Efforts to Sustain Asthma Home Visiting Interventions in

Massachusetts

Jean Zotter, JDDirector, Office of Integrated Policy, Planning

and Management

and Terry Mason, PhD Consultant

MA Background

• CHW Policy– MA Health Care Reform law - 2006

• Tasks MA DPH to conduct CHW workforce study• Study released 2010

– CHW certification law – 2010• Asthma CHW Best Practice Development

– Boston Public Health Commission– Children’s Hospital Boston– Mass Department of Public Health: READY Study

• Boston Medical Center & Baystate Medical Center

Massachusetts Health Care Landscape

• Moving away from fee-for-service (FFS) reimbursement

– By 2015 will be 80% global payment – public and private insurers including Medicaid

• States will need to understand how their Medicaid Office is funding preventive services to focus on coverage

Current Infrastructure

• Training and support developed and implemented for MDPH by Boston Public Health Commission’s CHEC Program– Included:

• Comprehensive Outreach Education Certificate Program offered by CHEC

• 4 Day Asthma Home Visitor Training developed by CHEC, 2 day “refresher” training annually

• 2 day Supervisor Training• Quarterly in-person support meetings

• Study protocols, educational materials, health outcomes measurement, high-risk definition

Insurer Perspective

• Response from Insurers to Asthma CHW Intervention– Openness to payment

• Some convinced it works• Some still need more cost benefit analysis

• To expand reimbursement wanted:– Standardized training– Standardized skill assessment/evaluation– Easy referral system

Opportunities - Moving Towards Coverage

Health Reform

• CMS Innovation Grants• Medical Homes, Health

Homes, Dual Eligibles• Bundled or Global

Payments• Accountable Care

Organizations• Hospital Community

Benefits• CMS Ruling

State/Local Infrastructure

• CHW certification• CHW training

CMS Ruling

• Permits states to reimburse for Medicaid covered preventive services delivered by non-licensed providers if “recommended by a physician or other licensed provider”– Effective Jan 2014– State Medicaid Agency must submit a

State Plan Amendment

Current Initiatives for Sustainable Funding in MA

• MassHealth Children’s High Risk Asthma Bundled Payment (CHABP) Pilot Project– Legislatively mandated– Establishes a bundled payment system for currently unreimbursed

asthma mitigation services - Phase 1, with goal of establishing comprehensive bundled payment for asthma care - Phase 2

– Engages limited pilot sites and targets high-risk pediatric asthma patients; designed to prevent hospital admissions and emergency room utilization

– Approved by CMS via 1115 waiver– Program cost and outcome evaluation will be used to explore

further program expansion

Current Initiatives for Sustainable Funding in MA

• Health Resources in Action’s New England Asthma Innovations Collaborative: CMS HCIA Award

• New England Initiative lead by Asthma Regional Council of New England

• Program Components:• Asthma Education and Home Visiting Service delivery expansion

(1136 children) • Workforce development • Committed Medicaid payers• Payer and Provider Learners Community

• Policy goal: sustainable payment system, 3 MA insurers committed to covering if ROI demonstrated, total 4 MCOs and 6 Medicaid programs in NE participating

Current Initiatives for Sustainable Funding in MA

• MDPH’s Prevention and Wellness Trust– $60 million fund established by state

legislature in 2012 – Pediatric asthma is one of four priority

conditions – Program Components for High-Risk Asthma:

• Clinical: care management• Home: asthma home visits• Schools: comprehensive school-based education

programs

The Road Ahead

• CMS Ruling – opportunity for coverage• For MA:

– Standardize home visit protocols, health outcome measures, educational key messages, high-risk definition

– Expand training: geographically, mentoring component, skill assessment, teen module

– Support QI for home visits– Promote business case for home visits to

insurers and provider groups

APCP’s Funding Support for CHW Work

• This presentation was supported by the federal agencies listed below. The content of the presentation is solely the responsibility of the presenter and does not necessarily reflect the views of those agencies:

– National Institute of Environmental Health Sciences (NIEHS); R01 ARRA Award; READY Study; #5R01ES017407-02

– Housing and Urban Development; Healthy Homes Technical Studies Award; READY2 Study; #MALHH0227-10

– Centers for Disease Control and Prevention; National Center for Environmental Health; Addressing Asthma from a Public Health Perspective; #5U59EH000501

Contact Information and Resources

Jean Zotter, jean.zotter@state.ma.us, 617-994-9807

•APHA Community Health Worker Section http://www.apha.org/membergroups/sections/aphasections/chw/•MDPH Office of Community Health Workers http://www.mass.gov/dph/communityhealthworkers•CDC E-Learning CHW http://www.cdc.gov/dhdsp/pubs/chw_elearning.htm •Seattle King County CHW Resources http://www.kingcounty.gov/healthservices/health/chronic/asthma/resources/tools.aspx •Asthma Prevention and Control Program

www.mass.gov/dph/asthma