Decisions made by the Federal government often feel remote and disconnected from the lives of local families. But, for Los Angeles children with asthma in low-income families, a recent Federal decision really hits home.
Medicaid and CHIP programs will begin paying for preventive services delivered by trained professionals who are not healthcare providers, but are members of the health care team. This means asthma educators and other professionals whose services are recommended by a doctor or nurse practitioner will be reimbursed. About seven million children in the United States live with asthma, costing the U.S. health care system about $56 billion each year. This decision is a victory because it will hopefully reduce costs and create more effective partnerships between healthcare providers and other members of the health care team.
There have been many studies showing how asthma educators/counselors, community health workers, and healthy homes specialists can reduce asthma symptoms and help families adhere to asthma management plans between doctor visits. However, the ability for families to access these professionals varied state to state. Asthma is the most common chronic health condition in children and its impact on health and quality of life depends on how well (or not) it is managed day-to-day. Following the doctor’s recommendations can be challenging, particularly if you live in an environment full of things that can trigger an asthma attack, like tobacco smoke, cockroaches, mold, dust mites, pet dander or even strong odors.
So what do these new Medicaid and CHIP changes mean for children struggling with asthma? For starters, many doctors don’t have enough time to spend instructing each patient/family how to take care of their chronic disease. By being able to recommend and work with these trained professionals, healthcare providers will have partners who can help families better understand the condition, identify and remove triggers, and ensure correct use of asthma medicines and equipment. Since half of Medicaid recipients are children, those with poorly-controlled asthma will have better access to community-and home-based services, some of which have been found to save an average of $5 to $14 for every dollar invested.
The Medicaid decision might also help sustain local community-based programs working to address asthma. For example, The Los Angeles Unified School District’s (LAUSD) Asthma Program could benefit from this new change. The program, funded by the Merck Childhood Asthma Network, uses school nurses to help improve asthma outcomes and decrease asthma-related school absences by educating teachers about asthma, teaching self-management skills to students and families and providing in-home case management. With approximately 77,000 district students suffering from asthma, the new ruling means improved quality and access to care for high-risk students in LAUSD’s Asthma Program.
If you are a parent of a child with asthma, a doctor or licensed provider struggling to keep up with patient demand and adherence, a community health center or nonprofit organization looking for ways to get quality and needed services reimbursed, then these changes are a step in the right direction. In both economic and human terms, we have a lot to gain from a more effective childhood asthma control strategy that keeps kids out of hospitals and emergency departments.
Dr. Floyd Malveaux is executive director of the Merck Childhood Asthma Network, Inc., and a member of the Childhood Asthma Leadership Coalition. E-mail Dr. Malveaux at firstname.lastname@example.org