Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
J Allergy Clin Immunol. 2017 Nov;140(5):1244-1249. doi: 10.1016/j.jaci.2016.12.975. Epub 2017 Feb 10.
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.
尽管国家哮喘指南建议针对室内环境暴露进行目标治疗，但大多数保险公司通常并未涵盖外展、教育、环境评估或家庭环境干预所需的耐用商品。然而，新兴的支付方式为涵盖家庭环境干预费用提供了新的潜在可能性。随着公共和私人保险公司将报销转向奖励更好的健康结果，这些机会正在出现，其主要特点是关注服务的价值而不是数量。这些用于环境干预的新的支付模式可以分为 2 类：增强的按服务收费报销和按每位患者支付的固定费用，涵盖与哮喘相关的费用。美国各地正在开展几个试点项目，随着这些项目证明其价值，并且随着支付越来越与低成本的更好结果保持一致，这些努力应该有一个光明的未来。医生应该意识到，这些新的可能性正在出现，用于支付其哮喘患者所需的室内环境干预的商品和服务的费用。
