Home Visits for Children With Asthma Reduce Medicaid Costs

Erica T. Marshall, MPH; Jing Guo, PhD; Elizabeth Flood, MPH; Megan T. Sandel, MPH, MD; Matthew D. Sadof, MD; Jean M. Zotter, JD

Disclosures

Prev Chronic Dis. 2020;17(2):e11 

In This Article

Abstract and Introduction

Abstract

We conducted a multicomponent, low-cost, home intervention for children with uncontrolled asthma, the Reducing Ethnic/Racial Asthma Disparities in Youth (READY) study, to evaluate its effect on health outcomes and its return on investment. From 2009 through 2014 the study enrolled 289 children aged 2 to 13 years with uncontrolled asthma and their adult caregivers in Boston and Springfield, Massachusetts. Community health workers (CHWs) led in-home asthma management and environmental trigger remediation education over 5 visits spanning 6 months. Asthma health outcomes and indoor environment data were collected via survey, and health use costs were accessed through Massachusetts Medicaid (MassHealth). Results showed significant improvements in asthma control, health care use, and environmental trigger reduction and a positive return on investment (1.34) for participants who had 2 or more emergency department visits 1 year prior to the first home visit. The CHW asthma home visiting intervention improved trigger management, clinical outcomes, and Medicaid cost savings, demonstrating that asthma home visits improve health quality and reduce costs.

Introduction

The effectiveness of home visits by community health workers (CHWs) to children with asthma in improving health outcomes for high-risk populations is established in the literature.[1] However, that evidence-based model of care has not been widely adopted by health care systems, mainly because of limited coverage by health care payers.[2] Although many studies have estimated a positive return on investment (ROI) for these home visits, few have used verified cost and use data from participants' medical claims. This absence of data is a barrier to widespread payer reimbursement.[3–5] Our study, Reducing Ethnic/Racial Asthma Disparities in Youth (READY), used insurance claims data to determine the potential cost savings for Massachusetts Medicaid (MassHealth) of integrating a CHW-led asthma home visiting program into the medical home model of care. The READY study was approved by the Massachusetts Department of Public Health (MDPH) Institutional Review Board (Approval # 00000701).

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