Asthma Medication Ratio

Hello, and welcome to the Quality Program's presentation on Asthma Medication Ratio.

The presentation today is designed to be informative and at the conclusion, our objective is, you will have an understanding of HEDIS and Horizon’s goals for the Quality Program.

Understand Asthma Medication Ratio and best practices.

Learn and have a better understanding about Horizon Healthy Journey and learn how to utilize Horizon's Care Management Department. Horizon's goal for the quality program is to improve clinical outcomes and performance on HEDIS measures and to promote the care our members receive.

So, what is HEDIS. HEDIS is an acronym that stands for Health Care Effectiveness Data and Information Set.

HEDIS was developed by the National Committee for Quality Assurance, also known as NCQA, and it is a set of standardized performance measures.

It ensures that the public has the information it needs in order to compare all organizations performances.

HEDIS is not exclusive to Horizon, 90% of America's health plans use HEDIS to measure performance on important dimensions of care and service.

There are 96 HEDIS measures in total, however, not all measures are in the Results and Recognition Program.

We have selected specific measures that focus on preventative care.

This presentation will focus on the HEDIS measure Asthma Medication Ratio. This slide is a brief overview of asthma and common triggers associated with asthma.

According to the Asthma Allergy Foundation of America, asthma causes swelling in the airways commonly triggered by exposure to certain irritants. The illustration of the lung at the bottom left is comparing a normal airway, which looks relaxed, to an asthmatic airway, which looks inflamed.

The bottom right illustration shows some examples of the most common triggers or causes of asthmatic episodes such as pollution, pets, dust and chemicals, just to name a few.

Fortunately, the Asthma Allergy foundation of America notes asthmatic episodes can be controlled with managed care and preventative treatment.

Let's take a look at some asthma statistics in New Jersey.

According to the State of New Jersey's Department of Health, the most up to date figures reported, approximately 600,000 adults and 167,000 children currently have asthma.

The highest asthma prevalence is reported amongst African American non-Hispanic adults.

In 2020, an article in New Jersey.com recently shared results from the American Lung Association annual report for the State of the Air in New Jersey.

The map displayed on the right illustrates the ozone grades or air quality of New Jersey, with the B grade representing the best air quality and a grade of F being the worst. Although the annual report noted some improvements with New Jersey's air quality, it still ranks the worst in the nation, especially with counties close to New York City and Philadelphia.

The annual report looked at 2 major air pollutants. Fine particle pollution, such as soot and low level ozone, such as smog and emissions.

The good news is the annual report also noted that compared to 2019, every county in New Jersey showed improvement for average levels of particle pollution except Mercer county. For low level ozone grades, 9 New Jersey counties received a failing grade.

However, the report notes, Monmouth, Cumberland and Atlantic counties did show some improvement.

The article notes, some of these improvements can be attributed to previous steps the state has taken to improve air quality and also the steps the state government is considering to reduce vehicle emissions even more by offering incentives for purchasing electric cars and building more charging stations.

According to the CDC and the Asthma Allergy Foundation of America, asthma prevention and treatment should include: avoiding some of the asthma triggers, as noted previously, such as dust, pet dander, mold, pollution, chemicals and cigarette smoke.

Review the asthma treatment plan with our members.

For example, quick relief, rescue medications, such as pro air, or long term control and maintenance medications, such as corticosteroids.

Encourage members to consider using an asthma peak flow diary or consider using an application on their smart device, such as a tablet or a phone, that will allow them to track their symptoms.

Also our network providers and members are encouraged to consider collaborating further with Horizon Healthy Journey or Horizon's Care Management team as an additional resource.

Finally, scheduling follow up visits will enable providers to monitor treatment plans and track progress.

Let's review some Asthma facts nationwide.

According to the CDC's asthma facts website, 1 in 13 people have asthma and 1 out of 12 school age children have asthma.

In the United States, African Americans have a higher rate of mortality from asthma than people of other races and ethnicities.

Asthma is more common in adult women versus men.

Asthma also carries a higher risk of severe illness with a COVID-19 diagnosis. Therefore, the CDC recommends that asthmatics limit the risk of exposure.

Also, in consideration of COVID-19, the CDC recommends additional preparations by making sure asthmatics have at least a 30-day supply of their medications.

The CDC has also updated their website with information regarding the COVID-19 vaccines.

The website notes, the CDC will continue to share updates regarding vaccine effectiveness and recommendations. More information on this can be found on the CDC's website www.cdc.gov.

So, let's take a look at the HEDIS measure Asthma Medication Ratio.

Asthma Medication Ratio is the percentage of members 5 to 64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year.

The eligible population are members who have persistent asthma, a true diagnosis of being asthmatic, and not seasonal or allergic asthma. In addition to this, they must meet at least 1 of the following criteria during both the measurement year and the year prior: At least 1 ED visit with the principal diagnosis of asthma.

At least 1 acute impatient encounter with the principal diagnosis of asthma without telehealth or at least 1 acute impatient discharge with a principal diagnosis of asthma on the discharge claim.

At least 4 outpatient visits, observation visits, telephone visits or online assessments on different dates of service with any diagnosis of asthma.

And at least 2 asthma medication dispensing events for any controller or reliever medications, or finally, at least 4 asthma medication dispensing events for any controller or reliever medication. There are some exclusions.

Some exclusions can be emphysema, COPD, chronic respiratory conditions due to fumes or vapes and these are just a few. Members who had no asthma controller or reliever medication dispensed during the measurement year may also be excluded.

Let's look at some best practices for meeting the Asthma Medication Ratio Compliance.

Develop an asthma action plan. Educate members on the importance of adhering to medications and reducing asthma triggers.

Advise members to incorporate inhalers into their daily routine. Reach out to members to schedule follow up visits for their condition.

Here we have an example of an asthma action plan.

Let's talk a little bit about Horizon Healthy Journey.

Horizon Healthy Journey Program is a great resource for providers and our members.

The department consists of a dedicated population health management team whose focus is to reach out to members through various methods to help remind them of preventative care services.

It's also helping in closing care gaps.

The program also offers opportunities for education and chronic disease management.

The number for our Horizon Healthy Journey team is listed here if you have any questions for them. This number can also be shared with your patients.

Types of outreach include live calls, direct mailings and member reward programs, just to name a few.

They also utilize some vendors who do different types of screenings such as colorectal cancer screenings and diabetic eye exams.

Here are some examples of some member focused outreach that is done by Horizon Healthy Journey.

And here are some asthma resources. The image on the left of the slide represents an example of the asthma resources by the Horizon Healthy Journey team. This comprehensive member booklet contains detailed information regarding asthma diagnosis, prevention and treatment.

If you would like to receive a digital copy of this booklet, please reach out to your assigned CQIL, who will be able to assist you. The image located on the right is an example of an asthma diary from Kidshealth.org.

As you may know an asthma diary helps our members keep track of how well they are managing their asthma by recording their triggers, symptoms and what medications helped relieve their symptoms.

Providers are able to monitor how well, their patients are doing and make any adjustments to their treatment plan.

Another resource available to our members is Horizons Care Management department.

Care Management is a unique opportunity for members to collaborate with our clinical team in efforts to educate and coordinate care to ensure quality of care is delivered to our members.

Members with an assigned care manager may receive updates on grant programs or community based programs to aid further in managing asthma.

Member's interested in care management assessments need to complete a health needs survey. The risk level scoring will indicate the need for additional outreach and assistance from our Care Management department.

If you think someone may benefit from our Care Management department, please feel free to use the numbers located on the right side of the slide and let them know, you're member would like to be assessed.

Here are some additional resources for network providers, which can also be found on Horizon NJ Health's website.

These are the references for this particular webinar.

Thank you for attending this recorded webinar. Please email any questions you may have to the quality department at Quality_RR@Horizonblue.com.

Located below this webinar and in the transcript is a link to our Survey Monkey. Please complete this brief survey, your feedback is appreciated.

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