1. Asthma Management and the Allergist: Better Outcomes at Lower Cost

2. Asthma Patients Cared for by Allergists Have: Fewer emergency care visits Fewer hospitalizations Reduced length of hospital stays Fewer emergency care visits Fewer hospitalizations Reduced length of hospital stays

3. Asthma Patients Cared for by Allergists Have: Fewer sick care office visits Fewer days missed – school and work Fewer sick care office visits Fewer days missed – school and work Increased productivity in work and personal lives Fewer sick days =

4. Asthma Patients Cared for by Allergists Have: Greater satisfaction with their care Improved quality of life Better overall outcomes that lower costs Greater satisfaction with their care Improved quality of life Better overall outcomes that lower costs

5. Asthma in the United States 22 million Americans 6.5 million children 14.7 million physician visits 1.8 million ER visits 497,000hospitalizations 22 million Americans 6.5 million children 14.7 million physician visits 1.8 million ER visits 497,000hospitalizations

6. Direct and Indirect Costs of Asthma Care Direct Medical Costs Hospital Care: Inpatient and ER Physician Services Pharmaceuticals $4.7 B $3.8 B $6.2 B Indirect Medical Costs Decreased worker productivity (lost work and school days) $5.0 B Total Direct and Indirect Costs$19.7 B

8. Setting Standards of Care According to Guidelines, people with asthma should expect: No or few asthma symptoms Prevention of all or most asthma attacks Participation in all activities No ER visits or hospital stays Less need for quick-relief meds No or few side effects from asthma meds According to Guidelines, people with asthma should expect: No or few asthma symptoms Prevention of all or most asthma attacks Participation in all activities No ER visits or hospital stays Less need for quick-relief meds No or few side effects from asthma meds

9. Compliance with Guidelines is Poor One multicenter study of 4,000 patients found: 83% had uncontrolled asthma 16% had inconsistent control 1.3% were controlled One multicenter study of 4,000 patients found: 83% had uncontrolled asthma 16% had inconsistent control 1.3% were controlled

10. Compliance with Guidelines is Poor Cost per patient per year

11. Compliance with Guidelines is Poor Asthma uncontrolled in 85% of inner-city students with asthma 50% had been treated in ER at least twice in previous two years 52% often had to limit activities 29% had nighttime symptoms once or more per week 17% missed five or more days of school per year because of asthma Asthma uncontrolled in 85% of inner-city students with asthma 50% had been treated in ER at least twice in previous two years 52% often had to limit activities 29% had nighttime symptoms once or more per week 17% missed five or more days of school per year because of asthma

12. Compliance with Guidelines is Poor Analysis of 24,000 Medicaid patients found non- adherence to NIH Guidelines : Fewer than 40% received rescue medication Fewer than 10% were regular users of inhaled corticosteroids Analysis of 24,000 Medicaid patients found non- adherence to NIH Guidelines : Fewer than 40% received rescue medication Fewer than 10% were regular users of inhaled corticosteroids

13. When to Refer to An Allergist Patients should be referred to a specialist if they: Have symptoms every day and often at night Have had life-threatening attack Do not meet treatment goals in 3-6 months Have unusual/hard-to-diagnose symptoms Have co-existing conditions Need additional tests Need more help and instruction Patients should be referred to a specialist if they: Have symptoms every day and often at night Have had life-threatening attack Do not meet treatment goals in 3-6 months Have unusual/hard-to-diagnose symptoms Have co-existing conditions Need additional tests Need more help and instruction

14. When to Refer to An Allergist Patients should be referred to a specialist if they: Might be helped by allergy shots Need oral or high-dose inhaled corticosteroids Use oral corticosteroids 2+ times/year Have been hospitalized for asthma Need help to identify asthma triggers Are children age 0-4 with frequent symptoms Patients should be referred to a specialist if they: Might be helped by allergy shots Need oral or high-dose inhaled corticosteroids Use oral corticosteroids 2+ times/year Have been hospitalized for asthma Need help to identify asthma triggers Are children age 0-4 with frequent symptoms

15. PCP Referral Patterns Often Differ from Guidelines Survey of pediatricians and family physicians found criteria for referral did not conform to Guidelines Study of PCPs found those who had training in allergic diseases were more likely to refer than those who were not as educated (78% vs. 46%) Survey of pediatricians and family physicians found criteria for referral did not conform to Guidelines Study of PCPs found those who had training in allergic diseases were more likely to refer than those who were not as educated (78% vs. 46%)

16. Allergists and NIH Guidelines In a survey of 1,954 patients in 12 MCOs, patients cared for by allergists reported: Fewer hospitalizations and ER visits Higher ratings for quality of care Fewer activity restrictions Improved physical functioning In a survey of 1,954 patients in 12 MCOs, patients cared for by allergists reported: Fewer hospitalizations and ER visits Higher ratings for quality of care Fewer activity restrictions Improved physical functioning

17. Asthma Treatment Outcomes Fewer hospitalizations Fewer ER visits and sick care office visits Improved patient satisfaction and QOL Fewer hospitalizations Fewer ER visits and sick care office visits Improved patient satisfaction and QOL

18. Asthma Treatment Outcomes – 497,000 Hospitalizations Asthma Treatment Outcomes – 497,000 Hospitalizations Number of Hospitalizations

19. Asthma Treatment Outcomes – 1.8 Million ER Visits Asthma Treatment Outcomes – 1.8 Million ER Visits Study of 9,500+ HMO patients documented lower risk of emergency asthma care with specialty care Randomized study of 2,000 children found patients seeing allergist were only 54% as likely to require ER services Comprehensive treatment in specialty allergy center reduced ER visits 76% Study of 9,500+ HMO patients documented lower risk of emergency asthma care with specialty care Randomized study of 2,000 children found patients seeing allergist were only 54% as likely to require ER services Comprehensive treatment in specialty allergy center reduced ER visits 76%

20. Asthma Treatment Outcomes – 14.7 Million Sick Care Visits Asthma Treatment Outcomes – 14.7 Million Sick Care Visits Number of Visits

21. Asthma Treatment Outcomes – 10 Million Lost Work Days 13 Million Lost School Days Asthma Treatment Outcomes – 10 Million Lost Work Days 13 Million Lost School Days Number of Lost Days

22. Asthma Treatment Outcomes – Patient Satisfaction and QOL Asthma Treatment Outcomes – Patient Satisfaction and QOL Patients who receive care from allergist are more satisfied and experience improved emotional and physician well-being Study of 400 HMO patients saw improvements in physical function, emotion, pain relief and general health Patients in private practice reported improvements in ability to participate in activities, emotional well-being and asthma control Patients who receive care from allergist are more satisfied and experience improved emotional and physician well-being Study of 400 HMO patients saw improvements in physical function, emotion, pain relief and general health Patients in private practice reported improvements in ability to participate in activities, emotional well-being and asthma control

23. Asthma Treatment Costs Studies show aggressive allergist management produces better outcomes AND reduces costs Specialty center experienced a 45% to 80% reduction in insurance claims AAFA study found 54% increase in cost of care when guidelines are not followed Failure to control asthma carries high price with 80% of all resources expended used by 20% of patients with uncontrolled disease Studies show aggressive allergist management produces better outcomes AND reduces costs Specialty center experienced a 45% to 80% reduction in insurance claims AAFA study found 54% increase in cost of care when guidelines are not followed Failure to control asthma carries high price with 80% of all resources expended used by 20% of patients with uncontrolled disease

24. Asthma Treatment Costs – $4.7 Billion in Hospitalizations Asthma Treatment Costs – $4.7 Billion in Hospitalizations Inpatient Care Costs

25. Asthma Treatment Costs – $546 Million in ER Visits ER Costs

26. How Allergists Improve Outcomes, Lower Costs Accurately diagnose disease types and severity Identify external triggers including allergens and advise on avoidance Administer immunotherapy (allergy shots) to decrease sensitivity to allergic triggers Develop and implement aggressive treatment plans Maintain disease control Prevent serious consequences Accurately diagnose disease types and severity Identify external triggers including allergens and advise on avoidance Administer immunotherapy (allergy shots) to decrease sensitivity to allergic triggers Develop and implement aggressive treatment plans Maintain disease control Prevent serious consequences

27. Aggressive Asthma Management – The Standard of Care Guidelines recommend early diagnosis and aggressive treatment Treatment to control symptoms – initiate at onset and step down with improvement Significant long-term benefits and cost savings outweigh high costs of initial therapy Guidelines recommend early diagnosis and aggressive treatment Treatment to control symptoms – initiate at onset and step down with improvement Significant long-term benefits and cost savings outweigh high costs of initial therapy

28. Emerging Role of New Treatments and Prevention Allergists aware of latest treatment and control strategies o Environmental pollutant and allergens o Self-management and trigger avoidance o Partnerships with health care providers, families and other caregivers o Immunotherapy specialists o Clinical trial participants Allergists aware of latest treatment and control strategies o Environmental pollutant and allergens o Self-management and trigger avoidance o Partnerships with health care providers, families and other caregivers o Immunotherapy specialists o Clinical trial participants

29. Specialty Care of Asthma in Health Plans Asthma management a model for the new strategy of managed care NCQA has made appropriate management of asthma a key indicator in evaluating the quality of health plans PCPs are demanding greater say in referring patients to specialists Asthma management a model for the new strategy of managed care NCQA has made appropriate management of asthma a key indicator in evaluating the quality of health plans PCPs are demanding greater say in referring patients to specialists

30. Specialty Care of Asthma in Health Plans ACAAI provides health plan checklist: Access to specialists Ongoing management for specialist care Unlimited visits Access to tests Access to medications and shots Management by specialist without high co-payments ACAAI provides health plan checklist: Access to specialists Ongoing management for specialist care Unlimited visits Access to tests Access to medications and shots Management by specialist without high co-payments

31. Asthma Management and the Allergist: Better Outcomes at Lower Cost Documented by an evidence-based review of the literature For a copy of the review, including an annotated bibliography, go to: www.acaai.org Documented by an evidence-based review of the literature For a copy of the review, including an annotated bibliography, go to: www.acaai.org