Plan takes a collaborative approach to asthma

Program stretches across multiple departments

The saying, "It takes a village" applies to asthma control as well, says Pamela Persichilli, RNC, director of clinical operations for Horizon NJ Health.

Asthma management is a collaborative effort across multiple departments at the West Trenton, NJ, health plan, which provides care for publicly insured members.

"At Horizon NJ Health, we work together throughout all the departments in the company to provide support for our members. Our disease managers, case managers, and asthma educators work in teams to help asthmatics learn how to manage their disease. Pharmacy has a role, the medical director has a role, the provider representatives have a role. We all work together," she says.

The health plan analyzes claims data and seeks patients who have been hospitalized or utilized the emergency department and reaches out to those who are not filling their medications or are using rescue medications frequently. In addition, members may be referred by their primary care physicians, by social workers, and by self-referral.

All members who are identified with having asthma receive educational materials. Disease management nurses call the most severely ill members and work with them to manage their disease.

"We focus on utilization. If a patient is hospitalized or visits the emergency room frequently, we know they're not managing their asthma well," says Dee Rago, RN, BSN, director for health and wellness.

The health plan gets a list each week of members who have made a visit to the emergency department. The disease managers look at the members' pharmacy data and evaluate the member's medication therapy, looking for opportunities for intervention.

"We've found that claims for emergency room visits hit much quicker than other claims. We can identify patients who have been to the emergency room within 14 days or less. They're still in that acute stage and are agreeable to interventions," Persichilli says.

Depending on what the results indicate, members may be referred to an asthma educator, a pharmacist, or a case manager.

"If we see someone who is utilizing rescue medications too frequently and isn't on a controller medication or hasn't been filling it as often as they should, we can contact the member and talk with them about managing their disease," Rago says.

The health plan's social work case managers, who are on site at some partner hospitals, meet with members in the emergency department and visit them in the hospital at the bedside, offering them asthma educational materials and linking with a disease management nurse they can contact with questions or concerns.

The hospital-based case managers make sure the patients are linked to a disease management nurse, often calling the nurse and introducing the patient while he or she is in the hospital.

When members are selected for individual disease management, a disease management nurse conducts a thorough assessment of the patients, their knowledge of asthma, and what they do to control it, says Susanne Gronostjski, RN, CCM, DDE, manager of health and wellness.

"We determine if they have the right equipment and if they know how to use it. We also find out if they have the right medication and if they are taking it as recommended. We help them identify their asthma triggers. An asthma trigger can be something as simple as carpet deodorizer or using bleach to clean, and these might create a problem for them," she says.

The goal is to find out what is causing the members' asthma attacks and to come up with interventions that can make a difference.

For instance, some members are not aware of triggers, such as room temperature that could cause an asthma attack. Many members live in housing developments where there is no individual control over the thermostat. In these cases, the disease manager suggests that the member use a room thermometer and open windows when the temperature gets to a certain level.

"We try to determine the problem or trigger and approach the problem with a solution in mind. The member may not understand what triggers the asthma attack, but we work to educate them and assist them before the trigger causes a problem, Gronostjski says.

For instance, one family lived in a basement underneath a laundry, an environment that could aggravate an asthma attack because of chemicals and mold. The damp air was precipitating a child's asthma attacks. With the help of a social worker from the health plan, the disease manager found them another place to live.

The members are assigned to a particular nurse depending on their risk level.

Through the screening process, Horizon NJ Health nurse specialists seek to match the member with the appropriate specialist nurse, Gronostjski says.

Community outreach is another component of the health's plan's asthma management program. The health plan's community educators attend health fairs and other statewide community and school events to help educate the public about asthma and other chronic diseases.

One educational tool that both adults and children enjoy is a 6-foot-tall interactive asthma storyboard that features a talking dog that tells a story about asthma in English and Spanish.

"Children and adults relate to the method of education and learn from the experience to control or manage their asthma," Persichilli says.

The asthma management nurses educate physicians about the health plan's asthma program and present asthma education programs in both English and Spanisha.

The health plan is working with state agencies in New Jersey on a program that encourages schools to get rid of asthma triggers and partnering with community agencies to make people aware of the importance of having an asthma action plan.