Healthy Homes: Indoor-Outdoor
Environmental Interventions to
Improve Asthma Outcomes
Michael McKnight
11/6/15
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A GHHI Family Story
https://youtu.be/rbF71lDmt4k
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Recommendations from NAEPP
It is essential to identify and reduce exposures to allergens
and irritants and to control other factors that have been
shown to increase asthma symptoms in your patient.
Effective allergen avoidance requires a multifaceted,
comprehensive approach; individual steps alone are generally
ineffective.
Focus on allergen-control education for cockroach, dust mite
and rodent allergens for patients sensitive to these allergens
as these have proven interventions.
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Healthy homes part of effective asthma
management
• Surgeon General’s Call to Action to Promote
Healthy Homes (2009)
• The Community Preventive Services Task force
recommends the use of home-based, multi-trigger
interventions with an environmental focus for children
and adolescents
• Cost-benefit studies show a return of $5.3 to $14.0 for each dollar
invested
• Home-based triggers cause 40% of asthma episodes1
1Robert
Wood Johnson Foundation Commission to Build a Healthier America.
Beyond Health Care: New Directions to a Healthier America Report. April 2009
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Address Root Causes at Home
Unhealthy
Home
Asthma
Episode
Treatment/
Inhaler
Hospital
Visit
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Common Home Asthma Triggers
Dust Mites
VOCs
Cockroaches
Tobacco Smoke
Pests
Animal Allergens
Mold
Smoke/Gas
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Environmental Assessment &
Education Together
Environmental Assessor-Energy Auditor (HHS/BPI)
• Conduct pre-intervention environmental assessments / audits
• Develop comprehensive scopes of work for properties
• Conduct post intervention assessments and audits
Community Environmental Health Educator (CHES/AE-C)
• Conduct asthma/HH resident education during assessment
• Coordinate client health surveys and data collection
• Distribute HEPA-Vacuum and indoor allergen reduction kit
• Referrals and follow-up client services
• Review asthma action plan
• Medication adherence
• Ongoing education, behavioral reinforcement,
and band follow-up with PCP / care managers
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Healthy Homes Interventions
• Installation of mattress and pillow covers
• Integrated pest management: gel baits, boric acid, glue traps,
reducing entry points, cleaning/behavioral change (clutter)
• Mold remediation
• Venting kitchen, bathroom and dryer; filter replacements
• Removal or steam cleaning of carpets
• Air filtering system installed in child’s bedroom
• Air conditioners and dehumidifiers
• Provision of a HEPA-vacuum and indoor allergen reduction
cleaning kit
• Other Healthy Homes Interventions with leveraged funding
(lead, radon, asbestos)
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GHHI Baltimore Healthy Homes Program
•
Direct Healthy Homes Program services began in 2000
•
Program targets asthma diagnosed children in
Baltimore; priority on children with prior ED visit or
hospitalization; family income ≤ 80% AMI
•
Primary Referral Sources - MCOs, health care providers,
Health Department, GHHI Baltimore partners
•
Units Completed - 1,660 families enrolled and 1,480
Healthy Homes interventions completed by the
program to date using tiered intervention strategy and
in-house GHHI Baltimore Hazard Reduction Team
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Healthy Homes Demonstration Project
Mean Change and Percent
Reduction of Key Outcomes
200 units completed with 139 respondents completing
6 month post intervention health surveys
Intake
Mean (StdDev)
6 Month
Mean (StdDev)
Pre Post Mean
Change
(StdDev)
One-sided t test
Percent
Reduction
Hospitalizations
0.364288
(0.923013)
0.141791
(0.53667)
0.238806
(0.824248)
0.0008
65.5%
ER Visits
0.942857
(1.22193)
0.701493
(1.097022)
0.261194
(1.250137)
0.015
27.7%
Physician Visits
1.76258
(1.462491)
1.340909
(1.413293)
0.389313
(1.460098)
0.002
22%
Calls to Physicians
2
(1.498792)
1.481203
(1.490381)
0.515152
(1.565296)
0.0002
26%
Work days missed
2.76259
(1.954492)
1.736842
(1.85413)
1.037879
(2.057959)
0.0000
37%
School/ daycare
missed
2.372093
(2.008069)
1.787402
(2.091669)
0.647059
(1.998254)
0.0002
27%
In the past 6 months
(N=139)
Environmental Justice, Vol 7. Number 6, 2014
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Outcomes and Impact
A look at GHHI Philadelphia’s impact:
•
•
•
•
70% fewer asthma-related client hospitalizations
76% fewer asthma-related client ED visits
62% fewer asthma-related client doctor’s office visits
53% fewer asthma-related client missed days of school
or daycare
• 55% fewer uses of Albuterol Pump
A look at GHHI Cleveland’s impact:
• 58% reduction in asthma-related client hospitalizations
• 63% reduction in asthma-related client ED visits
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Reduced Costs = Cashable Savings
• 1 asthma-related hospitalization on average
costs $7506 in Baltimore
• 1 asthma-related emergency room visit on
average costs $820 in Baltimore
Asthma
hospitalizations
and ED visits
Cashable
Savings
[2009-10 data]
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Challenges
• Funding sources: HUD, DOE, CDBG, philanthropy, utilities,
state and local housing funds. Healthcare investment for
home remediation services has not been significant.
• Currently no standard set of codes for Healthy Homes
measures and approved costs for services – Now working on
a guidance manual and reimbursement recommendations
including payment models
• Reimbursement traditionally only for licensed clinical
providers – Medicaid Rule Change adjusted “Who” is
available to be reimbursed, not “What” services are
reimbursable
• Coordination of care between medical providers and
community based services is still improving
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A Fractured Delivery System
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GHHI - A Model That Benefits Families
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Opportunities
• Medicaid Rule change for reimbursable professionals
• Waivers and State Plan Amendments
• Hospital community benefit investments - can encompass
“physical improvements and housing” and “environmental
improvements”
• Community health worker certifications and expanding role;
new home performance professional certifications for health
• Education Funding Connections - Costs school districts $29
per child per school absence
• Pay for Success / Social Impact Bonds
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GHHI Baltimore
Asthma PFS Model
&
Other Investors
Risk
mitigation
Target
setting
Service
delivery
funding
Upfront
capital
Repayment
Success
payments
Evaluation
&
Other Guarantors
(Baltimore foundations)
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Timeline
Draws
Year 1
Year 2
$
$
Year 3
Year 4
Year 5
Year 6
Year 7
$
Intervention
Evaluation
Savings &
Success
Payments
Guarantee
Payments
Guarantee
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• GHHI selected to participate in Social Innovation Fund’s first
PFS cohort with asthma PFS feasibility studies in 5 locations:
Location
Healthcare Org
Service Provider
Springfield, MA
Baystate Health
Partners for a Healthier Community
Memphis, TN
Le Bonheur
Children’s Hospital
Habitat for Humanity of Greater Memphis
Buffalo, NY
Monroe Plan for
Medical Care
Community Foundation of Greater Buffalo
& Heart of the City Neighborhoods, Inc.
Grand Rapids, MI
Spectrum Health
Health Net, Healthy Homes Coalition, &
Asthma Network of West Michigan
Salt Lake City, UT
University of Utah
Health Plans
Salt Lake County Office of Regional
Development
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GHHI National Scaling
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Our National Partners
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Questions?
Michael McKnight
Vice President of Policy and Innovation
[email protected]
202-769-5763
@McKnight_GHHI
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