Publication Date: January 2008
Publisher: California HealthCare Foundation
Author(s): Clarissa Hsu; Rita Mangione-Smith
Research Area: Health
Asthma is the most common diagnosis of children who visit the emergency room. Family members from predominantly urban, low-income areas account for a disproportionate share of these visits because they are less likely to have access to appropriate outpatient health services and more likely to be exposed to multiple asthma triggers.
Although a great deal has been done in recent years to improve asthma management, asthma care for these families remains a challenge. The underlying managed care structure in California provides an effective vehicle to design and implement strategies to improve asthma care for high-risk families enrolled in Medi-Cal.
The Collaborative Project Under a two-year grant funded by the California HealthCare Foundation, the Center for Health Care Strategies (CHCS) in collaboration with the National Initiative for Children's Healthcare Quality (NICHQ), the Medi-Cal Managed Care Division (MMCD), and the Improving Chronic Illness Care (ICIC) program of the MacColl Institute for Healthcare Innovation, worked with Medi-Cal managed care health plans and physician practices and clinics to develop and implement clinical and administrative practices to improve asthma care for Medi-Cal enrollees. This collaboration, the Plan/Practice Improvement Project (P/PIP), was an extension of work that had been done as part of the earlier California Asthma Collaborative.
The project had two major goals: establishing practices that improve clinical quality for enrollees with asthma; and maximizing limited resources by coordinating interventions and sharing information across stakeholder groups. The project was innovative in using virtual learning sessions rather than face-to-face meetings for the provider participants to most effectively use their time. The health plans participated in both virtual and face-to-face meetings. Evaluation A qualitative evaluation of this project was conducted by Rita Mangione-Smith, M.D., of the University of Washington, and Clarissa Hsu, of the Center for Community Health and Evaluation.
They found, among other things, that in most cases P/PIP was effective in fostering improved relationships among health plans and medical practice participants. Most practices implemented changes in their approach to the management and treatment of asthma patients, but these changes fell short of true implementation of the Chronic Care Model.