Change could aid kids with asthma

Decisions made by the federal government often feel disconnected from the lives of local families. But, for low-income children with asthma in Philadelphia, a recent federal decision really hits home.

Medicaid and CHIP programs will begin paying for preventive services delivered by trained professionals who may not be health-care providers but are members of the health-care team. This means asthma educators and other professionals whose services are recommended by a doctor or nurse-practitioner will be reimbursed. It's hoped that this decision will reduce costs and create more effective partnerships between providers and other members of a health-care team.

About seven million U.S. children live with asthma, costing about $56 billion each year. There have been many studies showing how asthma educators/counselors, community health workers, and healthy-homes specialists can reduce asthma symptoms and help families adhere to asthma management plans between doctor visits. However, the ability for families to access these professionals varied from state to state.

Asthma is the most common chronic health condition in children, and its impact on health and quality of life depends on how well it is managed day to day. Following a doctor's recommendations can be challenging, particularly if you live in an environment full of things that can trigger an asthma attack, including tobacco smoke, cockroaches, mold, dust mites, pet dander, or even strong odors.

Many doctors don't have time to spend instructing each patient/family in how to take care of chronic disease. By being able to recommend and work with trained professionals, providers will have partners who can help families better understand the condition, identify and remove triggers, and ensure correct use of medicines and equipment. Since half of Medicaid recipients are children, those with poorly controlled asthma will also have better access to community- and home-based services.

The Medicaid decision might also help sustain community-based programs. For example, the Children's Hospital of Philadelphia's asthma program, funded by the Merck Childhood Asthma Network, targets high-risk children in Philadelphia who frequent emergency rooms and do not have an established health-care provider. The program uses asthma educators/navigators to coordinate health-care services, to educate families and link them to providers, and to conduct home visits to reduce disparities in access to care.

In both economic and human terms, we have a lot to gain from a more effective childhood-asthma control strategy that keeps kids out of hospitals and emergency departments.