"Taking Public Health Approaches to Care in Massachusetts," Health Affairs, March 2011 30(3):435–38.
While research suggests patients benefit from home care visits and increased attention from nurses and community health workers, fee-for-service payment systems typically do not reimburse providers for such services.
Cambridge Health Alliance, an integrated health system in Massachusetts that focuses on public health and safety net populations, deployed a team consisting of a community health worker and a registered nurse who made at least three home visits to pediatric patients with asthma. The team, which was supported by a Web-based registry that tracked information about pediatric patients with asthma, including information about medical history, condition severity, treatment plan, and evidence-based treatment protocols, sought to help parents reduce or eliminate asthma triggers. The alliance, which relied on grants to provide this service, is taking a similar approach to reducing obesity, managing diabetes, and improving complex care for patients.
For children in the asthma program seen at two sites, the percentage with annual asthma-related admissions dropped from 10 percent in 2002 to 2 percent in 2009. The percentage of asthma-related emergency department visits fell from 20 percent in 2002 to 8 percent in 2009. The program has shown a return on investment of $4 for every $1 invested.