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California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more

23-682m Improve Quality Metrics While Helping Members Manage Asthma

Date: 07/17/23

Talk with patients about ways to improve medication adherence

An estimated 26.5 million Americans have asthma, including 6.1 million children. Asthma has also led to 13.8 million missed school days, 14.2 million lost workdays for adults and is the third leading cause of hospitalization for children under age 15.1

How you can help

Apply HEDIS guidelines

Use HEDIS®2 guidelines to help track whether your patients consistently fill their prescriptions for asthma controller drugs.

Measure

How to interpret the measure rate

Asthma Medication Ratio (AMR): This HEDIS measure evaluates the percentage of members ages 5-64 who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year.

The AMR is the number of controller units of medication divided by the number of units of total asthma medications (controller and rescue units) dispensed.

Goal: A medication ratio higher than 0.50 for the year.

If a member’s ratio is less than 0.50 it means that a member is using too much rescue medication and their asthma may not be controlled well.

Talk about challenges to adherence as part of routine conversations with patients

You can identify poor adherence during an empathetic discussion with the patient. Find out if these barriers are present so you can address each. Is the patient:

  • Not filling their medication?
  • Stopping treatment too soon?
  • Not following up with their physician or appointments?

Also consider addressing these other factors when you speak with patients:

Factors leading to poor adherence

Medication/regimen factors

  • Difficulties using inhaler device (e.g., arthritis)
  • Burdensome regimen (e.g., multiple times per day)
  • Multiple/different inhalers

Unintentional factors

  • Does not understand instructions
  • Absence of a daily routine
  • Forgetfulness
  • Cost (is a generic available?)

Perceptions or beliefs

  • Concerns about side effects (real or perceived)
  • Perception that treatment is not needed
  • Denial or anger about asthma or its treatment
  • Unrealistic expectations
  • Cultural or religious beliefs

Other

  • Dissatisfaction with physicians and other health care providers
  • Stigmatization

Remember these key components of asthma care

Applying the following guidelines may improve care:

Assess, diagnose and monitor asthma severity and control

  • Review medical history. Establish asthma diagnosis.
  • Initial visit: Assess asthma severity to start treatment.
  • Follow-up visit: Assess and control asthma at every visit. In the past four weeks, has the patient had:
    1. Daytime asthma symptoms more than twice/week?
    2. Any night waking due to asthma?
    3. Any activity limited due to asthma?
    4. Quick reliever use for symptoms more than twice/week?
  • Prioritize patients with a low asthma medication ratio (e.g., less than 0.5).

Educate for a partnership in care

  • Review medication technique and adherence. Demonstrate and have the patient demonstrate back.
  • Assess side effects.
  • Identify poor adherence: Check medication usage, date of last controller prescription, and date and dose counter on the inhaler.
  • Identify and/or review potential triggers and how to minimize exposure to them. Encourage patients to quit smoking and refer them to smoking cessation programs.
  • Discuss solutions with patients if they have any barriers to filling their prescription.
  • Discuss basic asthma facts:
    • Explain how the medications work.
    • Review the difference between a controller and a rescue medication.
    • Discuss how some are required even though you may not be having symptoms.

Maintain, step up, or step down the approach to manage asthma

  • Therapy is increased as needed and decreased when possible.
  • Identify and address any common problems such as inhaler technique, adherence, allergen exposure and provide patient education.

Complete a written asthma action plan and schedule follow-up

  • Review the asthma action plan with the patient and revise as needed. Encourage patient to follow their action plan.
  • Schedule next follow-up appointment with patient.

Resources

Refer to these resources for more information. 

Resource

Member flyer: Live Your Best Life with Asthma (PDF)

Provider tip sheet: Asthma Medication Ratio (PDF)

Provider flyer: Language assistance (PDF)

Provider flyer: Transportation services at no cost (PDF)

Population health management (PDF)

Global Initiative for Asthma (GINA) guidelines

Additional information

Providers are encouraged to access CHWP’s provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CHWP at 877 658 0305.

1American College of Allergy, Asthma, & Immunology.

2Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

 

This information applies to Physicians and Independent Practice Associations (IPAs).