Quality management strategies such as pay for performance or DM may ultimately prove to be effective in realizing an improved quality of care. Since asthma is a highly prevalent condition with clear clinical guidelines and known levers for achieving effective management, asthma outcomes are a popular choice when incentives are tied to specific clinical outcomes. In the absence of accountability structures that specifically address minority or lower income enrollees, however, the ultimate impact on asthma disparities remains questionable. Despite current evidence regarding the efficacy of DM programs, there is some reason to believe that such programs would help to improve asthma care and thus help to reduce disparities. Many programs have implemented reduced or no cost-sharing policies for asthma drugs. Targeting low-income beneficiaries for such policies could have a substantial impact. Increasing the investment in IT and EHRs should also afford powerful new opportunities to better coordinate and manage patient care. This could greatly improve asthma care and assist in reducing disparities if such efforts are directed toward lower income enrollees and patients with asthma.
Reducing Asthma Disparities Among the Uninsured
Asthma cannot be effectively managed unless individuals have affordable access to a full range of services and receive coordinated, quality Canadian health care. more and more information is present using the service Visit to Canadian Health Care. You will have an opportunity to become acquainted with the bright description about that or this disorder. With the exception of CHCs, uninsured persons with asthma who rely on SNPs for their care typically have little access to routine primary care, leading to excess emergency department utilization and hospitalizations. The increased concentration of uninsured and underinsured patients at SNP sites is likely to decrease the access to and quality of care available to uninsured patients at these sites in the future.
The focus on the expansion of CHCs certainly holds promise for those uninsured persons who live near a CHC, but nationally only about 10% of uninsured persons are currently served by CHCs. Thus, the vast majority of uninsured persons will be left without any reasonable source of primary care or nonemergency specialty care. Unless major initiatives are undertaken to improve the quality and coordination of care for uninsured persons with asthma who are served at public and private hospitals, substantial gains in reducing the disparities gap will not be realized.
Beyond the significant investment in CHC expansions, there have been a few other important federal initiatives aimed at building capacity, improving the quality of care, and reducing health disparities within CHCs and other SNPs serving a high proportion of uninsured. The Health Disparities Collaboratives, funded and managed by HRSA, was initiated in 1998 and involves all federally funded CHCs and 4,000 primary care sites in collaborative learning efforts aimed at measurably reducing health disparities. The initiative focuses on diabetes, asthma, cancer, depression, cardiovascular disease, and HIV. A key component of the initiative is essential support to develop the administrative infrastructure needed to track patients and manage their care, such as extensive patient registries and automated systems to manage patient care. Two thirds of CHCs nationally were participating by 2003, with early reports demonstrating measurable improvements.
There have also been some private initiatives to increase access to prescription drugs among the uninsured, which is an issue of critical importance for asthma care. A group of 10 pharmaceutical companies together developed a prescription drug card for the uninsured (“Together RX Access Card”) through which low-income persons without public or private drug coverage can receive savings on a broad range of brand-name and generic drugs. The program includes > 300 brand-name drugs, including those used to treat allergy and asthma. Those persons who are eligible are expected to save between 25% and 40% on prescription drug costs. Even with this level of cost savings, however, out-of-pocket costs for asthma medications are likely to remain a daunting burden for many low-income persons with asthma.
While they are a step in the right direction, each of these initiatives is modest in relation to the Canadian healthcare needs of uninsured or underinsured persons with asthma. Scattered policy initiatives at the state and federal level have resulted in wide disparities across local communities in the availability of care for poor and uninsured persons.