The overarching goal of the New England Asthma Innovations Collaborative (NEAIC) at Health Resources in Action (HRiA) is to improve asthma outcomes, quality of care, and health care costs of primarily Medicaid and CHIP-enrolled children by advancing innovative service delivery and sustainable payment systems across New England.
In order to achieve the Centers for Medicare and Medicaid Services’ (CMS) aim, NEAIC employs the following components of care in our models: 1) Asthma self-management education 2) Home environmental assessment with the provision of minor to moderate environmental intervention supplies to mitigate asthma triggers; and 3) Use of non-physician providers shown to be cost-effective deliverers of this level of care, particularly community health workers (CHWs) and certified asthma educators (AE-Cs).
NEAIC consists of eight Provider Sites located in four New England states: Connecticut, Massachusetts, Rhode Island and Vermont. Program sites will use one of two evidence-based home visiting interventions during the three-year program. The target population is pediatric patients (ages 2 through 17) with poorly controlled or uncontrolled asthma symptoms who have a history of using expensive urgent care, with a focus on high-cost Medicaid and CHIP patients. Patients will be enrolled in the intervention for an average of six to eight weeks with follow-up at six and twelve months after the first home visit. Medicaid payers will provide patient claims and encounter data to monitor costs and outcomes for their patient populations and some will consider new reimbursement policies should the interventions demonstrate positive health and cost outcomes.
NEAIC includes the following components:
- Workforce development: In an effort to promote a high-quality, well-trained workforce, NEAIC will: a) sponsor an Asthma Training Institute to increase the number of well qualified cost-effective providers, including certified asthma educators and community health works (CHWs) with a specialty in asthma; and b) explore and make recommendations for an innovative CHW asthma credentialing program that payers and provider practices across NE have requested and can benefit from. All of this will contribute to higher quality and culturally competent care, and we believe will help to support innovative Medicaid reimbursement as a result of demonstrated cost-effective outcomes.
- Rapid service delivery expansion for 1,136 high-risk children with asthma in CT, RI, MA, and VT including home visiting services to provide asthma self-management education, environmental assessments, and environmental supplies to control triggers.
- Committed Medicaid payers in several New England states will work to sustain these cost-effective programs by piloting reimbursement methodologies with the service providers, should the service model results demonstrate the CMMI three-part aims.
- A Payer and Provider Learners Community across all six New England states to rapidly disseminate demonstrated improvements to the quality and cost of asthma care, share viable reimbursement systems developed, successfully incorporate CHWs into the asthma care team, and disseminate best practices. The Learners Community builds on ARC’s existing networks and partnerships across the region, and is meant to increase awareness about these successful models with the goal of broader adoption across New England.
NEAIC’s components build in continuous quality improvement measures through rigorous data collection/analysis, strong partnerships, and commitments from interested payers and policy makers. The establishment and promotion of CHWs as strong health care delivery partners addressing environmental conditions as part and parcel of the disease management program — with reimbursement by payers — make this an innovative model for broad dissemination and potential for replication across the nation.
Stacey Chacker, BA
Heather Nelson, PhD, MPH
Senior Research Scientist