New members with asthma could raise payers' costs

Despite some payers' attempts to improve asthma patients' health outcomes, the incidence, hospitalization rates and costs related to asthma continue to rise. And since a large portion of the uninsured population has asthma, payers will soon see an influx of members with the costly chronic illness when the health insurance exchanges open for enrollment.

To help manage the increased costs of members with asthma, payers are developing new and innovative programs. And with good reason--each year asthma results in almost 11 million ambulatory physician encounters and 440,000 hospitalizations with annual medical costs averaging $3,300 per person. What's more, asthmatic patients traditionally have a low medication compliance rate, in the 30 percent range, reported AIS Health.

The good news is that in the post-reform market, payers "have a great opportunity to innovate new ways to deliver care that is better for patients and improves quality and value," Kylanne Green, president and CEO of healthcare accreditation organization URAC, told AIS Health.

To do that, payers must focus on disease management and care coordination efforts, including reaching out to previously uninsured members who aren't used to seeking medical treatment.

L.A. Care Health Plan, the nation's largest public health plan, is preparing for a flood of new members, especially ones with chronic illnesses, "and asthma and particularly [chronic obstructive pulmonary disease] have substantial costs," Howard Kahn, CEO of L.A. Care, told AIS Health. "That's where we'll see a lot of new costs."

But the benefit of insuring people with chronic illnesses like asthma, Kahn said, is they won't have to seek care at emergency rooms. The reform law "means [such people] will be able to be identified by our health plan ... and will get medical treatment" as well as help identifying asthma triggers in their homes.

L.A. Cares About Asthma program, for example, provides medical and environmental interventions, including educational mailings, an asthma action plan, nurse case managers and home visits from community-based organizations, to help members manage their asthma.

And it's working--members participating in L.A. Care's asthma program who completed at least two home visits in 2012 had a 52 percent average reduction in asthma-related emergency room visits from 2011 to 2012, plus improvement on an asthma control test.

L.A. Care isn't alone in trying to reduce asthma-related costs. Harvard Pilgrim recently announced it's launching a narrow network plan that uses nurses who act as "navigators" for patients. Under the plan, care coordinators are alerted if families frequently brings children to the emergency room for asthma and could then help the families control the condition, FierceHealthPayer previously reported.

To learn more:
- read the AIS Health article