Asthma and Disease Management: History and Development within an Integrated Healthcare System

Abstract

The object of this study was to evaluate an asthma disease management program within a group model HMO. We describe program results and the necessary components of a successful disease management program in a managed care environment. The setting was a nonprofit group model HMO in an integrated health system located in central and northeastern Pennsylvania. The participants were 312 asthma patients enrolled in the disease management program. Based on the NIH guidelines, interventions included physician and patient education provided by the asthma disease management implementation staff and specially trained nurse educators in a primary care setting. The main outcome measures were as follows: Preand post-asthma claims per member per month (PMPM) over 1 year; Juniper-based quality-of-life survey at baseline and 6 months after program enrollment; and patient satisfaction with asthma education. The asthma claims PMPM decreased from $28 baseline to $20 1 year after enrollment. In addition, 94.3% of enrollees rated the patient education as excellent, 2.2% as good, and 0.5% as fair. The quality-of-life composite survey score rose from 5.15 to 5.35 based on a scale from 1 to 7 (7 being the highest quality of life). In conclusion, with an emphasis on patient and provider education, PMPM costs for asthma can decrease while satisfaction increases. Based on the demonstrated success of the asthma disease management program, more interventions to manage other chronic diseases better have been introduced. Although these programs are tailored to meet the challenges of a particular disease, they all have the common characteristics of clinical leadership, support, patient and physician education, alternative care providers, and data acquisition and analysis.