Asthma Medication Ratio

Welcome to the Horizon Quality Programs Asthma Medication Ratio presentation.

The presentation today is designed to be informative and at the conclusion our objectives are that 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 learning 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 Healthcare Effectiveness Data and Information Set.

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

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

HEDIS is not exclusive to Horizon. The total number of HEDIS measures can vary from year to year. However, not all of the measures are in the R&R program.

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 and Allergy Foundation of America, asthma causes swelling of the airways commonly triggered by exposure to certain irritants.

The illustration of the lung on 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 and causes of asthmatic episodes from pollution, pets, dust and chemicals, just to name a few.

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

Now let's take a look at asthma management and how we're doing in the State of New Jersey.

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

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

In 2020, an article in New Jersey.com recently shared results of the American Lung Association’s annual report for the state of air in New Jersey.

The map displayed on the right illustrates the ozone grades, or air quality of New Jersey, with B grade representing the best air quality and a grade of F being the worst.

Although the annual report noticed 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 the Philadelphia areas.

The annual report looked at 2 major air pollutants, fine particle pollution and low level ozone.

The good news is that the annual report also noted that compared to 2019, every county in New Jersey showed improvement for average level particle pollution, except Mercer county.

For low level ozone grade, 9 New Jersey counties receive a failing grade. However, the report notes that Monmouth, Cumberland, and Atlantic counties did show some improvement.

The article notes some of the improvements can be attributed to the 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 incorporate avoiding some of the asthma triggers as noted previously, review the asthma treatment plan with our members, encourage members to consider using an asthma peak flow diary, or consider utilizing an application on their smart device, tablet or phones to track their symptoms.

And also our network providers and members are encouraged to consider collaborating further with the Horizon Healthy Journey Program or Horizon's Care Management Team as an additional resource.

And finally scheduling follow up visits to enable providers to monitor treatment plans and track progress.

Let's review some asthma facts nationwide according to the CDC.

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 Covid-19 diagnosis.

Therefore, the CDC recommends asthmatics limit their risk of exposure, for example, wearing masks, social distancing, hand-washing, avoiding large crowds, and avoiding someone who was sick in your household.

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 also updated their website with information regarding the 3 Covid-19 vaccines authorized.

The website notes that the CDC will continue to share updates regarding vaccine effectiveness and recommendations.

For more on this, it can be found on the CDC website, www.cdc.gov.

So let's move on to the HEDIS measure, Asthma Medication Ratio.

It is the percentage of members 5 to 64 years of age who are 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 allergenic asthma.

In addition to this, they must meet 1 of the following criteria both during the measurement year and the year prior.

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 medications dispensed during the measurement year may also be excluded.

Let's look at some recommended best practices for meeting Asthma Medication Ratio compliance.

Developing an asthma action plan, educating members on the importance of adhering to medications and reducing asthma triggers.

Advising members to incorporate inhalers into their daily routine, and reaching out to members to schedule follow-up visits for their condition.

Here we have an example of an Asthma Action Plan.

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 our members through various methods in helping to remind them of preventative care services and helping them closing care gaps.

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

The number for our Healthy Journey Team is listed here if you have any questions for them and it can be shared with your patients.

Outreaches include live calls, direct mailings and member reward programs, to name a few.

They also use vendors who do different types of screenings, such as colorectal cancer screening and diabetic eye exams for our Medicare HMO members.

These are a set of samples of member-focused outreach by Horizon Healthy Journey.

The image on the left of the slide represents an example of asthma resources by Horizon Healthy Journey.

This comprehensive member booklet contains detailed information regarding asthma diagnosis, prevention and treatment.

If you will like to receive a digital copy of this booklet, please reach out to your assigned CQIL 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, their symptoms, and what medications help 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 our Horizon Care Management Department.

Care Management is a unique opportunity for members to collaborate with our clinical team in an effort to educate and coordinate care to ensure quality 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 their asthma.

Members interested in Care Management, assessment needs to completed in a Health Needs Survey.

The risk level of scoring will indicate the need for additional outreaches 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 of the slide and let them know you have a member who would like to be assessed.

There are some additional resources for network providers that can be found on our Horizon NJ Health Website.

And here are the references for our webinar on Asthma Medication Ratio today.

Thank you for attending this webinar.

Please email any questions you may have to the Quality Department at Quality_RR@Horizonblue.com.

Located below this webinar and the transcript is a link to our Survey Monkey.

Please complete this brief survey. Your feedback is appreciated.

Thank you.

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