Promoting financing for best practices in asthma management for environmental contributors

The Commission to Build a Healthier America cited housing as a key determinant of health, particularly describing the impact of sub-standard housing on vulnerable populations. Asthma, which can be triggered by poor housing conditions, has nearly doubled in the U.S. over several decades, with approximately 9.4% of children and 7.3% of adults with current asthma. Low-income and minority populations suffer disproportionately, with higher hospitalization rates, frequent use of urgent care, and lower quality of life – making asthma one of the most expensive chronic diseases and responsible for highest costs among preventable pediatric hospitalizations. NHLBI's Asthma Expert Panel identifies “Education for a partnership between the patient and provider in asthma care” and “Control of environmental factors that affect asthma” as two of four key components of asthma care. Yet there is a critical lack of capacity to deliver asthma education in the clinic and home based environmental education and interventions (hereinafter ‘asthma services), primarily due to the lack of sustainable reimbursements by health payers --despite the evidence base that they can improve symptoms and reduce expensive urgent care.

In New England (NE) where asthma symptoms in approximately 2/3 of adults and children are considered to be “not well” or “very poorly” controlled, the NE Asthma Regional Council (ARC) is working on a long-term strategy to promote financing and delivery of asthma services in order to tackle environmental contributors to pediatric and adult asthma, with a focus on the region's most vulnerable populations. This presentation will describe components of this strategy, including collaborative efforts with the six NE State Asthma Programs, engagement of healthcare payers, and a small NE study of billing codes used to cover these services, as well as a discussion of how others may engage stakeholders in their own regions to promote financing for asthma services.