Business Case for Quality Phase II

(BCQII)

Ingrid Lamirault, CEOAlameda Alliance for HealthACAP Presentation – July 2009

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About AAH 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

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

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 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 ClinicProgram Name

Asthma Tools and Training Advancing Community Knowledge

Goal Reduce return ER visits for asthma by 30%

Strategy

Connect patients to their medical homeProvide families the tools and training to manage their child’s asthma at home

Previous SuccessSimilar 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 ClinicDesign and Evaluation

Randomized control design based on day of the week 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 Mathematica Policy Research, Inc. University of North Carolina

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ATTACK Intervention 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 asthma2. 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