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Journal Article


Taking Public Health Approaches to Care in Massachusetts



The Issue

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.

The Innovation

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.

Publication Details



C. Bielaszka-DuVernay, "Taking Public Health Approaches to Care in Massachusetts," Health Affairs, March 2011 30(3):435–38.