The Center for Medicare and Medicaid Innovation awarded HRiA a four-year Health Care Innovation Challenge grant to establish, develop, manage, and ongoingly improve the New England Asthma Innovation Collaborative (NEAIC). The goal of NEAIC was to improve asthma outcomes, quality of care, and health care costs of Medicaid and CHIP-enrolled children by advancing home-based asthma interventions, and to promote sustainable payment systems. NEAIC was a multi-state initiative that included nine health care providers, six Medicaid payers, and policy makers in CT, MA, RI, and VT. NEAIC’s nine clinical partners provided asthma home visiting services to 1,145 pediatric patients over two and a half years. Community Health Workers (CHWs) delivered the visits, with support and/or collaboration from clinical staff, including Certified Asthma Educators. The targeted population was high-cost Medicaid and CHIP pediatric patients (age two to 17 years) with a focus on those with uncontrolled symptoms and a history of using expensive urgent care. The three-year program also included workforce development, committed Medicaid payer involvement, and learning communities for CHWs and clinical partners.
NEAIC included two evaluations: an intervention evaluation based on data collected during home visits and environmental assessments, and an economic evaluation based on claims data. For the intervention evaluation, HRiA developed data collection tools and provided technical assistance to the pilot sites. Sites reported and HRiA analyzed data quarterly. HRiA also conducted focus groups with participant caregivers. Findings from data collected during the home visits showed a decrease in health care utilization and environmental exposures, and an improvement in asthma control and in caregiver quality of life. For the economic analysis, HRiA worked closely with CHPR, which conducted the analysis. HRiA obtained data use agreements with state Medicaid offices and with Medicaid Managed Care Organizations, and assured the transfer of the claims and encounter data. The economic evaluation was based on 12 months pre- and 12 months post-enrollment for the participants served through NEAIC, as well as a comparison population generated from the claims data (all pediatric members with a diagnosis of asthma). To address broader policy goals for long-term financing of the intervention, HRiA designed and conducted an assessment of New England health payers to better understand their attitudes, knowledge, and beliefs about the NEAIC intervention. Findings were presented at a Payer/Provider Summit and have informed subsequent payer discussions.