other languages as needed to treat its diverse population. Coloring books and other age-appropriate materials are provided that explain what asthma is and how it can be managed.
A holistic approach is taken with its members with asthma and all receive a PHQ9 depression screening and an asthma assessment that includes:
Adherence to asthma treatment plan including medications, physician visits, Asthma Action Plan
Condition monitoring with age-specific asthma control test
Health behaviors such as tobacco use, asthma trigger exposure
Consideration of other health conditions
Motivational interviewing is a counseling approach used by the nurses to foster a partnership and is used to detect members’ readiness to change and empower the member to take charge of their health. Bilingual English-Spanish nurses are on staff and translation services are available if the member does not speak English or Spanish.
Once assessed, L.A. Care’s registered nurses may refer members to health education classes and behavioral health classes, which are offered in four locations across the greater Los Angeles area. Members may also be assigned to a social worker and/or case manager as needed. L.A. Care contracts with QueensCare Health Centers to conduct in-home visits to members needing more one-on-one care. In 2014, L.A. Care and QueensCare expanded their geographic reach to additional communities and increased monthly referrals from approximately 35 to 95 members as a result.
In-home visits are conducted by community health workers (CHWs) to gain a snapshot of the member’s current health situation through care management, reduce the possibility of future asthma flare-ups through home environmental assessments, and to empower the member with the necessary skills to better manage and control their asthma through health education. CHWs conduct 3 in-home visits and do follow-up calls to members after each visit.
Referrals and Provider Outreach
Reports from each home visit are sent to the referring nurse on the education provided to the members, medications and devices used, results from the asthma control test and quality of life assessment, the environmental triggers identified and new recommendations for the member. The referring nurse will provide the primary care provider with the home visit report. The nurse’s reach out to the primary care provider if a member scores poorly on his or her ACT Test, is in need of an Asthma Action plan or if the member has a positive depression screening. The nurses also advocate for members if problems occur when they are requesting a nebulizer or a medication that needs a prior authorization.
L.A. Care uses the Healthcare Effectiveness Data and Information Set (HEDIS®) metrics1 for asthma to measure the outcomes of its program and uses other benchmarks for the appropriate use of medications.
Appropriate use of medication
To facilitate a comprehensive continuum of care, L.A. Care partners with providers to develop provider toolkits that, consist with evaluation tools such as the 2007 National Asthma Education and Prevention Guidelines, include tools for classifying asthma severity and control and the Asthma Control Test for children and adults. Management tools such as the asthma action plan and home environment checklist are also included in the provider toolkit.
L.A. Care prioritizes continual training for its nurses and staff to ensure that the techniques used in member outreach remain relevant and effective to address its members’ changing needs.
L.A. Care will conduct a gap analysis of admission and re-admission rates and launch its annual member satisfaction survey to assess the effectiveness of the program. According to L.A. Care’s annual satisfaction survey, more than 95% of L.A. Care members enrolled in the L.A. Cares About Asthma® program find program materials helpful, easy to understand and have learned from them.
1Healthcare performance measures of the National Committee for Quality Assurance (NCQA) used by health insurance plans to measure performance on important dimensions of care and service. Altogether, HEDIS consists of 81 measures across 5 domains of care.