Asthma

FOR PROVIDERS

Asthma

Our Health Services Asthma Program is designed with an emphasis on strengthening the patient-physician relations, increasing adherence to clinical guidelines.

Blue Cross’ multidisciplinary team of healthcare professionals collaborate to ensure each enrollee receives a “whole-person” approach to their disease management by addressing clinical functional, financial, psychosocial, environmental and support system needs.

The asthma program’s objectives are consistent with those set forth by the National Asthma Education Program sponsored by the US Department of Health and Human Services, Public Health Services and the National Institute of Health (NIH).

Eligible Members

The program is available to Blue Cross and Blue Shield of Louisiana, HMO Louisiana, Inc. and Federal Employee Program (FEP) primary members 18 to 80 years of age.

The selection process for our asthma program is based on hospital claims, encounters, and pharmacy and laboratory data. We analyze claims data to assess relative health risk, identify medical conditions and build a member-centric clinical profile.

The program is not available to members who have other insurance as primary, are being actively treated for cancer, a transplant recipient, have ESRD, HIV/AIDs, are a hospice care recipient or nursing home resident. This is a voluntary program and members may “opt out” of the program at any time.

Re-enrollment into Program

Asthma program members are re-enrolled based on nurse assessment for any of the following reasons:

Member requests re-enrollment
Physician refers member again
Member experiences a asthma-related admission
If the member has any of the following:

Increased relative risk scores
More than two hospitalizations in 12 months
Emergency room visits for asthma-related complications
Medication non-adherence (45-day-or-less gap in medication refills)

Our Care Management team includes physician advisors, registered nurses, pharmacists and behavioral health specialists.

Physicians receive the following when their patient enrolls

Written or telephonic notification if their patient is receiving ongoing nurse calls along with the nurse’s contact information.
Notification of their patients who may be in need of healthcare services via a care coordination nurse call.
Patient referral by Blue Cross nurses when member does not have an established patient-physician relationship.
Access to claims-based Blue Health Records with up to three years of claims history (through iLinkBLUE)