The Positive Impact of Asthma Action Plans

Blue Cross and Blue Shield of Illinois

Asthma is responsible for more than 10 million outpatient visits and 500,000 hospitalizations annually. The most striking statistic is that more than 4,000 deaths are due to asthma each year, many of which could be avoided with improved care. As a result, Blue Cross and Blue Shield of Illinois (BCBSIL) decided to concentrate its efforts on improving the care of asthma patients, a particularly prevalent condition in the Chicago area.

BCBSIL identified that network physicians were not using asthma action plans to improve care, as recommended by the National Asthma Education and Prevention Program (NAEPP) guidelines.

Since 2000, BCBSIL included the use of asthma action plans in its pay-for-performance program for HMO physician groups. An asthma action plan is completed by the physician and provides specific instructions for early treatment of asthma symptoms; including guidelines for calling the doctor or what to do if asthma control is worsening. All asthma patients should have an asthma action plan to follow at home, and these should be reviewed on a regular basis.

The Quality Improvement Fund (QIF) is the major quality improvement initiative used to improve care in the BCBSIL HMO product. This HMO product only contracts with Independent Practice Associations (IPAs). Each year the Plan selects specific measures to include as the focus of improvement efforts for the network, works with IPAs to achieve improvement and rewards improvement with funds set aside in the QIF.

BCBSIL works with IPAs throughout the year to identify appropriate members for interventions in order to help the IPAs improve their performance. One potential frustration for physicians is that quality improvement programs often inaccurately identify patients as requiring the intervention. For instance, a patient might be labeled asthmatic on the basis of a single asthma attack that occurred in the setting of an upper respiratory infection. Thus, as part of this activity, BCBSIL improved its criteria for identifying asthmatics and also allowed physicians to exclude inappropriate patients from the program. BCBSIL now mails each IPA instructions and a data request form for each member with asthma. IPA physicians are expected to create specific plans and to review them with their patients within six months of being notified of an asthmatic patient in their practice. In addition, these patients also receive annual mailings of the Asthma Care Diary or Personal Asthma Management brochure.

Since the action plan was included in the QIF, the percentage of HMO members with asthma receiving written asthma action plans has increased dramatically, from 21 percent in 2000 to 80 percent in 2006.

Program Contact: Carol Wilhoit, MD, MS, Medical Director, Quality Improvement, 312.653.2446, wilhoitC@bcbsil.com