Formed in 1994, the Asthma Network of West Michigan is believed to be the first grassroots asthma coalition in the nation to receive reimbursement for asthma education and case management services from health insurance plans. Located on the campus of Mercy Health Saint Mary’s, today its services have expanded to adults as well as children younger than school age, and five of Michigan’s largest payers now reimburse for home-based education and environmental assessments. To reach and improve the lives of the nearly 121,000 people in Western Michigan (Kent, Ottawa, and Muskegon counties) who have asthma — 24 percent of whom are children — the Asthma Network of West Michigan (ANWM) created a direct service arm of its coalition and implemented a home-based asthma case management program for school-aged children who had uncontrolled asthma. This independent nonprofit organization primarily serves low-income children and adults with moderate to severe asthma. As a community collaborative, ANWM is funded by six major contributing organizations*, including Trinity Health and Mercy Health Saint Mary’s, which is the network’s employer of record.
Never Tried Before
Their first pilot program in 1996 included the following comprehensive services:
- Home visits
- In-services for school staff regarding asthma awareness
- Physician care conferences to create a written asthma action plan
- Medical social worker visits to assist families with psychosocial barriers to asthma management
By delivering this type of intensive, personal care, ANWM was able to demonstrate success in controlling asthma and reducing emergency department visits and hospital admissions due to asthma. Three years after the initial pilot program was launched, a local health plan began to reimburse for ANWM’s services.
Over the years, Karen Meyerson, MSN, RN, FNP-C, AE-C, Director of the Asthma Network of West Michigan, and this nonprofit’s staff have conducted other pilot programs that have ultimately led to stable funding sources and cooperation from local government agencies that now refer patients to ANWM.
Meyerson explains how her work is funded. “We get reimbursed by Medicaid managed care plans, Medicare, and other commercial insurers. We have also been successful in raising grant funds and community benefit funds from local hospitals. It takes a lot of different funding streams to support our program, even with the insurance reimbursement.”
Demonstrated Clinical Outcomes
The data from the past 20 years reveal the story of ANWM’s success. “We find that there have been significant reductions in the number of hospitalizations overall, the number of days children have been hospitalized, and the number of emergency department visits,” Meyerson explains. “And, for low-income children with moderate to severe asthma who remained in the original case management study for at least 1 year, we saw an estimated average savings of $1,625 in hospital charges per patient.”
In total, Meyerson and her team estimate that the program results in approximately $800 in net healthcare savings per child per year, with a return to society — over two years — of $1.53 for every $1 invested. Patients often “graduate” from their program after just 6 to 12 months, when their asthma control has improved.
With such documented success, Meyerson has become a national expert on delivering and funding optimal asthma outcomes. She served as a participant in a roundtable discussion in Washington, D.C. in 2015, sponsored by the Brookings Institution and the Allergy and Asthma Foundation of America. The subsequent published report from that gathering features ANWM as a model program for health care delivery.
Also in 2015, the National Governor’s Association’s white paper on asthma celebrated ANWM as a “state success story.” The 2013 asthma reimbursement report by the CDC traces the history of ANWM’s excellent care delivery and innovative development of a funding stream.
Today, other Michigan coalitions have formed and have begun replicating ANWM’s model — and they have also been successful in securing payment for similar services in their respective communities.
As the director of ANWM’s innovative case management model of asthma care for 19 years, Meyerson has been a member of the National Asthma Educator Certification Board, served as the chair of that board, and is now an emeritus member.
Contact Karen Meyerson at 616.685.1432 or email@example.com
Sidebar: Facts about Asthma**
- Asthma costs nearly $56 billion a year.
- Asthma affects nearly 25 million Americans, including 1 in 11 children.
- In 2009, one in five children with asthma visited the emergency department.
- Asthma causes nearly 10.5 million missed school days and 14.2 million missed work days per year.
*Major funding sources: Amway, First Steps, Heart of West Michigan United Way, Mercy Health Saint Mary’s, Spectrum Health Healthier Communities, and Trinity Health
**Source: Asthma and Allergy Foundation of America