- Asthma is one of the most expensive chronic diseases for providers, payers, and patients. But a recent study in the American Journal of Managed Care showed that a stationary pediatric asthma management clinic can achieve a return on investment for smaller health systems and hospitals while improving patient outcomes.
The cost of asthma disease management was about $3,300 per individual in 2003, with the total economic impact reaching $56 billion in direct medical costs as well as losses in work productivity and school absences.
The chronic disease has especially troubled healthcare providers who are becoming increasingly more responsible for costs of care under value-based purchasing models. Pediatric asthma patients tend to experience excessive and costly hospital admissions and emergency department visits as well as limited disease control.
Large health systems and hospitals have attempted to control pediatric asthma management costs and outcomes by investing in Breathmobiles/pediatric asthma disease management programs (PADMAPs), explained researchers in the new study.
The mobile asthma clinics visit neighborhood schools during school hours to treat pediatric asthma patients. They operate an average 3.7 days a week and patients see a team of providers, which includes an asthma specialist, a registered nurse, a respiratory therapist, and a patient financial worker. The provider team uses National Heart, Lung, and Blood Institute Expert Panel Review asthma guidelines to direct patient care.
Through the Breathmobile programs, health systems and hospitals reported patient outcome and healthcare spending improvements. The programs resulted in reductions in asthma-related emergency department visits or hospitalizations from 37.3 percent prior to program entry to 8.7 percent within the first six visits to the program, stated a cited Disease Management study.
The Breathmobile program also demonstrated that up to 70 percent of asthmatic children could achieve asthma control after three visits regardless of initial disease severity if they remained engaged in the chronic disease management program and were treated according to asthma care guidelines.
While the mobile clinics improve patient outcomes, they require substantial start-up costs and resources. The program cost health systems and hospitals about $365,865 per year to purchase and operate one Breathmobile for the first seven years if patients are treated five days per week and excluding the asthma specialist’s compensation.
The total cost translates to $465 per half-day session.
However, the asthma disease management programs did realize a return on investment. A recent study in Population Health Management showed that four Breathmobiles in southern California in 2010 saved about $6.73 for each dollar invested. The positive return on investment stemmed from savings related to fewer emergency department visits and hospitalizations, decreased school absenteeism, and quality-adjusted life-years saved.
Despite a significant return on investment, the initial start-up and ongoing costs of running a mobile asthma disease management may be too much for smaller health systems and hospitals.
“Smaller health systems with smaller budgets and fewer patients may not have the resources to start an effective Breathmobile-like asthma program; yet, these groups have a similar percentage of patients with asthma and, therefore, incur a similar proportion of asthma-associated health and economic burden,” researchers in the American Journal of Managed Care study wrote.
To explore if smaller health systems and hospitals could realize a return on investment with a similar, but stationary asthma management program, researchers from the Los Angeles County+University of Southern California Medical Center partnered with a clinic system at Harbor-University of California, Los Angeles Medical Center.
The medical center and clinic system established a fixed asthma-specific clinic modeled on the Breathmobile/PADMAP program. The clinic employed an allergy-immunology specialist, two nursing/asthma educators, and a medical technician who coordinated appointments and managed financial matters. Pediatric nurses were used in lieu of full-time allergy-immunology staff as seen in the Breathmobile program because of staffing limitations.
The clinic also operated a half-day per week and the provider team followed the same asthma care guidelines, researchers noted.
The stationary pediatric asthma disease management clinic was able to similarly improve patient outcomes without incurring the high costs of a Breathmobile program.
Researchers reported the following patient outcome improvements:
• 50 percent of mild persistent asthma patients achieved disease control by the second visit and 70 percent achieve control by the third visit
• 97 percent of patients with mild persistent and 90 percent of those with moderate/severe persistent asthma achieved disease control by their sixth visit
• The program resulted in a 69 percent and 92 percent decrease in emergency department/urgent care visits and hospitalizations, respectively
The clinic also saw the patient outcome improvements at significantly less cost. The overhead for one half-day a week of clinic services was $10,000 per year.
As a result, the total cost of running the clinic was $192 per half day, the study uncovered.
With all patients enrolled in Medi-Cal, California’s Medicaid coverage program, researchers also found that the state’s Medicaid reimbursement would sustain the clinic’s operations.
“Based upon 2015 reimbursement rates for California Medi-Cal, there was a significant ROI [return on investment] in the context of reduced ED visits and hospitalizations,” researchers added.
Using existing staff from the health system and limiting the clinic’s operating hours resulted in a return on investment for a stationary asthma management clinic, the study concluded.