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Employers that offer asthma disease management programs can breathe easier when paying their health care bills.

The programs, usually offered by health maintenance organizations or drug manufacturers, save health plans money by reducing emergency room visits and hospitalizations for asthma patients.

And the more sophisticated asthma program managers can use employee health claims data to identify asthmatics even before a first attack occurs.

Asthma management programs work because they "empower asthma patients and their doctors with the knowledge and the wherewithal to treat their disease," said Todd Swim, health actuary and capitation practice leader for Buck Consultants Inc. in Chicago. "It's the empowerment that helps them."

And employers with asthma management programs reap savings in other areas of their health plans, because a patient whose asthma is under control is less likely to suffer from other illnesses.

"Asthma has certain synergies with people's overall health," explained Dr. Richard Bernstein, senior medical director in New York for Aetna-U.S. Healthcare.

As a result, "someone with diabetes and asthma will have fewer problems with diabetes if their asthma is under control," he said.

Aetna-U.S. Healthcare reports a 32% drop in direct asthma treatment costs since the HMO began offering asthma disease management four years ago in all of its plans.

In addition, Aetna-U.S. Healthcare has seen the number of asthma patients' hospital days decline by about 35%, hospital admissions are down 34%, and emergency room visits have fallen 26%.

Through its asthma management program, Boston-based Harvard Community Health Plan has seen the hospital admission rate drop by 25% for pediatric asthmatics and by 10% for adults.

Hospitalization and emergency room visits by Cincinnati-area patients enrolled in Anthem Blue Cross & Blue Shield's asthma management program dropped 44%, according to a two-year study by the Health Outcomes Institute of Bloomington, Minn. The HMO's asthma care program began in Dayton and Cincinnati and will be expanded to plans in Indiana, Kentucky and the rest of Ohio this year.

An asthma management program launched by Sears, Roebuck & Co. won high marks from employees.

Sears introduced its program in April 1995 in cooperation with Northbrook, Ill.-based Caremark International Inc. As of last summer, out of 6,000 employees identified as asthma sufferers, 1,100 have signed up to participate in the asthma program (BI, July 29, 1996).

Surveys of participating Sears employees have shown a 32% drop in disease symptoms and a 39% increase in activity among asthma sufferers. And, about 99% of the participating employees reported they are satisfied with the program, the company said.

Many HMOs offer asthma management programs because they give considerable bang for the buck, in some cases a 10-to-1 return on investment.

Asthma "is something that affects a large percentage of the population," said Dr. Bernstein. "Among chronic diseases, it's the most common."

For example, "we're tracking 60 different chronic illnesses, and asthma represents 7.4% of our membership," he said.

Asthma also is easier to control than some other conditions, such as hypertension, explained Buck's Mr. Swim. While people with asthma can monitor themselves and seek early intervention, people with hypertension often have no warning that they are about to have a stroke, he said.

"There are three critical factors necessary for disease management to work," Mr. Swim explained.

"First, it has to be one of the bigger-ticket items; second, it has to be a well-defined disease that can be isolated," Mr. Swim explained. "And third, it has to be a disease that you can help people control."

Asthma management programs also work in providing physicians with the most up-to-date treatment information from the National Institute of Health, these experts say.

"Doctors respond to education," which is the theme of asthma disease management, Dr. Bernstein said.

For example, like most HMOs, Aetna-U.S. Healthcare provides the physicians the names of patients with asthma or with the potential to develop asthma. The names are culled from data on member demographics, emergency room visits, hospitalizations and prescription drug use.

"We can target a letter to each primary care physician that gives them by name specific patients (in their practice) whose treatment they should re-evaluate," he illustrated.

And, to protect patient privacy, "we have very strict confidentiality guidelines," he said.

He also pointed out that the information isn't necessarily new information; it's just assembled in one place to show doctors the correlations.

For an asthma disease management program to be successful, "you have to know who has asthma," he said.

And even if an employer is willing to wade through the claims data provided by an insurer or third-party administrator, "they'll have to have a broad net to catch it," he said.

For example, 12 diagnostic codes contain the word "asthma," and there are at least 35 synonyms for it.

So a child diagnosed with "acute bronchialitis" may in fact suffer from asthma, Dr. Bernstein explained.

"Or say someone's been admitted with pneumonia, which could be a complication of asthma," he added.

"So we really need multiple data sources and algorithms to figure out who really has it," he said.

HMOs do not charge employers additional fees for asthma disease management because their focus is on wellness, Mr. Swim explained.

By contrast, a drug company may charge employers a fee for each employee enrolled in its program.

Another advantage to an HMO-run asthma management program is its independence, experts pointed out.

However, some drug makers, such as Wilmington, Del.-based Zeneca Pharmaceuticals Inc., have spun off independent disease management companies. Stuart Disease Management Services Inc. in Wilmington, Zeneca's spinoff, markets asthma management services to HMOs and is considering offering its services to large employers, a spokeswoman said.

SDMS provides consulting; information management services to analyze claims data and identify potential asthma patients, identify asthma treatment costs and treatment strategies; and education and intervention services to patients and doctors.

While Zeneca makes Accolade, an asthma drug, its program does not require its use.

Still, Dr. Bernstein said he thinks HMOs are better equipped to manage diseases like asthma because of their ability to collect information throughout each patient encounter.

For example, an HMO can assemble data on office visits, diagnostic tests, pharmacy use and hospital admissions or emergency room use to make correlations that can lead to more accurate diagnosis, he said.

HMOs also are more likely than insurers or employers to communicate directly with doctors about treatment protocols, he pointed out. "We're giving them information to help them make the best decision about treatment, and then we give them the support they may not have available."

For example, at Aetna-U.S. Healthcare, HMO nurses regularly call asthma patients to make sure they are following their doctors' advice.

The doctors participating in Aetna U.S. Healthcare's asthma disease management program are especially appreciative of this added service.

"They do things independently of me," said Dr. Bernard Schayes, a Manhattan primary care doctor. "An asthma nurse will follow patients and do some of the work that gets lost in a busy practice."

And because of the monthly reports on patients, "when all is said and done, I know who goes to the ER and who doesn't," he said.

And that's how Dr. Schayes knows the asthma management program is working: "Ten years ago in my practice, we used to hospitalize two to three asthma patients a month in the wintertime," he recounted. Now, "in the last two to three years I can't recall hospitalizing anyone."

Aetna-U.S. Healthcare also provides its asthma patient members with access to home medical equipment such as peak flow meters that help measure their breathing.

"This helps alert them to an attack even before symptoms begin," Dr. Bernstein explained. "We also give a book to everybody that explains in layman's terms how to use home self-management.'