AsthmaTufts Health Freedom Plan’s Asthma Program includes the following goals for health management for adult and pediatric members:
- To improve self-management skills to achieve optimal asthma control
- To maintain normal activity levels and reduce exacerbations
- To minimize the need for emergency room visits and hospitalization
- Predictive modeling is used to identify members who are at risk for uncontrolled asthma based on their medication utilization patterns, emergency room use, or inpatient admissions.
- Using Eliza speech recognition technology, outreach calls to members support identification of potential members for nurse care manager outreach. Referral to the program is based on the member’s assessment responses.
- Members also may be directly referred to the program by physicians, care managers, and self-referral.
InterventionsMember education and coaching include the following components:
- Identification and management of asthma triggers, the purpose and action of each medication, the importance of taking medication properly, and managing medication supply
- Recognizing when asthma is worsening
- An individual asthma action plan that includes self-monitoring to assess the level of asthma control, self-monitoring devices and tracking, and active/passive smoking
- Regular provider follow-up, and the importance of open, honest communication