With more tools than ever, expanded Wisconsin asthma program could dramatically reduce ER visits, overall costs
Wisconsin, healthcare, asthma, health policies, chronic disease, Cleanliness
By Talis Shelbourne
Talis Shelbourne reported this project on the intersection of asthma, housing and health systems with the support of a grant from USC Annenberg Center for Health Journalism's 2022 Impact Fund for Reporting on Health Equity and Health Systems.
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ANGELA PETERSON / MILWAUKEE JOURNAL SENTINEL
Wisconsin's Asthma Care Program began in 2003.
Nearly 20 years later, the program is being expanded with new sources of funding, larger geographic reach and home remediation options.
During the early years of the program, officials focused on education programs and ways to track how they were working, Asthma Program Manager Christine Rameker said.
By adding a new source of funding and placing the asthma program under a new umbrella department — the Bureau of Environmental and Occupational Health — Wisconsin is poised to make an unprecedented reprioritization of asthma.
Asthma, a respiratory condition characterized by chronically inflamed and hyperactive airways, afflicts tens of thousands of children throughout the state. Uncontrolled asthma has had a disparate impact in low-income communities and communities of color.
Jennifer Zapata, the state's chief medical officer of community health, has said the numbers are disappointing but unsurprising, given that medical care only affects 20% of a person's health.
"The other 80 percent is based on individual behavior, the environment you live in, your community. and economic and social factors that play a role," she said. "The 80 percent that happens outside of access to care is what is driving some of these inequities."
It's why the state's new asthma program is equipped with more tools than ever to address that 80%.
Proven to save money
Early on, Wisconsin's asthma program was receiving an average of $500,000 to $600,000 per year from the U.S. Centers for Disease Control and Prevention (CDC).
But the program lacked a cohesive-enough strategy to make a significant impact.
So a pilot program — which became the basis for the expanded "Asthma-Safe Homes Program" — was started in 2014 through grants from the CDC's National Asthma Control Program.
The pilot became a way to attract new funding sources, such as Medicaid reimbursement, which states receive after Medicaid-eligible residents access particular services.
"Medicaid has said years ago they would be willing fund such a program, but they needed us to prove that it works in Wisconsin," Rameker recalled.
Over eight years, the pilot program involved two annual home visits, with Children's Wisconsin visiting 50 families and the Kenosha County Health Department visiting 25 families.
Health officials would provide in-home asthma education and offer no-to-low-cost solutions to reduce asthma triggers in the home. The collective effort, while touching relatively few families, showed positive outcomes.
Among 71 participants who were part of the asthma care program, there were 79% fewer emergency department visits, 50% fewer hospitalizations and 78% fewer missed school and workdays, a January 2019 report from the Department of Health Services determined.
Based on its analysis, the program also helped families save money. When comparing how much they were paying for hospital visits a year prior to intervention compared to a year after intervention, the Department of Health Services reported saving families an average of nearly $800 in emergency department visits and hospitalizations.
Even after factoring in the taxpayer cost of the program — $679 per patient — that still meant a $117 savings.
Given the program's success, funding shifted from the CDC to the Medicaid program, Children's Health Insurance Program (CHIP) September 1, with a small batch of additional funding from the state. About $2.5 million has been approved to support the program, with $1.9 million set aside specifically for Medicaid reiumbursement.
Access to schools, childcare venues
With the expanded Wisconsin's asthma plan, families will receive the following:
A minimum of two and up to six in-home visits
Education on patients can best manage their asthma
A home environmental assessment
Items such as hypoallergenic bedding and HEPA vacuums
Three follow-up calls to track progress
Up to $5,000 to "address acute environmental hazards."
Rameker said the $5,000 is Part B of the plan, and it will only be eligible for a small subset of households. Homeowners and renters are eligible and the total available for repairs may increase to $8,000 per household overtime, depending on the need.
The agency is expecting to work on 250 homes per year.
It's the most significant investment in home remediation the state has made to address asthma, and involved adding two staff members to oversee the program this spring.
Nationally, the CDC has a goal of preventing 500,000 asthma-related hospital and emergency department visits by August 2024. As part of that goal, the agency issued guidelines for states to follow when developing their programs, one of which encourages partnerships with smaller organizations in local areas.
Fight Asthma Milwaukee Allies, a group of healthcare and government officials, local businesses and community members focused on reducing asthma-related hospital visits, would represent one likely partner in Milwaukee. FAM Allies, as it is most commonly known, works by providing multilingual asthma education, conducting needs assessments and helping manage the asthma care of children at high risk. In 2019, the organization reported carrying out 279 programs for 486 participants.
As a member of the Children's Health Alliance of Wisconsin, the state program will also have access into schools and childcare venues, where coordinators will try to locate and eliminate triggers.
Organizations who wanted to become a grantee of the Asthma Safe Homes Program applied to the Department of Health Services earlier in the year.
Reporter Talis Shelbourne
Editing Thomas Koetting
Photos & Video Angela Peterson
Data & Graphics Daphne Chen and Bill Schulz
Digital Production Jordan Tilkens
[This article was originally published by Milwaukee Journal Sentinel.]
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