Achieving equity in health reform: Reimbursing for evidence based best practices

The incidence of asthma has increased dramatically over the past several decades, currently affecting over 22 million people in the U.S. alone. Despite the fact that asthma is a disease that can be well-managed, a large proportion of patients report that their symptoms are not well-controlled, impairing their normal daily functioning. One study in New England found that approximately two-thirds of children and adults had symptoms that are considered to be poorly controlled, based on national criteria. Disease burden was particularly severe for those of lower socioeconomic status. There is ample current science on the components of cost effective care, as reviewed by the NHLBI's Asthma Expert Panel and supplemented by reviews conducted by the CDC. Yet many public and private payers fail to enable culturally appropriate care that is recommended for patients with poorly controlled disease. This care includes access to such services as disease self-management education sessions, or home environment assessments for potential asthma triggers. The Asthma Regional Council conducted an in-depth survey of state Medicaid programs and commercial insurance companies, comparing reimbursement policies with published national best practice guidelines. Twenty five surveys, consisting of 48 questions, were completed from across the New England region, representing public and private payers in each of the six states. The presentation will present the survey results, which not only provides a rich understanding of how the health system can improve asthma outcomes for those at highest risk, but offers lessons in designing payment reform to improve a myriad of chronic diseases.