Using Social Impact Financing to Improve Asthma Outcomes

The Childhood Asthma Leadership Coalition hosted a webinar on September 29, 2014 to discuss efforts underway to use a social impact bond (SIB) financing model to address the range of complex issues that children with asthma face to get their chronic condition under control. SIBs are a potentially powerful tool for improving services for medically underserved children with asthma.

This webinar explored three emerging social financing models that tackle chronic asthma, working to demonstrate the dual social and financial benefits of up-front investment in asthma management and prevention. The following presenters discussed SIB models underway in Fresno, CA, Alameda County, CA and Baltimore, MD:

• Tony Iton, MD, JD, MPH: Senior Vice President, Healthy Communities, The California Endowment
• Anne Kelsey Lamb, MPH: Director, Regional Asthma Management & Prevention (RAMP)
• Ruth Ann Norton: President & CEO, Green & Healthy Homes Initiative
• Alice Yu: Associate, Third Sector Capital Partners
• Maria Hernandez, PhD: President, Impact4Health; Special Advisor on Social Impact Investing, Health Research for Action, UC Berkeley School of Public Health

In its most basic form, private investors participating in a SIB model pay the upfront costs for providing social services - from services related to criminal justice, to education, to health - and government agencies repay investors with a return on their investment if the program achieves agreed-upon outcomes (such as decreased healthcare expenditures).  

SIB models focused on asthma are designed to demonstrate that by educating patients and taking action against asthma triggers at home, insurers can achieve significant savings on emergency room visits, hospitalizations and other healthcare costs.

Download the webinar slides. 

Play the webinar recording. 

Coalition for Healthier Schools Back to School Toolkit

Every September, and after each return to school following a vacation, kids’ hospitalizations due to asthma increase sharply in large part because of poor indoor air quality and exposure to asthma triggers including chemicals in schools. It is essential for parents, teachers, and all school employees to be proactive in ensuring the schools are healthy and safe for children and the adults.

In an effort to provide guidance towards an environmentally healthy school, the Coalition for Healthier Schools has released its annual Back to School Toolkit with fact sheets and guides on Indoor Air Quality, Healthy Purchasing, Green Cleaning, Tips for Tours, and more.

Asthma Awareness Month 2014 Coalition Toolkit

May is Asthma Awareness Month, creating an important opportunity for Childhood Asthma Leadership Coalition member organizations and their partners to raise the important role public policy plays in helping children with asthma stay healthy.

Much of the news and social media outreach about Asthma Awareness Month will likely focus on tips for parents or local experts’ perspectives on the problem’s scope. But we can help audiences to see that decisions in Washington and state capitals have an important impact on the health of local children. With funding for the Children’s Health Insurance Program (CHIP) set to expire next year, raising the voices of the childhood asthma community is especially important.

This toolkit offers ideas and examples you can use in your community. Feel free to use any or all of these resources:

• Traditional Media
  • A sample op-ed that connects CHIP’s future with the health of local children and urges congressional representatives to take a stand for children’s health.
  • A tipsheet on pitching newspaper opinion editors
• Social Media
  • Sample Facebook and Twitter posts designed to gradually move your online networks, over the course of the month from awareness of CHIP’s important role for children with asthma to engagement with policymakers
  • A social media tipsheet
• Other Communications
  • A sample newsletter article intended to inform and engage your mailing lists

The toolkit was developed by First Focus for Coalition members. If you have questions or need extra help, please feel free to contact the First Focus communications team. If you use the toolkit in your Asthma Awareness Month outreach efforts, please share examples of your work to make it even easier for other Coalition members to get involved.

National Asthma Control Program Funding Opportunity Announcement Overview

On March 5, 2014, the U.S. Centers for Disease Control and Prevention (CDC) issued a new funding opportunity announcement (FOA) for the National Asthma Control Program (NACP). The attached document provides an overview of new program requirements and opportunities, with a particular focus on differences between this new FOA and previous funding requirements.

Letter on the Free-Care Rule to the Centers for Medicare and Medicaid Services

This letter was sent by the Coalition to ask CMS to clarify its regulation on Medicaid reimbursements to schools for providing health services to Medicaid-enrolled children. CMS guidance states that schools can only bill Medicaid for health services if they also bill third party insurers covering other kids, which is burdensome for schools to comply with. The HHS Appeals Board took up this issue and ruled that CMS did not have the right to enforce such a rule, but reimbursements to schools continue to be a hurdle. This letter asks CMS to allow schools to bill Medicaid for health services provided as intended by the HHS ruling.

Click here to view the letter

Federal Funding Letter

This letter was sent by the Coalition to the leaders of the Appropriations Committees in the House and the Senate to ask them to fund a number of federal programs that matter most for children affected by asthma for fiscal year 2015.

Click here to download the letter

Overview of Federal Funding for Childhood Asthma

This document serves as a resource to show funding levels of federal programs relating to child asthma over the last few budget cycles as well as President Obama’s most recent budget request to Congress for FY 2015.

Click here to download the overview

2013 Year in Review

As we begin a new year for the Childhood Asthma Leadership Coalition, it is important to take a look back at our accomplishments in 2013 and evaluate our progress toward addressing the serious and pervasive problem of childhood asthma in the United States. This document highlights the major accomplishments of our three workgroups; reviews our efforts to engage with Federal leaders on asthma and our outreach to leaders on Capitol Hill; and describes actions in 2013 to strategically grow the Coalition and increase its media presence.

Paying for Asthma Management at School

Asthma is the most common chronic condition among school-aged children in the United States, and the school setting is an important place for asthma management. The availability of effective school-based asthma services depends greatly on a school system’s ability to obtain Medicaid reimbursement or other funding. Current federal Medicaid policy limits reimbursement for some of the services that students with asthma require at school.

The Childhood Asthma Leadership Coalition, National Association of School Nurses and the National Alliance for Medicaid in Education, Inc., sponsored this Thursday, January 30, 2014 webinar to explore reimbursement hurdles and new opportunities for delivering effective health services in schools for students with asthma. Presenters described public and private funding sources used by school districts to cover nursing services; examined recent legal challenges to the “free care rule,” which is an obstacle to Medicaid reimbursement in schools; and discussed new ways to increase access to health services in schools. The webinar also examined opportunities under health reform law and recent changes to federal Medicaid policy that could allow community health workers to help deliver preventive services to children in schools.

Webinar presenters:

• Greg Morris, JD, Executive Director, LEAnet: A National Coalition of Local Education Agencies
• Mary Kusler, Director, Government Relations, National Education Association
• Janet Lowe, MA, RN, LSN, CPNP, Coordinator, Saint Paul Public Schools Third-Party Reimbursement Program; Member, National Association of School Nurses
• Katie Horton, RN, MPH, JD, Research Professor at the George Washington University Department of Health Policy, moderator.

The Influence of Setting on Care Coordination for Childhood Asthma

Effective care coordination can improve quality of life for children with asthma and their families. Using a treatment approach that marries health care and social support services can help manage symptoms, create asthma care plans and better monitor progress.

But does the care setting have an impact on the design of the care coordination program? And can childhood asthma be managed the same way at school as it is in a community health center or hospital system?

The Merck Childhood Asthma Network (MCAN) sponsored this September 24, 2013, webinar on “The Influence of Setting on Care Coordination for Childhood Asthma.” Presenters explored how diverse settings influence childhood asthma care coordination program design, focusing on care implementation through school district nursing services, urban pediatric health systems, federally qualified health centers, and in partnership with multiple providers and organizations.

Webinar presenters included:

• Dr. Floyd J. Malveaux, Executive Director, Merck Childhood Asthma Network
• Noreen M. Clark, PhD, Director, Center for Managing Chronic Disease, University of Michigan School of Public Health
• Dr. Victoria Persky, Principal Investigator, Addressing Asthma in Englewood Project, Professor of Epidemiology, University of Illinois at Chicago School of Public Health
• Dr. Marielena Lara-Greenberg, Co-Principal Investigator, La Red Project, RAND Corporation
• Dr. Gilberto Ramos, Co-Principal Investigator, La Red Project, University of Puerto Rico
• Dr. Kimberly Uyeda, Principal Investigator, LAUSD Asthma Program, Director, Student Medical Services, Community Partnerships and Medi-Cal Programs, Los Angeles Unified School District
• Dr. Tyra Bryant-Stephens, Principal Investigator, CHOP Asthma Care Navigator Program, Director and Founder, Community Asthma Prevention Program, Children’s Hospital of Philadelphia (CHOP)

Access a PDF version of the slideshow here.

Medicaid and Preventive Services – Recent Regulatory Updates

Effective January 1, 2014, the Centers for Medicaid and Medicare Services is changing Medicaid regulations regarding which types of providers can be reimbursed for providing preventive services to Medicaid and CHIP beneficiaries. The attached one-page Q&A explains how this important Medicaid change will impact coverage of community-based interventions for low-income children with asthma.

Click here to read the document

Letter Supporting Medicaid Reimbursement for Community Prevention Efforts

Coalition members sent this letter recently to Administrator Tavenner in support of recent actions by the Department of Health and Human Services to clarify that community prevention efforts are eligible for reimbursement under Medicaid.

Click here to read the letter. 

CMS Announces Webinar Series

The Center for Medicaid and CHIP Services is hosting a new technical assistance series, Promoting Prevention in Medicaid and CHIP. This series is part of a new and expanding effort to support state efforts to improve beneficiary access to high-quality preventive health services that would great benefit children with asthma.

Working with Managed Care Organizations to promote prevention
May 21, 3:00-4:00 p.m. EDT
877-267-1577; Meeting ID: 8494
https://webinar.cms.hhs.gov/ppmc2/

Using health IT to improve access to preventive services
May 30, 2:00-3:00 p.m. EDT
877-267-1577; Meeting ID: 0374
https://webinar.cms.hhs.gov/ppmc3/

Building partnerships and financing prevention in Medicaid and CHIP (In partnership with ASTHO)
June 13, 2:00-3:00 p.m. (Eastern)
877-267-1577; Meeting ID: 2168
https://webinar.cms.hhs.gov/ppmc4/

Coalition Comments on Proposed ACA Navigator Rule

In April, the Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) issued a proposed rule implementing provisions of the Navigator program. State Exchanges must establish Navigator programs to provide information to consumers regarding health insurance coverage across Exchanges, and state Medicaid and CHIP programs. State Navigator programs have the potential to greatly assist children and families in enrolling in coverage options for which they are eligible. These proposed regulations create certain training/certification and “meaningful access” standards applicable to entities that operate as Navigators. The Childhood Asthma Leadership Coalition submitted the attached comments to CMS in response to this proposed rule.

Click here to read the comments.

Asthma Awareness Month TweetChat May 3rd

Asthma is the most common chronic health condition affecting kids. We’re partnering with the CDC and the American Lung Association for Asthma Awareness Month, to share data from CDC’s National Asthma Control Program and talk about how each of us can make a difference for kids’ health. Join us on Twitter Friday, 5/3, from 12-1p ET, using the hashtag #asthma.

Click the hashtag to see tweets.

Developing Mechanisms for Sustainable Funding of Community Asthma Management

On February 6, 2013, the Childhood Asthma Leadership Coalition hosted a webinar entitled: Developing Mechanisms for Sustainable Funding of Community Asthma Management. The webinar examined new and ongoing efforts underway in Massachusetts to address the burden of childhood asthma through delivery system innovations and new reimbursement models that promote community-based interventions to reduce asthma triggers in homes and community settings.

The following presenters participated in this webinar:

• Dr. Monica Le, MD, MPH, Associate Medical Director, Office of Clinical Affairs, Commonwealth Medicine, Center for Health Policy and Research
• Jean Zotter, JD, Director, Massachusetts Asthma Prevention and Control Program, Massachusetts Department of Public Health
• Stacey Chacker, Director of the Asthma Regional Council of New England, a program of Health Resources in Action

Presenters discussed how stakeholders in Massachusetts have worked to build partnerships, engage payers, and develop the business case necessary to move innovative payment and delivery models forward to give children better access to asthma services in their community.

Slides from the webinar can be found in the attached document; a recording of the webinar is also available. When the recording page opens, click the “Playback” button () and follow the instructions to begin watching the webinar. During the webinar, we experienced technical difficulties at 32:24. Please advance to the next section at the 45:30 timestamp to continue following the session.

To continue the dialogue started during the webinar, the Coalition has also released a white paper entitled “Using Medicaid to Advance Community-Based Childhood Asthma Interventions: A Review of Innovative Medicaid Programs in Massachusetts and Opportunities for Expansion under Medicaid Nationwide.”

Using Medicaid to Advance Community-Based Childhood Asthma Interventions

On February 6, 2013, the Childhood Asthma Leadership Coalition hosted a webinar entitled: Developing Mechanisms for Sustainable Funding of Community Asthma Management. The webinar examined new and ongoing efforts underway in Massachusetts to address the burden of childhood asthma through delivery system innovations and new reimbursement models that promote community-based interventions to reduce asthma triggers in homes and community settings.

To continue the dialogue started during the webinar, the Coalition has also released a white paper entitled Using Medicaid to Advance Community-Based Childhood Asthma Interventions: A Review of Innovative Medicaid Programs in Massachusetts and Opportunities for Expansion under Medicaid Nationwide. The attached white paper:

• Reviews community asthma interventions;
• Describes new initiatives underway in Massachusetts to promote community-based asthma prevention for children; and
• Discusses opportunities for state Medicaid programs to incorporate these interventions into Medicaid and the Children’s Health Insurance Program (CHIP) programs nationwide.

Medicaid EHB Comments

In late January, the Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on the implementation of the Medicaid expansion provisions of the Affordable Care Act. The Childhood Asthma Leadership Coalition submitted comments to CMS.

Click here to see the comments.

Community Action to Fight Asthma (CAFA) Briefing Kit

The Community Action to Fight Asthma (CAFA) Briefing Kit was developed as a tool to educate decision-makers about the problem of asthma and the need for environmental policy changes. Originally developed in 2004 and updated in 2007 and 2009, the kit includes science-based fact sheets on the health impacts of poor air quality in schools, homes, and outdoor environments. It also includes general information about asthma in California, the structure and purpose of the CAFA Network, and broad policy priorities. Copies can be downloaded at http://www.rampasthma.org/advocacy/asthma-briefing-kit/. For hard copies, inquire at info@rampasthma.org.

Continuous Coverage

ACA and Changing Policy: Continuous Coverage

About the Series: In February 2010, the George Washington University School of Public Health and Health Services, Department of Health Policy released Changing pO2licy: The Elements for Improving Childhood Asthma Outcomes. The report provided a comprehensive look at childhood asthma prevalence, risk factors and disparities; described best practices for clinical care and disease management; and, outlined evidence-based policy recommendations to improve the prevention, diagnosis, treatment, and long-term management of childhood asthma.

The report identified five essential elements for improving asthma outcomes in children:

1. 1. Stable and continuous health insurance
   2. High-quality clinical care, case management and asthma education available for all children
   3. The ability to continuously exchange information and monitor progress, using health information technology
   4. Reducing asthma triggers in homes and communities
   5. Learning what works and increasing knowledge

Following the release of these recommendations, Congress passed the Affordable Care Act (ACA), emphasizing expanding access to private health insurance and Medicaid and reforming the healthcare delivery system to improve quality. The ACA includes provisions to eliminate health care disparities, strengthen public health programs and access to preventive services, invest in expanding and improving the health care workforce, and encourage care coordination and disease management.

Many ACA provisions correspond to recommendations in the Changing pO2licy report and have the potential to profoundly impact the prevention and treatment of childhood asthma.

This paper focuses on one of the five essential elements for improving asthma outcomes in children: stable and continuous health insurance. The accompanying chart describes ACA provisions and implementation activities that could be activated to help millions of children most at risk for asthma.

Click here to view the chart.