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Potential Savings From Increasing Adherence to Inhaled Corticosteroid Therapy in Medicaid-Enrolled Children

George Rust, MD, MPH, FAAFP, FACPM; Shun Zhang, MD, MPH; Luceta McRoy, PhD; and Maria Pisu, PhD
Increasing adherence to inhaled corticosteroids for Medicaid-enrolled children with asthma could cost-effectively decrease both Medicaid spending and adverse clinical outcomes.
Further research is also needed to calibrate the breadth of intervention (adherence-only interventions vs broader self-management improvement strategies) required to achieve significant outcomes improvement. It is a testable hypothesis that an extremely targeted approach focused specifically on increasing ICS-Rx adherence might have some significant impact with a substantial ROI, but this will need to be rigorously examined in interventional comparative effectiveness research trials. If ROI does indeed drive the dollar level of investment that managed care organizations or state Medicaid programs are willing to invest in outcomes improvement, then a small targeted investment focused on improving adherence might be more likely to show a cost-effective impact on outcomes than if the same dollars were spent on more diffuse efforts. Our analyses provide some benchmarks for gauging a reasonable level of investment in asthma outcomes improvement interventions for managed care organizations or state Medicaid programs seeking to find the synergies between preventing adverse outcomes and achieving cost control or cost reductions.

Finding effective interventions is a major challenge, but the outcomes of this study provide the foundation of a business case to be made for state Medicaid programs and their contracting managed care organizations to take 2 actions simultaneously: 1) use Medicaid claims data as a public health surveillance system or population health management data feedback loop, which provides both adverse outcome sentinel event surveillance (ED visits), as well as actionable information on a highly relevant patient behavior (long-term controller medication refills); 2) invest a reasonable amount of money (as defined by the ROI demonstrated in this analysis) to improve self-management behaviors among children with asthma, with a specific focus on ICS-Rx medication adherence.

CONCLUSIONS

If effective large-scale interventions can be found, there may be substantial cost savings to be gained from increasing real-world adherence to ICS-Rx among Medicaid-enrolled children with asthma. The potential costeffectiveness of interventions and potential ROI can be measured against these cost projections.

Author Affiliations: National Center for Primary Care (GR, SZ, LC), Department of Family Medicine (GR), and Department of Community Health & Preventive Medicine (SZ), Morehouse School of Medicine, Atlanta, GA; Division of Preventive Medicine, University of Alabama (MP), Birmingham, AL.

Source of Funding: This work was produced with support from Agency for Healthcare Research and Quality (AHRQ) grant numbers 1K18HS022444 and R24HS019470; DHHS Office of Minority Health grant number MPCMP121069; and National Institute of Health/National Institute on Minority Health and Health Disparities grant numbers U54MD008173 and 3U54MD007588.

Author Disclosures: Dr Rust received a cancer health equity research grant through Morehouse School of Medicine from Amgen Foundation. Dr Zhang reports no conflicts of interest.

Authorship Information: Concept and design (GR, SZ); acquisition of data (GR, SZ); analysis and interpretation of data (SZ); drafting of the manuscript (GR, SZ); critical revision of the manuscript for important intellectual content (GR); statistical analysis (SZ); provision of patients or study materials (); obtaining funding (GR); administrative, technical, or logistic support (GR); and supervision (GR).

Address correspondence to: George Rust, MD, MPH, FAAFP, FACPM, National Center for Primary Care, Morehouse School of Medicine, 720 Westview Dr, Atlanta, GA 30310. E-mail: GRust@msm.edu.
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