Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #100130

Marissa R. Scalia, MPH, National Center for Environmental Health, Air Pollution and Respiratory Health Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd., MS E-17, Atlanta, GA 30333, 404-498-1879, mscalia@cdc.gov and Seymour Williams, MD, National Center for Environmental Health, Air Pollution and Respiratory Health Branch, Centers for Disease Control, 1600 Clifton Rd NE, MS E-17, Atlanta, GA 30333.

Research Objective: Our study evaluated the coverage of quality asthma care in a convenience sample of employer-sponsored health insurance plans.

Methods: We identified the standards of asthma care as defined by the National Asthma Education and Prevention Program (NAEPP) and assessed the coverage of the associated activities found in health insurance benefits summaries received from three employers. Health benefits managers clarified information missing from or ambiguous in the summaries. We also compared the smoking cessation benefits to the benefit design recommendations made by the Office on Smoking and Health at the Centers for Disease Control and Prevention (CDC).

Results: Our review included 22 plans: eight preferred provider organizations (PPOs), seven fee-for-service-with-PPO-option plans, six health maintenance organization plans, and one consumer-driven plan. All the plans covered most of the recommended interventions. In two of the plans, neither spacers nor chambers were covered as a pharmacy benefit or as medical supplies. Education as a stand-alone service, including asthma education, was excluded by 14 of the plans. Fifteen of the 22 plans covered nicotine replacement therapy and Bupropion for smoking cessation as part of the pharmacy benefit or smoking cessation benefit. Each of six of the plans had a smoking cessation program. Of those six plans, one offered counseling alone, four offered counseling combined with nicotine replacement therapy and Bupropion, and one offered Bupropion and nicotine replacement but not smoking cessation counseling.

Conclusions: All of the contracts covered most of the recommended equipment and activities of quality asthma care; however, our review revealed at least three potential opportunities to further improve coverage. First, NAEPP recommends that spacers and chambers be used to improve the delivery of medications; therefore, covering spacers and chambers is reasonable, especially for high-risk groups such as children. Second, although some education is likely to be delivered during a limited office visit, covering stand-alone asthma education may improve patient self-management, which is emphasized by the NAEPP guidelines. Third, more than half of the plans included Bupropion for smoking cessation and nicotine replacement therapy, but less than a quarter of the plans offered a smoking cessation program that included counseling, and fewer offered a multifaceted smoking cessation program. Therefore, a key priority in these employer-sponsored health insurance plans should be to provide comprehensive smoking cessation services, given the substantial health improvements and savings for both enrollees and employers.

Learning Objectives: