New York State Department of Health Office of Health Insurance Programs

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New York State Department of HealthOffice of
Health Insurance Programs

• Asthma Self Management
• Training Services For New York Medicaid
  Beneficiaries
• Part I- Development
• James Figge, MD, MBA, Medical Director
• Office of Health Insurance Programs
• Donna Haskin, RN, BSN, Director
• Program and Quality Initiatives
• Bureau of Primary and Chronic Care Delivery
• Office of Health Insurance Programs
• Pat Waniewski, RN, MS, Director
• Bureau of Community Chronic Disease Prevention
• Center for Community Health

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Agenda

• The burden of asthma in NYS
• Past and current asthma quality improvement work
• NYS Asthma Framework/Gap Analysis
• Climate for change/ ASMT Legislation

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Asthma in NYS

• In 2008, asthma affected approximately 1.3
  million NYS adults and 491,000 children
  (2006-2008)
• During 2005-2007, an average of 255 deaths per
  year occurred due to asthma in NYS
• Source NYS Asthma Surveillance Summary Report
  2009

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New York Medicaid Program

• FY 2007-2008 New York Medicaid is a 47 Billion
  Dollar Program
• 4.2 Million Recipients

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Asthma Among NYS Medicaid Managed Care Population

• In 2007, nearly 162,000 (10.4) NYS Medicaid
  managed care enrollees were classified as having
  asthma
• Over 49,000 (4.7) NYS Medicaid managed care
  enrollees were classified as having persistent
  asthma
• Source NYS Asthma Surveillance Summary Report
  2009

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Asthma Among NYS Medicaid Managed Care Population

• More than 170 million were spent on
  asthma-related services for more than 160,000
  asthma universe enrollees in 2007
• In 2007, there were approximately
• 221,000 doctor and outpatient visits
• 33,000 ED visits
• 6,200 hospital discharges
• Source NYS Asthma Surveillance Summary Report
  2009

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Initial Stages of Development

• Asthma Quality Improvement initiatives began in
  1998
• Using Medicaid paid claims data-identified need
  to focus efforts on asthma
• Reached out to public health partners

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Initial Stages of Development

• Extensive evidence-based research on best
  practices and models of care
• Re-tooled existing UR/QIO Contract
• 1998- Developed an Asthma Quality Improvement
  Project (A-QIP)

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Chronic Care ModelChanging Practice - Changing
Lives

• A population based model that relies on
  knowing
• Which patients have the illness
• Assuring that they receive evidence-based care
• Empowering the patient to actively participate in
  their own care

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Integrated Care ManagementAsthma QIP Goals

• Develop quality indicator monitoring system for
  asthma- hospital outpatient departments
  community health centers (disease registries,
  real time chart audits/feedback, comparison
  reports)
• Improve process-of-care at selected sites use of
  evidence-based guidelines, chart prompts, care
  reminders, care coordination, in-office care
  teams, specialist referrals when appropriate,
  etc.
• 
  
  
• Improve patient perceptions of care received
  knowledge/capacity for self-management
• Promote disseminate educational materials
• Utilize community resources

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Asthma QIP Participants

• In the beginning (1998)- Five Article 28 clinics
  and DTCs voluntarily agreed to participate in
  the Asthma QIP
• Eleven years later (2009)- Twenty-nine
• A-QIP participants

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Public Health Collaboration/Partnership

• Aligned work efforts with the NYS Asthma Program
  to share resources, support representation, apply
  sound principals of public health to the Medicaid
  population.
• Partnered with NYS Asthma Coalitions- to link
  resources with Medicaid providers and consumers
  of care.
• Research and presentation of educational
  coverage for Medicare, private insurers, Medicaid
  coverage in other states, and other third party
  insurers.
• Worked with asthma public health officials to
  develop a Framework for Improving Asthma
  Outcomes in NYS

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New York State Asthma Plan 2006-2011

• Seamless, evidence- based, patient/family
  centered asthma care exists for all New Yorkers
  with asthma.
• Disparities in asthma diagnosis, treatment and
  outcomes are eliminated.
• "Asthma-Friendly" communities exist in New York.
• Policy makers, health care providers and
  consumers have an increased understanding of
  asthma and treat and manage asthma effectively.
• A Statewide Public/Private Collaboration exists
  to shape, implement and monitor New Yorks action
  which will improve asthma outcomes in New York.

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Public Health Gap Analysis

• As part of the NYS Asthma Plan- Public Health
  Officials did a gap analysis of asthma care
  benefits (including MA FFS, MC, FHP and CHP)
• Analysis was based on the 4 key components of
  asthma care defined by the NAEPP Asthma
  Guidelines for the Diagnosis, Evaluation and
  Management of Adults and Children with Asthma

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Public Health Gap Analysis

• Process
• Public/Private workgroup formed (2006-2007)
• Focus on public health insurance programs
• Examined asthma benefits for MFF, MMC, FHP, CHP
• Identified/summarized gaps
• Prioritized recommendations

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Summary of Gap Analysis for Components of Asthma
Care

• 1. Assessment and Monitoring
• Primary or specialty care office visit group
  visits not covered for all public insurers.
• Equipment Spacers, peak flow meters and
  disposable nebulizer kits are not covered for
  Child Health Plus and Family Health Plus.
• Home environmental assessment and remediation
  not covered for all public insurers.

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Summary of Gap Analysis for Components of Asthma
Care

• 2. Pharmacological Therapy
• Differences between formularies for public
  insurers. The are no recommended generic
  controller medications.
• 3. Control of Factors Contributing to
• Asthma Severity
• Smoking cessation counseling group counseling
  not covered for Fee-for-Service (As of 1/1/2009
  Medicaid provides reimbursement for SCC for
  pregnant women. As of 1/1/2010, SCC will be
  expanded to cover post-partum women and children
  adolescents ages 10 to 21 years)

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Summary of Gap Analysis for Components of Asthma
Care

• 4. Patient Education (PRIORITY)
• Group asthma education not covered for all
  public insurers.
• Care/Case Management not covered for
  Fee-for-Service unless the enrollee qualifies for
  a comprehensive Medicaid Case Management Program

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Climate for change.

• The Medicaid Institute at the United Hospital
  Fund released a white paper entitled
  Administration of Medicaid in New York State
  Key Players and Their Roles November 6, 2006.
• Comprehensive assessment of the NYS Medicaid
  Program

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Climate for change ..

• January 2007 Administrative vision to put
  patients first
• A focus on primary care, wellness and prevention
• Enhanced reimbursement for ambulatory care
• Significant changes in Medicaid reimbursement to
  support ambulatory care investments
  investments in primary care.

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AHRQ Prevention Quality Indicator Maps
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Critical (key) Drivers of Change..

• Documentation of poor asthma control
• using reliable data
• Building the business case to support buy-in to
  provide asthma self management education services
• Funding to support coverage of education as a
  stand-alone, billable service

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NYS Medicaid Policy

• The 2008-09 Executive Budget amended the social
  services law to require coverage of asthma (ASMT)
  and diabetes (DSMT) self-management training
  services for Medicaid beneficiaries diagnosed
  with asthma and/or diabetes

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Prescriber Education Program

• Implemented in SYF 2008-2009 A Medicaid
  Pharmacy Initiative
• Partnership between the DOH and several academic
  institutions
• Provides prescribers with an evidence-based,
  non-commercial source of objective information
  about pharmaceuticals

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Prescriber Education Program

• Goal to optimize the quality of care for NYS
  Medicaid beneficiaries by providing clinicians
  with the most current info on best practices in
  pharmaceuticals and therapeutics.
• Two components
• Core curriculum
• Statewide on-site educational sessions
• Web-link lthttp//www.nyhealth.gov/health_care/med
  icaid/program/prescriber_education/presc-education
  proggt

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Next Steps

• Part II Implementation of the NYS Medicaid
  Asthma Self Management Training Services (ASMT)
  Program
• Webinar scheduled for November 10, 2009

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Acknowledgements

• Deborah Bachrach, Deputy Commissioner
• NYS Medicaid Director
• Office of Health Insurance Programs
• Dale L. Morse, MD, MS
• Assistant Commissioner, Office of Science

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Acknowledgements

• Gregory Allen, Director
• Division of Financial Planning and Policy
• Office of Health Insurance Programs
• Karen Kalaijian, Assistant Director
• Medicaid Policy and Care Delivery Group
• Office of Health Insurance Programs
• Linda Palmer, RN, BS
• Bureau of Primary and Chronic Care Delivery
• Office of Health Insurance
• Mary Jane OBrien, RN
• Bureau of Primary and Chronic Care Delivery

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Acknowledgements

• IPRO
• Harry M. Feder, M.P.A., Senior Vice President
  Program Operations
• Alan Silver, M.D., M.P.H., Medical Officer
• Health Care Quality Improvement Division
• Thomas Lemme, PA-C, MBA, Improvement Coordinator
• Health Care Quality Improvement
• Veronica Pryor, R.N., M.P.A., Project Manager
• Health Care Quality Improvement

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Questions?

• Medicaid Update October 2008 issue
• http//www.health.state.ny.us/health_care/medicaid
  /program/update/2008/2008-10.htm

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Thank You!

• James Figge, MD, MBA, Medical Director
• Office of Health Insurance Programs
• ltjjf06_at_health.state.ny .usgt
• Donna Haskin, RN, BSN
• Director, Program and Quality Initiatives
• Bureau of Primary and Chronic Care Delivery
• Office of Health Insurance Programs
• ltdlh04_at_health.state.ny.usgt
• Pat Waniewski, RN, MS
• Director, Bureau of Community Chronic Disease
  Prevention
• Center for Community Health
• ltpaw04_at_health.state.ny.usgt