Florida Asthma & Tobacco Cessation Learning & Action Network - - PowerPoint PPT Presentation

Florida Asthma & Tobacco Cessation Learning & Action Network UnitedHealthcare Lessons Learned

Diana P. Valderrama, MPH Quality- Senior Clinical Data Analyst

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About our Plan

• Quality- Primary Care Provider Model.
• 82% Medicaid membership
• Majority of asthmatic population in Region 4: Volusia and Duval counties.
• Goal: to improve asthma control for children ages 5 – 18 by September 30, 2018 as

evidenced by reducing ED visits for asthma by at least 10% from baseline

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Definition Number

Children ages 5 – 18 with asthma 12,504 (Aug 2016-Aug 2017) Diagnosed > 90 days and with > 2 ED visits in past year 1,267 (Aug 2016-Aug 2017) Sub-population (Region 7) 140 (Aug 2016-Aug 2017)

Lessons Learned

• Quality Improvement Process
• PCP Access and Availability
• Pharmacy Rejection for Asthma Medication
• Post ER- Follow up

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Quality Improvement Process

• PDSA Cycle- Plan, Do, Study , Act
• Simple test of change
• Process measures
• Fishbone diagram and driver’s diagrams
• Interdepartmental collaboration
• Leveraging available resources

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• Run the

test

• Analyze

results

• Plan the

test

• Adapt or

Abandon

ACT PLAN DO STUDY

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PCP Access and Availability Survey

• Top 10 PCPs for Subpopulation
• What we learned:
• Referrals to specialist
• Same day walk in appointments
• Extended hours/weekend hours
• Access to PDL
• Patient Education
• Opportunities for improvement identified:
• Symptom management plan (e.g. allergen testing)
• Teaching proper use of medication
• Resources availability

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Pharmacy Rejection Data

• Top 10 providers with rejections for asthma medication
• Both control and rescue medicine

Findings:

• Plan benefits limitations message- Refills too early
• Majority of rejections at 1 provider group
• Majority of rejections were resolved
• Members did not come back for the medication
• Opportunity:
• Improve use and communication of pharmacy rejection data for

asthma medication.

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Post-ER Outreach

• Implemented post-ER outreach by Community Health Workers (CHWs)
• Successfully engaged leadership and clinical frontline staff

Member Stories:

• One member was utilizing the ER because it was close to home and they

did not have transportation to medical appointments. The CHW informed the member of the transport benefit available to them, and provided the phone number to schedule transportation whenever it is needed. The member was not aware of this benefit.

• Another member stated they did not have a PCP nor specialist treating the

child’s asthma. The CHW connected the member with our Member Services department to correct the assigned PCP to one that is in close proximity to the member.

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Rate of ER Visits for Asthma

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28.8 57.6 50.4 71.4 43.5 65.7 80.9 44.1 51.5 70.9 63.5 40.7 0.0 0.0 8.4 0.0 0.0 0.0 0.0 20.0 40.0 60.0 80.0 100.0 120.0 140.0 160.0 180.0 200.0 Count of ER Visits per 1,000

Rate of ER Visits for Asthma (n=140)

Questions?