Last updated: May 2020

Author: Asthma Program, Vermont Department of Health

The Asthma Program is tasked with carrying out five infrastructure strategies (leadership, partnerships, surveillance, communication and evaluation) to support home- and school-based services strategies as well as health systems strategies aimed at promoting public health – health care collaboration.

The purpose of this measure is to encourage broad, strategic thinking about the asthma program’s place in the health care reform context and to support program planning to ensure asthma guideline care is properly located to reduce the burden of asthma throughout the state and can be sustained over time. Our target was chosen to continue to drive growth in this area as more and more experience is gained with identifying and pursuing 3 new opportunities each year. The target was achieved in year 3 with sustained improvements through to year 5!

More and more opportunities have been identified each year, including building off previous years' efforts. These opportunities have in part been identified through working with the Asthma Advisory Panel. The Asthma Program hosts a quarterly Asthma Advisory Panel. This panel invites key partners throughout the state including physicians, school nurses, industrial hygienists, housing partners, asthma educators, community health workers, hospital administrators and other governmental partners. Topics for the meeting come from the panel members themselves.

Examples of opportunities for expansion of comprehensive asthma control services include various pilots to explore reimbursement models for asthma self-management education, to shift from volume to value based service delivery, experimenting with collaborative models for reaching high risk or hard-to-reach populations, developing, refining and better aligning performance measurement and quality improvement efforts across the system, training and capacity building to bolster asthma education and guideline care delivery, strengthen care coordination for those with severe or uncontrolled asthma, and expanding the use of home visiting for self-management education, trigger reduction and referrals.

• Environmental Health is a partner that works with the Vermont Asthma Program on school based environment assessments.
• Vermont Department of Labor is a partner that works on the worksite wellness program.
• OneTouch is a partner that works with the Vermont Asthma Program on linking individuals to education and environmental remediation based on home visits. Other partners in the OneTouch program include Healthy Homes and Weatherization.
• Maternal and Child Health is a division in the Department of Health that works with the Vermont Asthma Program on increasing coordination at schools and among school nurses to address absenteeism and asthma education for school nurses/students, including training school nurses in selected supervisory unions throughout the state on asthma self-management.
• Blueprint for Health is a partner that works with the Vermont Asthma Program on educating community health teams on asthma education and tools available to improve self-management, including Asthma Action Plans and Healthier Living Workshops that support improving asthma management.
• Rutland Regional Medical Center is a partner that works with the Vermont Asthma Program on home visiting programs, the MAPLE hospital discharge protocol and community education.
• DVHA is a partner that works with the Vermont Asthma Program on reducing the burden of asthma among Medicaid-insured including exploring reimbursement for community-based education.
• Vermont Department of Health Offices of Local Health are partners that work with the Vermont Asthma Program to disseminate asthma action plans and reach local communities
• Asthma Advisory Panel is a partner that works with the Vermont Asthma Program on developing strategic goals and relationships.
• Asthma Regional Council is a partner that works with the Vermont Asthma Program on facilitating meetings between the different New England Asthma Programs
• Northeast American Lung Association is a partner that works with the Vermont Asthma Program on supplying education materials to asthma educators within the state.
• University of Vermont: Pediatrics is a partner that works with the Vermont Asthma Program on expanding access and delivery of supplementary asthma self-management education to those with uncontrolled asthma and severe persistent asthma to prevent asthma-related emergency department visits and hospitalizations.
• Vermont Chronic Care Initiative is a partner that will work with the asthma program on incorporating asthma education into their case management home visiting programs
• Vermont One Care is a partner that works with the Vermont Asthma Program at improving care for pediatric and adult populations by hosting a learning collaborative and facilitating quality improvement projects among participating providers and practices in guideline care.
• Hark Website Design, Branding & Communication is a partner that works with Vermont Asthma Program creating a digital media plan with the goal of increasing awareness of secondhand smoke exposures, increasing referrals to 802Quits, promoting importance of flu shots and asthma action plans, and reducing exposures to asthma triggers in homes and schools.

Encouraging broad, strategic thinking about the asthma program to ensure that guideline based care, health care systems, services for high need populations, and infrastructures for those with asthma are available and well integrated as health care reform and development continues.  Other approaches include:

• improving quality of medical services through training, QI, or decision support
• encouraging provision of reimbursement for asthma self-management education (SME) and/or home visits
• develop and incorporate asthma quality measures throughout systems
• develop and implement mechanisms for linking Public Health and Health Care services
• advance the evidence base for implementation of comprehensive asthma services

The Asthma Program gains through the Asthma Advisory Panel and other local partners a state wide collaborative that is engaged in current asthma research, advocates for Asthma program work throughout the state, and supports the Vermont Asthma Program by helping to identify, validate and review priorities, plans, and products it pursues.  The following are some of the priority opportunities for expansion of comprehensive asthma control services the Vermont Asthma Program has pursued to leverage health care reform in recent years:

• Reimbursement: Planning models and mechanisms for reimbursement of community-based asthma education services to Medicaid members in clinic, community, home and school settings; involves developing a plan for delivery of time sensitive code content
• Measures: exploring of ACOS in developing and using asthma and tobacco quality measures; discussed the possibility of cross-tabbing measures (e.g., treatment plan, tobacco use and asthma diagnosis, PQI hospital admissions for asthma)
• Quality: discussed with the ACO clinical director the role of asthma education in improving outcomes and the value of program resources to prevent hospitalizations, such as Quality Improvement Learning Collaboratives, referrals to 802Quits, and guideline care materials for providers
• Measures: The Asthma Program commented on and recommended for stronger status (e.g., payment) for three measures related to preventing hospitalizations and promoting proper medication use
• Reimbursement: The Asthma Program worked with Medicaid to distribute the in-clinic asthma education codes and will monitor their usage in claims
• Quality: The Asthma Program hosted a training in 2016 to bolster and standardize the asthma education provided through the SASH home visiting program, created out of health care reform through the Blueprint for Health
• Implementing: The VCCI home visiting asthma pilot in Burlington is to offer asthma self-management education to eligible Medicaid clients with complex chronic disease conditions. 
• Reimbursement: planning efforts to improve in the all-payer model the rate of medication management for people with asthma, and the rate of tobacco use and cessation intervention, starting with an approved waiver with CMS, a pilot called Next Gen underway in four geographic areas to work to transition from volume based to value based reimbursement per the Triple Aim

The Program will continue to work with all its partners to establish priority opportunities.