Sustainable Financing for Home-Based Asthma Services: Snapshots of Innovation and Progress Across the Country
This report from PHI’s Regional Asthma Management and Prevention Program and the National Center for Healthy Housing (NCHH) explores the different approaches and pathways to building systems to expand and sustain access to home-based asthma services.
- Regional Asthma Management
Prevention Program and the National Center for Healthy Housing
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Focus Areas
Capacity Building & Leadership, Environmental Health, Healthy Communities -
Issues
Asthma -
Programs
Regional Asthma Management and Prevention Program
Asthma home visiting is an evidence-based intervention proven to improve health outcomes, lower healthcare utilization costs and improve patient care. Yet far too many people with poorly controlled asthma lack access to these key services.
Historically, asthma home visiting programs have had to rely on unstable grant funding to provide services. But in recent years, that pattern has begun to shift, and we are seeing progress in communities and states across the country in building systems for sustainable asthma home visiting services. Now is the time to learn from these successes and build on momentum across the country.
This report from PHI’s Regional Asthma Management and Prevention Program (RAMP) and the National Center for Healthy Housing (NCHH) explores how building systems to expand and sustain access to home-based asthma services can take a long time and the many pathways for achieving similar outcomes. This scan provides an overview of what progress and pathways might look like.
This report also features success stories from across the country, highlighting both state Medicaid policy advances and stories about local partnerships, pilot programs and other innovations that create a groundswell for statewide change; all serving as models for new community action.
read the reportLooking for additional support? NCHH and RAMP offer customized technical assistance and support that can help you translate the information in this tool into concrete actions. Email today: askanexpert@nchh.org or TA@rampasthma.org.
Examples of Progress:
- Expanding strategic and cross-sector partnerships, such as implementing a joint demonstration to show a comprehensive approach to healthy housing, including asthma home visiting services in a community.
- Prioritizing asthma home visiting services, such as expanding the focus of an agency or organization (e.g., a community weatherization program) to include asthma home visiting services like environmental asthma trigger assessments.
- Achieving local systems change, like securing a managed care plan contract to cover asthma home visiting services for their members with uncontrolled asthma.
- Working on policy development; for example, meeting with the state Medicaid agency clinical director, strategy director, and, ultimately, financing officers, to discuss policy mechanisms that may increase coverage for and access to home-based asthma services in your state.
- Creating and adopting new policies, like helping the state Medicaid agency write a policy to cover asthma home visiting services for eligible members and defining those groups.
- Implementing new policies, including supporting workgroups to plan implementation of new state Medicaid policies that cover asthma home visiting services
Minnesota: Case Study & Lessons Learned
Minnesota has an enhanced asthma care law (EACL) for Medicaid beneficiaries that includes a home assessment of environmental asthma triggers and the provision of allergen-reducing products. CHW Solutions, a community partner, is currently working through implementation challenges to increase provision of the services.
Key Lessons from Minnesota
• Passing a policy is not always the end goal. Figuring out how to implement policies on the ground effectively is just as critical to success.
• It takes an investment of time upfront to try out a model and tenacity to prove the model. Then, the next step is scaling the model.
• A multipronged approach to policy and program work can increase access to services faster than a single approach.
Hawai’i: Case Study & Lessons Learned
Hawai’i is leveraging a strong relationship between the state department of health and the state Medicaid agency to achieve the goal of Medicaid coverage for asthma self-management education and home environmental asthma trigger assessments through an incremental approach to state plan amendments.
Key Lessons from Hawai’i
• Genuine partnerships between state agencies and state Medicaid, and between Medicaid and the federal government, can be a key asset to making policy progress possible.
• Policy change can be achieved all at once or through incremental steps. There’s no one right way.
• Having model policies from other states to review, learn from, and adapt accelerates the adoption of preventive service policies for asthma nationwide.
New York: Case Study & Lessons Learned
New York’s Medicaid system is implementing the New York Health Equity Reform (NYHER) waiver, to build a delivery system with a focus on health equity, including regional social care network lead entities (SCNs) that will provide asthma remediation services, building on a rich history of both asthma and healthy housing programs.
Key Lessons from New York
• Expect to pursue multiple policy tracks and stay persistent. Feasible policy options will change rapidly, but even an unsuccessful attempt can gain important momentum in policy transformation. With every attempt, partners learn necessary details and forge necessary connections without which no policy can be successful. Every step is a building step, knowledge is cumulative towards successful policy change, even if your first policy target is not the pathway your state or community can ultimately make work. Policy is opportunistic, and the prepared team is ready when opportunity presents itself with detailed policy solutions that can fit the opportunities.
• There are multiple policy solutions that can achieve the same outcome. It’s important to explore and understand all options and determine which is most feasible for a given place and time.
California: Case Study & Lessons Learned
California’s Medicaid system adopted the Asthma Preventive Services benefit, covering asthma self-management education and a home environmental asthma trigger assessment for qualifying individuals and is providing asthma remediation through a waiver using the federal “in lieu of services” rule, covering trigger remediation supplies and services.
Key Lessons from California
• Broad and committed partnerships—developed over many years and with a range of partnering organizations—are a tremendous strength to support both state and local efforts.
• After policy development and passage, policy implementation requires ongoing dialogue between policymakers and implementers to be successful.
Alexandra, Virginia: Case Study & Lessons Learned
Alexandria, Virginia, is using data-driven interventions to improve asthma and housing quality. Authentic community engagement has led to a stronger foundation for future policy change.
Key Lessons from Alexandra, Virginia
• Authentic community engagement leads to stronger foundation for future policy change.
• Data-driven interventions increase impact, foster new understandings, and highlight potential opportunities.
• Constructive partnerships and individual relationships are a connective tissue that can support work in any community.
Michigan: Case Study & Lessons Learned
In Michigan, the Ingham Health Plan Corporation’s track record and preparation, along with their partnerships, have been instrumental to achieving their success.
Key Lessons from Michigan
• Relationship-building is central to sustainability work.
• Broadly articulating the value add of asthma home visiting programs is a key step toward sustainability.
• State capacity building ensures local programs have the support needed to be successful.
Originally published by Regional Asthma Management and Prevention Program
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