Business Case for Quality Phase II (BCQII)

1. Business Case for Quality Phase II (BCQII) Ingrid Lamirault, CEO Alameda Alliance for Health ACAP Presentation – July 2009

2. About AAH • Alameda Alliance for Health (AAH) is a local health plan (a public entity) in Alameda County, CA • The health plan serves over 102,000 members • Medi-Cal (Medicaid): 88,000 members • Medicare Special Needs Plan: 1,150 members • Healthy Families (CHIP): 9,200 members • Group plan for State/County In-Home Supportive Services workers: 4,400 members

3. Impact of Asthma • 20% of children in Oakland have asthma - twice the national average • Children’s Hospital-Oakland (CHO) is the primary provider for severe uncontrolled asthma • Asthma is the primary reason for emergency room visits • 4,755 asthma emergency room visits/year • 25-30% of these patients had previous ER visit in last year • Asthma is the primary reason for hospitalization • 1,805 asthma hospitalizations

4. Impact of Asthma • Almost 5,000 children enrolled in the AAH plans have an asthma diagnosis • One third of these members received ER services at CHO and were treated multiple times in the ER for asthma-related events • ER visits in one year among this group • Range: 2-18 visits • Mean: 3 visits

5. AAH and CHO Collaboration 2003 2005 2008 Develop asthma data warehouse (CHCS) In-office training of PCPs for patient education (CHCF) ER based intervention called ATTACK Clinic (CHCS BCQII)

6. About ATTACK Clinic Program Name Asthma Tools and Training Advancing Community Knowledge Goal Reduce return ER visits for asthma by 30% Strategy • Connect patients to their medical home • Provide families the tools and training to manage their child’s asthma at home Previous Success Similar program in D.C. reduced ER and hospitalizations by 40% * *Teach, S. J. Improved Asthma Outcomes in a High Morbidity Pediatric Population Results of an Emergency Department-Based Randomized Clinical Trial. Archives of Pediatric and Adolescent Medicine. 2006;160 535-541.

7. ATTACK ClinicDesign and Evaluation • Randomized control design based on day of the week • On treatment days, patients are referred to the ATTACK clinic for the intervention • On control days, patients are referred to their PCP • CHCS has developed separate contracts for independent statistical analysis and evaluation • Mathematica Policy Research, Inc. • University of North Carolina

8. ATTACK Intervention • ER-based educational/medical intervention for families of children with asthma in separate CHO clinic • One-time visit for children 2-18 years: • Asthma management plan for family and school • Intensive 1:1 education for child and parent/guardian • Pathophysiology of asthma • Asthma medications – how to use and why • Referral to county asthma case management or specialists • Warm hand-off to PCP (appt/progress note)

9. Results After one year • Data use agreement between AAH, Mathematica and UNC • 156 number of families seen in the ATTACK Clinic • Inconsistent referrals to ATTACK clinic from ER • AAH staff taking a more active role in recruitment through ER face sheets