Boston Globe graphic
If you didn’t see the story, it describes how Children’s Hospital Boston successfully used community health workers to reduce acute asthma attacks, and save money:
Hospitalizations for asthma have been dramatically cut by a program that helps families reduce the conditions that trigger attacks, saving $1.46 in hospital care for every $1 spent on prevention, according to a Children’s Hospital Boston study being released today.
The hospital’s program, the Community Asthma Initiative, targeted 283 children with asthma in some of Boston’s poorest neighborhoods. Health workers taught families how to correctly use medications and eliminate triggers of attack, such as contaminated bedding and feather dusters. They also provided each family a vacuum cleaner with special filters.
After the first year, asthma-related emergency room visits for children in the program plummeted 68 percent compared with their emergency room trips in the year before enrolling, and there was an 85 percent drop in hospitalizations, according to the study published online in the journal Pediatrics.
Additionally, there was a 43 percent decrease in the number of children who had to limit physical activity and a 41 percent reduction in reports of missed school days. For their parents, that translated into a 50 percent drop in the time they had to miss work to care for ailing youngsters, the study found.
The program’s success led MassHealth to begin a similar pilot among children it covers. Under the new waiver agreement with the federal government, selected primary care sites will receive a payment to provide home visits and care coordination by community health workers and supplies to mitigate environmental asthma triggers in the home. These services are typically not provided under Medicaid.
The project points out two implications for the upcoming payment reform legislation:
First is the value of flexibility in covered benefits, which is a key advantage of global payments. Our friends at Commonwealth Care Alliance, which covers dual eligible (Medicare+Medicaid) seniors under a global payment, calls it “giving the checkbook to the care managers.” Insurance doesn’t normally cover vacuum cleaners, yet the Children’s program found that advanced filter vacuums were critical to keeping the kids healthy. We think global payments provides the best opportunity for expanding services with a focus on health, rather than the details of the reimbursement system.
Second is the role Community Health Workers (CHWs) can play in a reformed health care system. The Children’s Hospital program depended on CHWs, who come from the community they serve, to provide the needed education and care. Massachusetts DPH is helping building a strong CHW workforce, and is setting up a CHW Certification Board to assure high standards and continuing education and development. We have urged the legislature to specifically direct ACOs to include CHWs as part of care teams. CHWs can make the link between patient and health care in a culturally-connected way, reducing disparities and improving health.
-Brian Rosman
