New England communities have among the highest rates of asthma in the nation, causing an enormous societal burden of human suffering, lost capacity and productivity as well as fiscal costs. The good news is that people with asthma can live active lives unimpaired by their disease. Proper management can reduce the burden of asthma on individuals, families and society, avoiding costly hospitalizations, emergency room visits, sick visits to the doctor and missed days at work and school.
Proper asthma management includes controlling environmental triggers in the home that may contribute to asthma symptoms, including dust, pests (cockroaches), dog/cat dander, environmental tobacco smoke, pesticides, cleaning chemicals, mold, and many others. Although control of environmental triggers is a core component of the National Asthma Education and Prevention Program’s asthma management guidelines, interventions to reduce home-based triggers are not routinely delivered—they are often perceived as beyond the scope of medical care. Robust evidence demonstrates that if environmental interventions – shown to be effective in improving asthma symptoms and financially viable – are to be sustainable, and if they are to meet their potential to help reduce the burden of asthma, they need to be embedded in traditional delivery systems and financed by those funding sources that pay for health care.
Past Activities
The Environmental Health Program works in partnership with the Asthma Regional Council to advance the delivery and financing of home-based education and environmental interventions for asthma—as part of comprehensive asthma management activities--across New England. Five constituencies influence the availability of services and supplies that can improve asthma outcomes. Past activities have focused on three of these constituencies: payers, government agencies, and health care providers. They have included:
- a successful symposium for health payers in 2005 to bring awareness about effectiveness of environmental interventions for asthma and to encourage them to change policies so that they reimburse for home-based visits and environmental services and supplies. Since the Symposium, several payers in Massachusetts have agreed to cover the costs of these services for patients whose asthma is not well-controlled.
- expert assistance provided to two health payers in the design of in-home programs to provide families with information, materials and services to reduce asthma triggers, which have led to ongoing programs to make these services available
- a business case for providers, payers and advocates that presents evidence about the costs, cost-savings and cost-effectiveness of in-home environmental interventions and asthma education more broadly. EHP presented the business case on a national webinar sponsored by EPA’s Communities in Action for Asthma Friendly Environments (listen here).
- a white paper comprised of case-studies of effective home-based asthma management programs offered by health departments around the country to encourage broader adoption of these programs by state, county and municipal health departments. This analysis has been widely used by asthma managers in state health departments across the country.
- a major conference for Massachusetts asthma providers to educate them on recent updates to the national asthma management guidelines and to finalize a consensus statement about actions needed by fellow providers, payers and government decision-makers, including increasing access to environmental services and supplies for people with asthma who is not under control. Asthma managers elsewhere in New England are now inviting ARC and EHP to convene similar discussions of providers in their states, with the hope that consensus statements will lead to policy change by public and private decision-makers.
Current Activities
- Asthma: A Business Case for Employers and Health Care Purchasers. EHP and ARC are finalizing a second business case, this one for employers and large purchasers of health care, who have the potential to influence insurance coverage as well to provide programs for their employees and reduce exposures in the work environment. The business case reviews the evidence about cost and effectiveness of initiatives to reduce the burden of asthma, and recommends three strategies to adapt these initiatives to the workplace. The new business case is expected to be released in February, 2010.
- Centralized system for coordinating asthma home visits. In conjunction with the Boston Public Health Commission, EHP is leading a groundbreaking project in Boston to establish a centralized system for referring people whose asthma is not under control to home visit services that provide both asthma education and environmental interventions. A centralized system has potential to reduce costs associated with urgent care visits for asthma, and to be of particular benefit to low income and minority populations who suffer disproportionately from asthma. Under the auspices of the Boston Home Visit Collaborative, hospitals, health centers, and local asthma coalitions have agreed to work with the City to standardize the training, mechanisms for referral and feedback, protocols, educational tools etc. to be used by all home visit providers. The Collaborative will be seeking agreements with public and private health insurers to cover the costs of the home visits and associated services and supplies, so that home visits become a sustainable component of asthma management for City residents.
We are also addressing the role of chemicals in causing and exacerbating asthma, and urging a new focus in asthma research and policy on primary prevention: advancing understanding of and action to reduce the incidence of the disease. EHP was instrumental in establishing a commitment in the Commonwealth of Massachusetts Strategic Plan for Asthma to developing a “Roadmap for the Primary Prevention of Asthma.” See our project Chronic Disease Prevention through Safer Materials, Products, Technologies and Practices.
