Better Outcomes at Lower Cost - American College of Allergy ...
Better Outcomes at Lower Cost - American College of Allergy ...
Better Outcomes at Lower Cost - American College of Allergy ...
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Specialty Care <strong>of</strong> Asthmain Health Plansuse <strong>of</strong> asthma medic<strong>at</strong>ions a key indic<strong>at</strong>or inevalu<strong>at</strong>ing the quality <strong>of</strong> managed careprograms. [44]Even PCPs increasingly aredemanding a gre<strong>at</strong>er say inreferring p<strong>at</strong>ients to specialistswhen the disease is severe,<strong>at</strong>ypical or requires specializedknowledge for optimummanagement. [45]As asthma management becomes moresophistic<strong>at</strong>ed, health care plans are seeking acompetitive edge through programs th<strong>at</strong>optimize p<strong>at</strong>ient health educ<strong>at</strong>ion, symptomcontrol and aggressive tre<strong>at</strong>ment th<strong>at</strong> avoidssevere exacerb<strong>at</strong>ions <strong>of</strong> the disease. Plans withgoals <strong>of</strong> reducing participant turnover and th<strong>at</strong>emphasize lifestyle change are most successful<strong>at</strong> s<strong>at</strong>isfying p<strong>at</strong>ients and reducing costs. In areview <strong>of</strong> health care trends prepared forManaged Care Medicine, asthma managementwas chosen as a model for the new str<strong>at</strong>egy <strong>of</strong>managed care. [43] “Asthma is a healthproblem th<strong>at</strong> pays large dividends if a properfront-end investment is made in p<strong>at</strong>ienteduc<strong>at</strong>ion and preventive care,” the authornoted. “Such an intervention can significantlyimprove symptom control and reduce hospitaland emergency room use . . . . The PCP[primary care physician] should have aconsulting rel<strong>at</strong>ionship with an allergyspecialist who can perform any part <strong>of</strong> theinitial evalu<strong>at</strong>ion for asthma or diseasemanagement th<strong>at</strong> the PCP is not able to provide.”Managed care organiz<strong>at</strong>ions have an addedmotiv<strong>at</strong>ion to optimize asthma management.The N<strong>at</strong>ional Committee for QualityAssurance (NCQA) has made the appropri<strong>at</strong>eAsthma specialists also arespreading the word toconsumers. The <strong>American</strong><strong>College</strong> <strong>of</strong> Asthma, <strong>Allergy</strong> andImmunotherapy (ACAAI), forexample, has launched aneduc<strong>at</strong>ion campaign to help consumersevalu<strong>at</strong>e allergy and asthma benefits in healthplans. When individuals with allergies orasthma enroll in a health plan – or have anannual open enrollment period for changingplans – the ACAAI provides a Checklist as aguide to determine whether an employee’sinsurance options allow:• access to specialists for diagnosis <strong>of</strong> asthmaand other allergic diseases• ongoing management for specialist care <strong>of</strong>asthma and allergies• unlimited visits to specialist care for asthmaand allergies• access to diagnostic tests for asthma andallergies• access to medic<strong>at</strong>ions and tests prescribed byspecialists, including immunotherapy or“allergy shots”• consult<strong>at</strong>ion and/or management by aspecialist without co-payments th<strong>at</strong> aregre<strong>at</strong>er than those for generalist care.15
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