Detroit Asthma Demonstration Project. Mary Sue Schottenfels CLEARCorps Detroit James Forshee, MD Molina Healthcare

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1 Detroit Asthma Demonstration Project Mary Sue Schottenfels CLEARCorps Detroit James Forshee, MD Molina Healthcare

2 Healthy Homes + Asthma The Asthma Picture in Michigan 9.7% of children in Michigan have diagnosed asthma 11.3% of Detroit children have diagnosed asthma 40 percent of asthma episodes are caused by housing-based triggers Source: Research shows that home-based environmental interventions can contribute to asthma trigger reduction and better health outcomes 2

3 Healthy Homes + Asthma a partnership between Molina Healthcare of Michigan CLEARCorps Detroit Wayne Children s Healthcare Access Program (WCHAP) funded by The Kresge Foundation and The Jewish Fund 3

4 ASTHMA DEMONSTRATION PROJECT: 40 Homes with Asthmatic Children Ages 2-11 Will Receive Environmental Assessment of Home Evaluation of Asthma Triggers and other environmental hazards Family Action Plan & Intensive Asthma Education by WCHAP Healthy and Safety Products & Minor Home Repairs 4

5 Healthy Homes + Asthma Products HEPA Rated Vacuum Mattress & Pillow Covers Pest Management Supplies Air Purifier Covered Trash Cans Dehumidifier Gutter Extenders Cleaning Supplies Minor Repairs Carpet Removal/Cleaning Vent Bathroom/Dryer to Outside Remove Clutter/Dumpster Repair Plumbing Leaks Minor Roof Repair Pest Extermination Mold remediation HVAC repair Partner Referrals for Free Services Furnace Tune Up/ Replacement DTE Energy Lead Hazard Abatement - City of Detroit & State of Michigan Step Forward Michigan for property tax assistance 5

6 Molina Healthcare Our mission is to provide quality healthcare services to financially vulnerable families and individuals covered by government programs. 6

7 16 years 399,200 lives 3 large population centers Wayne County Genesee County Kent County Population: 214,800 TANF 46,200 ABAD 4,600 CSHCS 9,800 Dual-SNP 9,000 Mi Health Link 7

8 Molina in Michigan Asthma: Top 5 Admission diagnoses Top 5 ED visit diagnoses Top 2 or 3 CSHCS ED visits (seasonal) Medication possession ratio concern 8

9 Operational Plan Identification Recruitment Systematic home visits (The STAR partner CLEARCorps) 9

10 Wayne Children s Healthcare Access Program (Wayne CHAP) WCHAP strives to improve quality, access and health outcomes for children eligible for Medicaid by promoting the Medical Home Model 10

11 Wayne CHAP Asthma Education Services 11

12 12

hospitalizations Fewer ED visits for asthma Better

13 Healthy Homes + Asthma Projected Outcomes Lowered health plan costs for medical care and RX Fewer hospitalizations Fewer ED visits for asthma Better controller v rescue medicine ratio Fewer missed school and work days 13

14 Healthy Homes + Asthma Outcomes Measurement Health care utilization and cost data (Molina encounters/claims) 1 year before and 1 year after the intervention Children with months enrollment with Molina Measures on asthma-related knowledge, behaviors, and missed school days Baseline and 6 months follow-up resident surveys (CLEARCorps & WCHAP) Intervention Costs (CLEARCorps) Associated with remediating each unit Indirect costs 14

15 Healthy Homes + Asthma Program Demonstration: Update As of May 6, 2016 Working with cohort from Molina Healthcare of children whose asthma is out of control 38 members (of 40 in cohort) enrolled into program. 27 have begun WCHAP intensive MATCH model asthma education 20 have received Family Action Plans 19 have begun asthma-specific repair process 10 clients have completed repair process Average Repair Cost: $1,749 Average Healthy Homes Product Cost: $490

16 Healthy Homes Product Install HEPA-Rated Vacuum Cleaner and supplies Hypo-allergenic mattress and pillow encasements Furnace filter installation Asthma Friendly cleaning supplies: Murphy s Oil, Simple Green, Vinegar, Baking Soda Good quality mop and bucket with a wringer Covered trash can and food storage containers - pest prevention Smoking Jacket to reduce 3 rd hand smoke Downspout extenders to help with drainage Integrated Pest Management (IPM) asthma friendly roach and mice traps Installation of safety products: Smoke detectors, carbon monoxide detectors, fire extinguishers

17 Healthy Homes Product Install

18 Heating and Ventilation New Furnace Unvent Dryer - Before Vented Dryer - After 18

19 Bathroom Ventilation and mold remediation Bathroom Mold Growth - Before Bathroom Mold Growth - Before Bathroom Ventilation and mold remediation - After 19

20 Leaks, Cleaning, and Cleanable Surfaces Tub Surround and faucet Before After 20

21 Drainage New Downspout and extension Before After 21

22 Leaks and Mold Growth Roof Replacement Before After 22

Healthy Homes + Asthma Results from Phase One Small Sample Interesting Results 20 units enrolled and assessed 19 had intervention 16 had follow up (to date) Self reported outcomes Stopped smoking

23 Healthy Homes + Asthma Results from Phase One Small Sample Interesting Results 20 units enrolled and assessed 19 had intervention 16 had follow up (to date) Self reported outcomes Stopped smoking inside: 5 Started venting: 4 Better understands child s asthma meds: 15 Understands household triggers/ attempted to reduce: 16 More cleaning: 16 Stopped using strong cleaners/ scented products: 10 23

Self reported outcomes Child uses rescue inhaler less: 94% Less missed school days: 80% Less ER visits reported: 93% Child is on controller medication: 93% Child has Asthma Action

24 Self reported outcomes Child uses rescue inhaler less: 94% Less missed school days: 80% Less ER visits reported: 93% Child is on controller medication: 93% Child has Asthma Action Plan: 69% Less triggers reported in home: 88% Referred others to CCD or WCHAP: 83% Healthy Homes + Asthma Results from Phase One Child s asthma reported to be better in control: 100% 24

25 Jewish Fund Grant $8,434 in Repairs Plumbing Leaks/ roof repairs/carpet cleaning/ installed humidifier/air duct cleaning/pest extermination $4,594 in Products Healthy Homes + Asthma Results from Phase One Total Investment Smoke/CO detectors/ fire extinguishers/cleaning supplies/smoking jackets/etc. $79,588+ in partner contributions Furnace replacement x 4 Energy Star Refrigerators x 3 Lead grants x 5 Asbestos Abatement Roof Repairs and Gutter Installs/NIP Step Forward Tax Assistance WCHAP Asthma Education

26 PHASE ONE: CLEARCorps Interventions on Cahalan Family Action Plan MATCH Model Asthma Education Health and Safety Product Install Asbestos Abatement to enable furnace replacement Furnace Replacement Lead Abatement through State of Michigan LSHP New Furnace through HH+A 26

27 Testimonial Two of my children are asthmatics. One of them used to have to go the doctor three or four times a month we didn t know what was causing his asthma to flare up we thought it was the company across the street, but it ended up being the actual house itself. - Client on Cahalan St. 27

28 Healthy Homes + Asthma family on Cahalan St. Two Children are Asthmatics CCD working on Family Action Plan 28

29 Healthy Homes + Asthma Program Demonstration: Update Giving parents the tools they need to reduce asthma triggers in the home.

30 Thank you. Questions?

EPR 3 (2007) Measures of Assessment and Monitoring Education Control of Environmental Factors Medication

EPR 3 (2007) Measures of Assessment and Monitoring Education Control of Environmental Factors Medication EPR 3 (2007) Component 1: Measures of Assessment and Monitoring Component 2: Education Component 3: Control of Environmental Factors Component 4: Medication KEY DIFFERENCES FROM 1997 EXPERT PANEL REPORT