HUD Healthy Homes Improving Asthma Outcomes
Improving Asthma Outcomes Through Home Interventions
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Marty Nee
HUD Office of Healthy Homes
HUD Office of Healthy Homes and Lead Hazard Control
Healthy Homes and Asthma
Healthy Homes and Asthma Housing
Health
Energy
Healthy Homes
Improving Asthma Outcomes
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Coordinating Home Inter entions
Coordinating Home Interventions
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Single Portal Access to Services
Si
l P t lA
t S i
Use of Standardized Assessment Tools Comprehensive Assessments Resident ducation
Resident Education Coordinated Interventions
Healthy Homes
Improving Asthma Outcomes
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In‐Home
In
Home Health Assessments
Health Assessments
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Who
Community Health Workers Registered Nurses
Environmental Health Specialist Respiratory Therapists
Respiratory Therapists Certified Asthma Educators Healthy Homes
Improving Asthma Outcomes
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In‐Home
In
Home Health Assessments/Services
Health Assessments/Services
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What
Home Environmental Assessments
In‐home resident education on asthma management, including trigger avoidance Equipment or Services that Reduce Asthma
Equipment or Services that Reduce Asthma Triggers
Coordination with appropriate agencies to
Coordination with appropriate agencies to conduct construction related remediation
Reducing Ethnic/Racial Disparity in Youth Study
(MA DPH, Boston and Baystate Medical Centers) Pediatric Asthma Home Visiting Intervention Preliminary Results – Health Outcomes Pre vs Post (N = 119) Pre
Post
92.5
100
78.3
80
67.5
61.2
60
40
45
27.6
20
0
75.2
48.7
39.5
37.2
27.4
4.3
ED Visit
ED Visit
Hospitalization
Urgent care Use
Urgent care Use
Oral Steroid
Oral
Steroid
Medication
Used
Funded by HUD Healthy Homes Technical Studies and AARA R01 grants
Recived AAP
Recived AAP
Actually Used
Actually
Used
the AAP*
NHP Asthma Population Achievements
 The lowest hospitalization rate since the
Asthma program’s inception in 1999 1.9 %
 ER use in 2012 at lowest rate in the
program’s
’ hi
history
t
att 8
8.8%
8%
 Controller /Reliever medication Ratio .72
8
Healthy Homes
Improving Asthma Outcomes
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Why Now is the Time for Action
Why
Now is the Time for Action
ACA – changes to health care financing and reimbursement for services
reimbursement for services
CMS – opportunities for funding non clinical services
HUD – adoption of priority for home interventions that coordinate with health and
interventions that coordinate with health and energy; promotion of Asthma Summits
DOE – adoption of guidance for weatherization DOE adoption of guidance for weatherization
programs to clarify health related allowable costs
Healthy Homes
Improving Asthma Outcomes
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ACA – moving from fee for service ACA
mo ing from fee for ser ice
to patient based outcomes p
• Initiatives around home based asthma interventions – CMMI grants
• Aligning patient outcomes with funding
Healthy Homes
Improving Asthma Outcomes
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Severity of Illness and Median Charges for
Top 25 APR-DRGs, Alfred I. duPont Hospital
for Children, 2010
Severity of Illness
Minor
Moderate
Major
APR DRG #
APR-DRG
$
#
$
#
$
Severe
#
$
ASTHMA 502 $9,229
$9 229 212 $10,983
$10 983 24 $9,925
$9 925 7 $77,818
$77 818
Delaware Health and Social Services, Division of Public Health, Health Statistics Center
Healthy Homes
Improving Asthma Outcomes
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Medicaid and Home Based Asthma Interventions
Medicaid
and Home Based Asthma Interventions
Recent CMS regulatory change
• How do previous Medicaid regulations limit p
g
access to community‐based services?
What does the new rule say?
• What does the new rule say?
• What impact will this change have on coverage? Healthy Homes
Improving Asthma Outcomes
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HUD Policy Priority Points
HUD Policy Priority Points
(Value of up to 4 points when competing for funds) Priority 1 – Promoting Access to Health Care
Priority 4 Priority
4 – Promoting coordination of housing Promoting coordination of housing
rehabilitation with health and energy
Healthy Homes
Improving Asthma Outcomes
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Priority 1 Priority
1 – Promoting Access to Health Care
Promoting Access to Health Care
• Strategic objective to connect HUD assistance to health care programs and benefits in efforts to
health care programs and benefits in efforts to improve health and housing outcomes • Close relationship between health and housing p
g
stability with respect to vulnerable populations. • HUD encourages grantees to undertake collaborations with public, private, nonprofit, and community‐ and faith‐based organizations to increase access to health insurance and to improve
increase access to health insurance and to improve housing and health outcomes
Healthy Homes
Improving Asthma Outcomes
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Priority 4 – Coordination of housing rehabilitation Priority 4 Coordination of housing rehabilitation
with health and energy
“Applicants are encouraged to coordinate the delivery of housing repair/rehabilitation with community, fh
/ h bl
h
hospital or public health programs that utilize community health workers, Promotores(as), health
community health workers, Promotores(as), health educators or other similar positions that assesses the indoor quality of home environments for conditions that may impact resident health for example in the
that may impact resident health, for example, in the coordination of rehabilitation activities with programs that assess the home environments of asthmatic children for asthma triggers.” hild
f
h
i
”
Healthy Homes
Improving Asthma Outcomes
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• Asthma Summits
Asthma Summits
Federal, State and local programs promoting to d l S
dl l
i
Health Care Providers and Payers (Medicaid, Managed Care Organizations, Private Insurers) the clinical and economic value of home assessments and intervention for asthma triggers.
Healthy Homes
Improving Asthma Outcomes
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Anticipated Outcomes
Anticipated
Outcomes
Promotion of the model and alignment with key national messages
key national messages
Examination and discussion of impediments to adoption of the home focused model
adoption of the home focused model
Inter‐program experience sharing and lessons learned
Adoption by health care payers of the home focused model for pediatric asthma patients
focused model for pediatric asthma patients
Healthy Homes
Improving Asthma Outcomes
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How can the health providers and public health How
can the health providers and public health
agencies influence the targeting of housing funding?
• HUD – Healthy Homes/LHC funding
• HUD –
HUD CDBG/HOME funding
CDBG/HOME f di
– Consolidated Plans/Action Plans
• State and Local Resources
Healthy Homes
Improving Asthma Outcomes
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Questions?