Medicaid Payment Innovations to Financially Sustain Comprehensive Childhood Asthma Management Programs at Federally Qualified Health CentersSeq ID: 584
Authors: Markus AR, Andres E, West K, Gerstein MT, Lyons V
Website link: http://journals.sagepub.com/doi/10.1177/2150129713486479
Publicly Available: Yes
Billing and Reimbursement:
Policy: MCO contract language and reimbursement models
Background. One in 7 children in the United States is diagnosed with asthma, the leading cause of chronic childhood disease. Although a manageable condition when recommended medication regimens are followed and environmental control measures implemented, asthma remains the third most common reason for hospitalization among non-newborn hospital stays. As the primary health care home to a fifth of all low-income children who are especially vulnerable to asthma, federally qualified health centers play a critical role in providing comprehensive and preventive asthma care to their pediatric patients. Many health centers rely on the asthma education and counseling services of traditional and nontraditional providers, such as clinicians and community health workers, who may or may not be certified as asthma educators, as essential elements of asthma management and control. Asthma counselors are particularly valuable for patient home assessments and tailored education and counseling that are recommended components of evidence-based asthma care. Yet sustainable reimbursement for their services is a frequent challenge. Methods. We conducted an environmental scan
of innovative approaches to securing adequate Medicaid reimbursement for asthma educator services provided as part of asthma management and control. Results. We identified a number of models at the individual health center, Medicaid health plan, and Medicaid state program level for securing sustainable reimbursement for asthma educators. Whereas state-based approaches are preferable to more incremental options at the health center and health plan level, local approaches may be more feasible for some health centers. Conclusion. Asthma educators provide essential, cost-effective services as part of childhood asthma care management. This analysis identifies creative solutions for health centers and other health care organizations to consider as mechanisms for sustaining the important services of these providers.