Program Improves Asthma Care, While Reducing Costs
WINSTON-SALEM, N.C. – Wake Forest University Baptist Medical Center and community agencies from throughout the region are collaborating on a program to help eligible Medicaid recipients manage their asthma. The result is lower medical costs and fewer hospital stays – while providing patients access to better care.
Patients in the program have better control of their asthma, see their primary care physicians more often and spend less time in the emergency department and hospital, according to William P. Moran, M.D., medical director for Central Piedmont Access II (CPA II).
“At one practice in Forsyth County, the program has reduced medical costs by 24 percent, emergency room visits by 42 percent and hospital stays by 38 percent,” said Moran. “It is clearly working.”
CPA II is a regional network organized by Wake Forest Baptist more than two years ago. There are 13 similar initiatives across the state. CPA II contracts with the state to manage asthma care and other chronic diseases for eligible Medicaid recipients.
CPA II’s members include 47 clinics and physician practices, health departments, hospitals and departments of social services in Davie, Forsyth, Stokes, Surry, Wilkes and Yadkin counties. The network currently manages asthma care for more than 60,000 Medicaid recipients.
The state’s initial goal was to link every Medicaid recipient with a primary care doctor and to build community health networks operated by community physicians, hospitals, and departments of health and social services.
The second step was to get diseases like asthma and diabetes under control, to help patients keep regular appointments, to prevent emergency room visits and to ensure that patients are getting the right kind of medicine.
It made sense to start with asthma because asthma is the most common chronic illness in children, and a leading cause of missed school days, Moran said.
CPA II has hired nurses and patient educators who work directly with Medicaid patients with a diagnosis of asthma. The patients receive peak-flow meters to monitor their breathing capacity. Their medications are watched closely and their families are trained in an asthma care plan. The program also ensures that the asthma patients get flu shots each year.
“As we developed our asthma action plans, we started to saturate the practices with them,” said Moran. “It got to be easy to do the right thing.”
For example, the medical practices have “respiratory closets” that contain the meters and other supplies.
If an asthma patient does go to an emergency department for an asthma-related problem, an automated system notifies the patient’s case manager. Within 24 hours, the nurse can follow up and find out what happened to put that patient in the emergency department and what can be done to prevent it from happening again.
The program also works to control drug costs. For example, pharmacists review medications and make recommendations to the physicians.
“We hope that practices apply the same disease management principles to all of their patients,” said Moran, “not just those receiving Medicaid. This will expand the benefits of what we’ve learned to more people in our region.”
CPA II, in addition to focusing on asthma, has targeted diabetes, as have all networks across the state. But regional groups like CPA II can pilot different medical conditions, Moran said. CPA II is going to focus on congestive heart failure and frail elderly. Greensboro is going to focus on attention deficit hyperactivity disorder, Asheville is working on depression and Charlotte on emergency departments, he said, and the networks will be able to share with one another what they have learned.
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About Wake Forest University Baptist Medical Center: Wake Forest Baptist is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University School of Medicine. It is licensed to operate 1,282 acute care, psychiatric, rehabilitation and long-term care beds and is consistently ranked as one of “America’s Best Hospitals” by U.S. News & World Report.
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