CHRONIC CARE: Healthfirst teams up with AIRnyc to reduce hospital admissions and increase asthma control

The Challenge: People of color in New York City disproportionately suffer from asthma and other chronic diseases. Black and Hispanic New Yorkers are more than twice as likely as other New Yorkers to use emergency care for asthma. (Source) Their conditions are exacerbated by housing instability, food insecurity, unemployment, health inequity, and a lack of access to healthcare services.

Our Goal: To reduce hospital admissions and increase asthma control among members with asthma through community partnerships.

The Healthfirst Solution: We leveraged our membership claims data to identify people of color who would benefit from partnership with AIRnyc. Through this partnership, Community Health Workers met selected individuals to discuss and support ways to improve health. This ranged from acquiring medical supplies to pest management services and making connections to social care. The program consisted of more than six outreach calls, home visits with a needs assessment, outbound referrals, and continued engagement based on member risk profile.

Population Health Improvements: 

  • 32% increase in asthma medication ratio adherence among enrolled members
  • 43% decrease in ER admissions
  • 46% decrease in medical/surgical visits
  • 20% increase in PCP visits

Takeaway: The partnership between AIRnyc and Healthfirst indicates that home visits and ongoing engagement are critical to address health outcomes impacted by nonclinical factors in the neighborhood and at home. The success of this program has led to expansion to more members at risk of developing asthma and other respiratory conditions.