Health Plan Notification and Feedback to Providers Is Associated With Increased Filling of Preventer Medications for Children With Asthma Enrolled in Medicaid

Abstract

Cooper WO, Ray WA, Arbogast PG, Garrison M, Dudley JA, Christakis DA. J Pediatr. 2008;152(4):481–488 PURPOSE OF THE STUDY. To determine if children enrolled in Medicaid managed care that provides asthma-specific communication to providers would be more likely to have adequate asthma-medication filling. STUDY POPULATION. The study included 4498 children between the ages of 2 and 17 years with moderate-to-severe asthma enrolled in Medicaid in Tennessee and Washington State from 2000 and 2002. METHODS. Study subjects had (1) an asthma hospitalization or asthma emergency department (ED) visit, (2) high use of asthma medications in the 6 months before their hospitalization or ED visit, and (3) stayed in the same Medicaid health plan from study entry through follow-up. Interviews were conducted with health plans to identify communication strategies used to improve asthma care by providers in the plan. The main outcome measure was guideline-recommended filling of asthma-preventer medications. RESULTS. In the 365-day follow-up period, children in plans that provided specific feedback to providers about asthma quality and notified providers when children had an asthma-related event had higher rates of filling prescriptions than children in plans with neither (164.6 ± 13 vs 135.3 ± 10.8 days; P < .05). For children with the greatest asthma severity, enrollment in a plan with both features was associated with 27.1 additional days of filling (95% confidence interval: 0.7–53.4 days) during the follow-up period. CONCLUSIONS. Health plan communication to providers was associated with increased preventer filling in children with moderate-to-severe asthma in 2 state Medicaid programs. REVIEWER COMMENTS. The children with the higher preventer fill rates only used their medications for less than half of the year. Identification of patients at high risk and frequent follow-up are needed to ensure more regular use of preventer medications. Health plans could assist providers by providing quarterly updates of fill rates for these patients at high risk so that intervention could occur before the patient ends up in the hospital or ED.