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Being rushed to the emergency room as the result of a severe asthma episode is a frightening event for a two-year-old child and a parent. "I didn't recognize that it was so bad. I should've intervened sooner," says Michelle*, who has since received education on treating her daughter Kari's asthma. She now regularly visits the asthma clinic at Children's Hospital Oakland to keep Kari's asthma in check and recognizes the subtle early warning signs of an attack.

Behind the scenes, every time a member like Kari visits the hospital's emergency room due to an asthma episode, her health plan, Alameda Alliance for Health, is notified. The health plan then works with the primary care provider to facilitate referrals--approximately 60 per week--to the asthma clinic or to community-based asthma case management programs for education and self-management training. Coordinating this action is not a simple task, but it is one example of the results of the California Asthma Collaborative, a two-year initiative managed by the Center for Health Care Strategies and funded by the California HealthCare Foundation to help Medicaid health plans implement asthma guidelines effectively.

Through this collaborative, CHCS is working with Medi-Cal officials and health plans to standardize and improve asthma care for Medicaid enrollees across the state. Eleven teams--composed of consumers, providers, health plans, and community service organizations--are piloting integrated approaches to asthma management, such as the quality improvement project developed by Alameda Alliance and its hospital, provider, and community-based organization partners.

This innovative effort is driving unprecedented partnerships among organizations that traditionally have not collaborated on improving health care quality. "There used to be a huge time lag of up to two months between when a child with asthma was seen in the ER and their next provider visit," says Brenda Goldstein, Health Programs Manager, Alameda Alliance for Health. "Through this collaborative, we're identifying children quickly and supporting them in getting the care and education they need to stay healthy."

Central to identifying its target population for appropriate intervention is the plan's asthma data warehouse.  The database not only identifies members diagnosed with persistent asthma and enables valuable reporting by provider, age, encounter, and pharmacy data, it also flags members who do not have a controller medication, and generates monthly provider reports on a variety of criteria, including members with eight or more beta agonists. The health plan is then able to stratify this disease-specific population by level of risk and implement appropriate levels of interventions, putting new partnerships to work for members like Michelle and Kari.

As a result of its quality improvement pilot project, Alameda Alliance for Health experienced significant gains in its quality measures for children with asthma. The health plan improved its HEDIS scores for use of appropriate asthma medications by nearly three percent and halved the number of children receiving eight or more beta agonist prescriptions in one year. Emergency room visits and inpatient stays also decreased.

*Names changed to protect identity of members.