Asthma Program (Breathe Easy)

Chronic conditions such as asthma can be difficult to manage. Neighborhood’s Disease Management team of nurses will work with you and your doctors to help you take care of your condition and to help you lead and health and active life. We will tell your doctor about your condition and how we help you stay well. We can also help with the environmental or social barriers you face that make it difficult to stay healthy

You may be eligible for the program

• If you experience wheezing, coughing and shortness of breath 2 or more times a week during the day
• If you are waking up coughing or wheezing 2 or more times a month at night,

The goal of Neighborhood Health Plan of Rhode Island’s (Neighborhood) Breathe Easy Asthma Program is to enable and empower members with persistent asthma to live healthy, active lives, confident in their abilities to manage asthma. Built on evidence-based practice guidelines, the asthma disease management program is designed to reinforce the physicians’ treatment plan through member outreach/ education, monitoring and management.

Neighborhood identifies members ages 2 years and older for participation in the Breathe Easy Program. Members are considered to have persistent asthma if claims data meets one or more of the following criteria in each of the 12 months of a 24 month period:

• at least four asthma medication dispensing events in the year (excluding leukotriene receptor antagonists if that is the only asthma medication dispensed)
• at least one Emergency Department visit with primary diagnosis of asthma in the year
• at least one acute inpatient stay with primary diagnosis of asthma in the year
• at least four outpatient visits with any diagnosis of asthma and at least two asthma medication dispensing events in the year.

Member resources

• Members in the Breathe Easy Program receive periodic mailings that contain educational resources and recommendations to assist them in better managing their condition. Topics covered include:
  • Use of anti-inflammatory medications for persistent asthma
  • Importance of establishing a written asthma action plan
  • Environmental triggers that may exacerbate a member’s condition
  • Need for regular physician visits (at least two times per year)
• Members identified as being at the highest risk will receive telephonic outreach from an Asthma Disease Manager. The Asthma Disease Manager will discuss lifestyle issues that may exacerbate their condition, discuss self-management strategies, evaluate their status, review and discuss their responses to the Asthma Control Survey and in general, monitor their condition and adherence to treatment goals.; click here for more details
• Asthma Education Resources
• Asthma Services
• Smoking Cessation Resources

Provider resources

Neighborhood provides targeted physicians with actionable information derived from health plan claims and pharmacy data to support improved patient outcomes.

• Quarterly reports include
  • Detailed, member-level information summarizing asthma hospitalizations, emergency department visits, and recent medication usage.
  • Aggregate site specific information summarizing PCP visits, flu vaccine, and medication usage.
  • Neighborhood-enrolled members who have picked up more than 5 short-acting beta-agonists in the preceding 6 months without picking up a controller medication
• The Breathe Easy Program provides access to an Asthma care manager to support the primary clinician's work to provide proactive, evidence-based asthma care. 
• Clinical Practice Guidelines
• Summary Report 2007; NAEPP Expert Panel 3 Report; Guidelines for the Diagnosis and Management of Asthma.
• See additional resources under Member Resources

Outcome Measurement and Effectiveness
We want to make sure that our Breathe Easy Program is effective in achieving improved health outcomes for our members with asthma and in its delivery of services to our members and providers. Some of the key measures that Neighborhood pays attention to to assess the program include:

• HEDIS measure: Use of Appropriate Asthma Medications
• Member satisfaction with Neighborhood’s disease management services (annual survey / complaints data).