Tyjhe Hargrove, who was 5 years old when his mother joined Affinity Health Plan, has suffered from asthma since he was a baby. He has trouble breathing when the weather is especially cold or especially hot or the air is full of pollen. Nights are the worst, says his mother, Kimberly Hargrove of Brooklyn. It was a nighttime attack that sent her son to a hospital emergency room several years ago. Affinity, a fast-growing managed care company serving low-income families throughout metropolitan New York, developed its asthma management program to help new members like the Hargroves.
Asthma is the biggest cause of hospitalization of children in New York City, says Richard G. Younge, M.D., M.P.H., until recently Affinity's senior vice president and chief medical officer. To keep Tyjhe and other youngsters out of the hospital, Younge and the Affinity staff developed a system to promptly identify new members with asthma and give them the knowledge and tools to manage the disease.
The primary goal was to improve health outcomes, but the organization was also interested in reducing emergency and inpatient asthma care costs if possible, says Younge.
Kimberly Hargrove applied to Affinity for health care coverage for her family in 2004. In addition to an assessment questionnaire included with the enrollment materials sent to new members, Affinity employs a telephone-call service to conduct assessments on the phone. Through this process, Affinity identified Tyjhe's as having moderate persistent asthma-Level Three on the four-level asthma-severity scale used by Affinity. (Level Four, the most serious, is severe persistent asthma.)
Tyjhe's assessment went to Mimi Berlin, R.N., Affinity's asthma case manager. Whatever the member's asthma level, she mails out a packet of asthma education materials with a letter inviting the new member and his or her primary care provider to contact Affinity for assistance in meeting asthma care needs.
New members with Level Three or Level Four asthma also get direct intervention. Berlin automatically refers them for a home visit by one of several registered respiratory therapists, who are employees of a medical equipment vendor. Their job is to review the signs, symptoms and triggers of asthma, see if the individual is on the right medication, and provide any needed equipment, such as a peak flow meter or nebulizer, and instruction in its use.
Affinity's members tend to move and change phone numbers frequently, and hooking up with the family can be a challenge. Fortunately, for the Hargroves, it was not. Shortly after her membership approval, Kimberly received a call asking when would be a good time for a visit.
The therapist administered a breathing test to Tyjhe, which showed his lung function at the low end of the acceptable range, according to his mother. Tyjhe already had an inhaler, but the therapist realized he was having trouble using it correctly. That, says Kimberly Hargrove, is where the therapist made a real difference. She provided a spacer-a device that attaches to an inhaler and captures just the right amount of medication in a chamber, making it easier to administer an effective dose.
After a visit, the therapist reports back to the Affinity asthma case manager on what was done. The case manager informs the member's primary care provider of the steps taken and any recommendations for additional care. The Affinity program—called AIR for Asthma Is Relieved—provides for at least one follow-up home visit.
Affinity's return-on-investment analysis concluded that the program more than pays for itself in savings. But Younge emphasizes that there are also returns external to Affinity's own balance sheet. One, he hopes, will prove to be reduced school absenteeism, he says, adding, "It's hard to put a dollar amount on that."
(Based on interviews with Kimberly Hargrove and members of the Affinity staff.)
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