title: Something new in the air: Paying for community-based environmental approaches to asthma prevention and control.
abstract: Despite the recommendation in national asthma guidelines to target indoor environmental exposures, most insurers generally have not covered the outreach, education, environmental assessments, or durable goods integral to home environmental interventions. However, emerging payment approaches offer new potential for coverage of home-based environmental intervention costs. These opportunities are becoming available as public and private insurers shift reimbursement to reward better health outcomes, and their key characteristic is a focus on the value rather than the volume of services. These new payment models for environmental interventions can be divided into 2 categories: enhanced fee-for-service reimbursement and set payments per patient that cover asthma-related costs. Several pilot programs across the United States are underway, and as they prove their value and as payment increasingly becomes aligned with better outcomes at lower cost, these efforts should have a bright future. Physicians should be aware that these new possibilities are emerging for payment of the goods and services needed for indoor environmental interventions for their patients with asthma.
authors.affiliation: Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Tschudy
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
authors.forename: Joshua
authors.initials: J
authors.lastname: Sharfstein
authors.affiliation: Division of Pediatric Allergy/Immunology, Johns Hopkins School of Medicine, Baltimore, Md. Electronic address: ematsui@jhmi.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Matsui
authors.affiliation: Allergy/Immunology Division, Children's Mercy, Hospital, Kansas City, Mo.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Barnes
authors.affiliation: Asthma Regional Council of New England, Health Resources in Action, Boston, Mass.
authors.forename: Stacey
authors.initials: S
authors.lastname: Chacker
authors.affiliation: Allergen Science & Consulting, Lenoir, NC.
authors.forename: Rosa
authors.initials: R
authors.lastname: Codina
authors.affiliation: Jefferson University, Philadelphia, Pa.
authors.forename: John R
authors.initials: JR
authors.lastname: Cohn
authors.affiliation: Pediatrics and Public Health, Boston University, National Center For Medical-Legal Partnership, Boston, Mass.
authors.forename: Megan
authors.initials: M
authors.lastname: Sandel
authors.affiliation: Washington University School of Medicine, St Louis, Mo.
authors.forename: H James
authors.initials: HJ
authors.lastname: Wedner
mesh_terms: D000485:Allergens / Q000009:adverse effects / Q000276:immunology; D001249:Asthma / Q000453:epidemiology* / Q000517:prevention & control; D003256:Community Participation; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care; D061345:Early Medical Intervention / Q000191:economics*; D004781:Environmental Exposure / Q000009:adverse effects; D006801:Humans; D010353:Patient Education as Topic / Q000191:economics; D012051:Reimbursement Mechanisms; D016540:Smoking Cessation / Q000191:economics; D014481:United States / Q000453:epidemiology
chemical_list: D000485:Allergens
keywords: Asthma; environmental interventions; health care payment