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Asthma Management and the Allergist: Better Outcomes at Lower Cost

Asthma Management and the Allergist: Better Outcomes at Lower Cost. Asthma Patients Cared for by Allergists Have:. Fewer emergency care visits Fewer hospitalizations Reduced length of hospital stays. Asthma Patients Cared for by Allergists Have:. Fewer sick care office visits

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Asthma Management and the Allergist: Better Outcomes at Lower Cost

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  1. Asthma Managementand the Allergist: Better Outcomes at Lower Cost

  2. Asthma Patients Cared for by Allergists Have: • Fewer emergency care visits • Fewer hospitalizations • Reduced length of hospital stays

  3. Asthma Patients Cared for by Allergists Have: • Fewer sick care office visits • Fewer days missed – school and work Increased productivity in work and personal lives Fewer sick days =

  4. Asthma Patients Cared for by Allergists Have: • Greater satisfaction with their care • Improved quality of life • Better overall outcomes that lower costs

  5. Asthma in the United States • 22 million Americans • 6.5 million children • 14.7 million physician visits • 1.8 million ER visits • 497,000 hospitalizations

  6. Direct and IndirectCosts of Asthma Care

  7. Setting Standards of Care • According to Guidelines, people with asthma should expect: • No or few asthma symptoms • Prevention of all or most asthma attacks • Participation in all activities • No ER visits or hospital stays • Less need for quick-relief meds • No or few side effects from asthma meds

  8. Compliance with Guidelines is Poor • One multicenter study of 4,000 patients found: • 83% had uncontrolled asthma • 16% had inconsistent control • 1.3% were controlled

  9. Compliance with Guidelines is Poor Cost per patient per year

  10. Compliance with Guidelines is Poor • Asthma uncontrolled in 85% of inner-city students with asthma • 50% had been treated in ER at least twice in previous two years • 52% often had to limit activities • 29% had nighttime symptoms once or more per week • 17% missed five or more days of school per year because of asthma

  11. Compliance with Guidelines is Poor • Analysis of 24,000 Medicaid patients found non-adherence to NIH Guidelines : • Fewer than 40% received rescue medication • Fewer than 10% were regular users of inhaled corticosteroids

  12. When to Refer to An Allergist • Patients should be referred to a specialist if they: • Have symptoms every day and often at night • Have had life-threatening attack • Do not meet treatment goals in 3-6 months • Have unusual/hard-to-diagnose symptoms • Have co-existing conditions • Need additional tests • Need more help and instruction

  13. When to Refer to An Allergist • Patients should be referred to a specialist if they: • Might be helped by allergy shots • Need oral or high-dose inhaled corticosteroids • Use oral corticosteroids 2+ times/year • Have been hospitalized for asthma • Need help to identify asthma triggers • Are children age 0-4 with frequent symptoms

  14. PCP Referral Patterns Often Differ from Guidelines • Survey of pediatricians and family physicians found criteria for referral did not conform to Guidelines • Study of PCPs found those who had training in allergic diseases were more likely to refer than those who were not as educated (78% vs. 46%)

  15. Allergists and NIH Guidelines • In a survey of 1,954 patients in 12 MCOs, patients cared for by allergists reported: • Fewer hospitalizations and ER visits • Higher ratings for quality of care • Fewer activity restrictions • Improved physical functioning

  16. Asthma Treatment Outcomes • Fewer hospitalizations • Fewer ER visits and sick care office visits • Improved patient satisfaction and QOL

  17. Asthma Treatment Outcomes – 497,000 Hospitalizations Number of Hospitalizations

  18. Asthma Treatment Outcomes – 1.8 Million ER Visits • Study of 9,500+ HMO patients documented lower risk of emergency asthma care with specialty care • Randomized study of 2,000 children found patients seeing allergist were only 54% as likely to require ER services • Comprehensive treatment in specialty allergy center reduced ER visits 76%

  19. Asthma Treatment Outcomes – 14.7 Million Sick Care Visits Number of Visits

  20. Asthma Treatment Outcomes – 10 Million Lost Work Days 13 Million Lost School Days Number of Lost Days

  21. Asthma Treatment Outcomes – Patient Satisfaction and QOL • Patients who receive care from allergist are more satisfied and experience improved emotional and physician well-being • Study of 400 HMO patients saw improvements in physical function, emotion, pain relief and general health • Patients in private practice reported improvements in ability to participate in activities, emotional well-being and asthma control

  22. Asthma Treatment Costs • Studies show aggressive allergist management produces better outcomes AND reduces costs • Specialty center experienced a 45% to 80% reduction in insurance claims • AAFA study found 54% increase in cost of care when guidelines are not followed • Failure to control asthma carries high price with 80% of all resources expended used by 20% of patients with uncontrolled disease

  23. Asthma Treatment Costs – $4.7 Billion in Hospitalizations Inpatient Care Costs

  24. Asthma Treatment Costs – $546 Million in ER Visits ER Costs

  25. How Allergists Improve Outcomes, Lower Costs • Accurately diagnose disease types and severity • Identify external triggers including allergens and advise on avoidance • Administer immunotherapy (allergy shots) to decrease sensitivity to allergic triggers • Develop and implement aggressive treatment plans • Maintain disease control • Prevent serious consequences

  26. Aggressive Asthma Management – The Standard of Care • Guidelines recommend early diagnosis and aggressive treatment • Treatment to control symptoms – initiate at onset and step down with improvement • Significant long-term benefits and cost savings outweigh high costs of initial therapy

  27. Emerging Role of New Treatments and Prevention • Allergists aware of latest treatment and control strategies • Environmental pollutant and allergens • Self-management and trigger avoidance • Partnerships with health care providers, families and other caregivers • Immunotherapy specialists • Clinical trial participants

  28. Specialty Care of Asthma in Health Plans • Asthma management a model for the new strategy of managed care • NCQA has made appropriate management of asthma a key indicator in evaluating the quality of health plans • PCPs are demanding greater say in referring patients to specialists

  29. Specialty Care of Asthma in Health Plans • ACAAI provides health plan checklist: • Access to specialists • Ongoing management for specialist care • Unlimited visits • Access to tests • Access to medications and shots • Management by specialist without high co-payments

  30. Asthma Management and the Allergist:Better Outcomes at Lower Cost Documented by an evidence-based review of the literature For a copy of the review, including an annotated bibliography, go to: www.acaai.org

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