The NCQA’s white paper outlines the realities of asthma care in the United States and the policy and clinical interventions that may provide improvements.
RT’s Three Key Takeaways:
- Asthma care needs urgent attention: The NCQA report emphasizes that asthma care lags behind other chronic diseases like diabetes and heart failure, highlighting the need for better management and access.
- Six strategies to improve outcomes: The roundtable identified priorities including better insurance coverage, expanded workforce, updated quality metrics, improved care delivery, patient-centered approaches, and environmental policy changes.
- Collaboration is essential: The report calls for cooperation among stakeholders, including payers, providers, and policymakers, to bridge the gap between ideal asthma care and current patient experiences.
The National Committee for Quality Assurance (NCQA) released a new white paper focused on improving outcomes for people with asthma.
The report is a result of an NCQA roundtable discussion on how to improve access to appropriate asthma care, assure that clinical care aligns with a quality framework, and provide more patient-centered care.
Held in May 2024, NCQA in collaboration with AstraZeneca Pharmaceuticals convened the Asthma Management & Education Roundtable, which included a diverse panel of clinicians, public/community health experts, and patient advocates.
“Compared to other chronic diseases, such as diabetes or heart failure, asthma care needs a lot of attention. As a society, we must do a better job at helping people manage their asthma while addressing their health-related social needs and environmental and social factors that impact their outcomes,” says Caroline Blaum, MD, NCQA assistant vice president of the Chronic Conditions and Complex Care Knowledge Center, in a release. “Engaging with various health care thought leaders about asthma and its management is key to a well-rounded discussion about barriers and solutions in asthma treatment. These focused discussions pointed to various issues related to asthma management and uncovered much needed improvements.”
Six Strategies to Improve Asthma Outcomes
Roundtable participants outlined six strategies to improve asthma outcomes in the United States, which state:
- Coverage: All people should have appropriate and standardized insurance coverage for their asthma care, self-management support and education, care coordination, and evidence-based pharmacological treatment. Interventions such as virtual care and home visits should be covered, as well as office spirometry.
- Workforce: While the clinician workforce for asthma care is in short supply, reinforcements are available if appropriate clinicians are enlisted including nurse practitioners, urgent care clinicians, and physician assistants. In some areas of the country, particularly in rural areas, primary care, pulmonary, and allergy specialists can be unavailable, and telehealth and licensing across states may assist in bringing needed specialty care to shortage areas. Additionally, community pharmacists can support evidence-based pharmaceutical care, and community health workers can help establish meaningful contact and educational assistance. Regardless, all providers who interact with asthma patients need training and resources to understand guidelines and best practices.
- Quality Framework: Quality metrics and standards for asthma care are underdeveloped, outdated or not consistent with guidelines compared to those for other chronic diseases. Measure developers need to develop metrics based on current guidelines for medical care that can be used for quality improvement as well as accountability and provider incentives. Measurement should consider addressing important issues such as availability of patient self-management support, care coordination, patient-reported outcomes, and pediatric asthma care.
- Care Delivery: Assure that asthma prescribing is based on current guidelines with inhaled corticosteroids as the basis of therapy, with appropriate provision of other reliever and controller medications and biologics as appropriate. Principles of chronic disease management should be applied to asthma, including patient education and self-management support, care coordination, use of multidisciplinary teams for management, and home visits. Electronic Health Record interoperability is important to allow different providers to communicate.
- Person-Centered Care: Clinicians should implement a culture of “asthma wellness,” so that patients and families understand that asthma symptoms and exacerbations are nearly entirely preventable. In addition, clinicians should be trained in principles of patient-centered care and techniques related to patient engagement, such as motivational interviewing and shared decision-making. Human-centered design methods should be employed to meet patients where they are and provide innovative and age-appropriate self-management such as social media and games.
- Environmental and Other Policy: Knowing that air quality is critical, and poor air quality is often associated with underserved areas, policy interventions are needed, such as defining lower acceptable particulate matter thresholds. Other policy interventions could encourage/reimburse home visits for asthma trigger investigation, and public-private partnerships, such as using pollutant taxes to fund remediation work, should be considered.
The roundtable discussion concluded with the alignment that there is much work to do to make high-quality care available to all asthma patients.
“A range of barriers and challenges need to be addressed, and all stakeholders must work together to achieve the goals,” reads a release from the NCQA. “It will take innovative approaches, forward-thinking momentum, and the cooperation and coordination of payers, employers, states, the federal government, and providers to work together to bridge the gap between the clinical ideal for asthma care and the disparate lived experiences and outcomes that patients often face.”
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