December 11th, 2018
This document is a resource for asthma program managers and partner organizations who are considering options for implementing or redesigning reimbursement mechanisms to increase access to evidence-based asthma management practices. It describes challenges and successes in detail, provides program contact information, and includes a list of actions that have led to enhanced and expanded reimbursement for asthma services.
Most people can control their asthma and live symptom-free. Some factors that can help people control their asthma include regular access to care, knowledge about how to use prescribed medications, and skills to modify the environment to reduce or eliminate exposure to allergens and irritants. These measures are reinforced by the most current, nationally-recognized guidelines developed by the National Asthma Education and Prevention Program (NAEPP) of the National Institutes of Health. Yet the latest research indicates that many people with asthma are not receiving care based on NAEPP guidelines, and many are not receiving regular asthma care. Meanwhile, asthma prevalence rates continue to climb, particularly among children, women, blacks, and low-income families.
A top priority of the CDC National Asthma Control Program (NACP) is helping people manage their asthma better. To this end, NACP convened a workgroup of Program grantees with a wide range of experience in developing strategies to improve reimbursement for asthma self-management education and environmental management. These factors are known to substantially improve patients’ ability to manage their disease. Through a series of webinars conducted between July and December 2011, workgroup members convened to identify the challenges and solutions for stimulating positive reimbursement practices.
Some of the challenges identified by workgroup members included:
• a lack of certified asthma educators and other non-physician providers with specific asthma training;
• low reimbursement rates for asthma services delivered by billable providers;
• difficulty engaging third-party payers in the reimbursement dialog; and
• complexity of federal reimbursement regulations for Medicaid including different local or state codes to identify services, procedures, or supplies.
Factors contributing to success in overcoming these and other challenges included:
• conducting gap analyses of reimbursement practices and coverage of benefits for asthma services;
• recognizing certified asthma educators as billable providers;
• demonstrating cost-savings through pilot projects and evaluations; and
• partnering with strong asthma champions who can engage decision-makers.