The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

HEALTHSPRING MEDICARE ADVANTAGE PLAN-COMPREHENSIVE CASE MANAGEMENT RESPIRATORY PROGRAM.

Deandrea Prince, Michael Davidson, Frederick Watson; Health Services, HealthSpring, Houston, TX

Background: HealthSpring, a Medicare Advantage Plan, has approximately 8,000 members with a COPD/Asthma diagnosis in the Texas market. The 2010 costs of COPD/Asthma related care among HealthSpring beneficiaries age >/= 65 years account for a significant part of medical expenses and a third of the acute admissions. In an attempt to reduce admissions, HealthSpring devised a unique approach which utilizes a Respiratory Therapist through the Comprehensive Case Management Respiratory Program. Objective: The Comprehensive Case Management Respiratory Program uses a Respiratory Therapist to focus on coordination of services to enhance the members'quality of life, reduce re-admissions, facilitate provision of services, and promote quality cost effective outcomes. Specifically, those diagnosed are targeted for more personalized attention. The program is also beneficial for our Special Care Program (SNP) members to meet CMS regulatory requirements and the members'personal health improvement goals. Method: The program was implemented for members with a COPD/Asthma diagnosis and two hospital encounters within the previous six months. The first step of the program consists of a respiratory therapist home visit after the member is discharged from the hospital. The second step following the initial home visit, the member will receive ongoing reinforcement telephonically from the Respiratory Therapist who interfaces with providers to facilitate effective communication, referrals, development of discharge planning and alternative treatment arrangements. Relevant metrics are tracked and compiled, such as medical cost and acute admissions, which are reviewed intermittently. Results: 265 patients with COPD/Asthma were enrolled in the program during the 2010 calendar year. The acute admits per thousand (ADK) decreased by 40%. This represents a considerable reduction in respiratory admissions and in overall medical expenses. There were small increases in durable medical equipment (DME) and utilization in prescription drugs which is indicative of members'adherence to using the respiratory equipment and medication. Conclusions: This program yielded significant results for patients with a COPD/Asthma diagnosis. The benefits of using a respiratory therapist, in a managed care setting, telephonically and face to face has had a great impact on reducing hospital admissions and utilization through education to improve the quality of life.
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