Building the Case for Asthma as a Disease Management Program

Abstract

Asthma is a common disease that affects between 5.5% and 7.0% of the population. It is an example of a disease where good guidelines and an accepted model of treatment exist, but have not been fully implemented. In the latter part of 2000, Blue Cross Blue Shield of Minnesota (BCBSM) had existing and successful disease management (DM) programs for diabetes and heart disease and was looking to expand the concept to other diseases. Asthma was one of the conditions under consideration. This study, done in conjunction with PharMetrics, Inc. of Watertown, MA was done to establish the opportunity present to help Blue Cross members with the disease, and to help decide whether developing such a program made sense for the health plan. In addition, if the answer to the second question were yes, the study would lay the groundwork for that program. Using 2 years of BCBSM claims data, the study identified, stratified, and analyzed the cohort of BCBSM members with a diagnosis of asthma according to severity of illness, individual drug or drug combination treatment, emergency room usage, hospitalization, and total episode costs for asthma. Health plan results were benchmarked against the experience of others across the country represented in the (then) 20+ million managed care lives in PharMetrics' Integrated Outcomes Database. The results showed that in some of the recommended guidelines for asthma care BCBSM members led the nation in compliance, but that there was ample opportunity for improvement thus justifying moving forward in developing a disease management program. The results also seemed to validate many of the recommendations for asthma care expressed in the Expert Panel Report 2 on the diagnosis and treatment of asthma from the National Heart Lung and Blood Institute of the National Institutes of Health. (Disease Management 2004;7:202–215)