This overview of the state of New Hampshire’s progress in building and sustaining systems to support access to asthma home visiting services is a part of a series of success stories developed by RAMP and the National Center for Healthy Housing. Others are featured in Sustainable Financing for Home-Based Asthma Services: Snapshots of Innovation and Progress Across the Country.
When considering the best way to increase access to home-based asthma services, the New Hampshire Department of Health and Human Services (DHHS)’ Asthma Control Program began by assessing the needs and existing assets of communities across the state. Recognizing New Hampshire’s leadership in mobile integrated healthcare (MIH), a model that partners emergency medical services (EMS) professionals with healthcare providers and community organizations to deliver non-emergency care beyond traditional 911 responses, the team identified MIH as a key avenue to explore.
Education about managing asthma, identifying triggers, and using medications correctly can help prevent many asthma-related health crises and emergency calls. MIH allows this education to take place in the home, which leads to more personalized instruction that addresses specific triggers and circumstances in a patient’s daily environment. MIH also provides an opportunity for EMS staff to identify and address other, non-asthma-related needs that may contribute to poor health.
The DHHS Asthma Control Program understood that New Hampshire EMS personnel—including first responders, EMTs, advanced EMTs, and paramedics—were well positioned to follow up with patients for educational visits once an emergency is resolved. They already enter homes during 911 calls and have rapport with patients, making them trusted community figures. Unlike many healthcare providers constrained by short appointment times, EMS staff can be more flexible, delivering home visits that are tailored to each patient’s individual needs. Bringing care directly to patients’ homes and communities is particularly effective in New Hampshire, where residents are widely dispersed and the availability of transportation can impact a person’s access to care. EMS personnel are also prepared to provide education about asthma alongside other health conditions, which is a critical advantage considering many New Hampshire residents with asthma have other chronic conditions.
Many EMS professionals are eager to provide these types of services. One EMS provider explained, “This gives me a chance to really help people by connecting them to healthcare and social services to address the underlying need,” instead of repeatedly responding to the same types of emergencies.
To make this approach work, DHHS Asthma Control Program staff created standard implementation elements while allowing each community to adapt other aspects to fit their needs. With funding from the National Asthma Control Program, the DHHS team supported three MIH programs in rural, northern New Hampshire. They provided standard asthma trainings, home assessment tools, and recommended practices/procedures all while encouraging local programs to use their own strengths. In one community, for instance, the EMS agency leader serves as the town clerk and leveraged her connections to establish referral systems that helped launch their asthma services. The DHHS Asthma Control Program’s Paula Holigan explained, “No one size fits all. There are certain practices you can replicate, but other dimensions of the program need to be flexible.”
To sustain these accomplishments, the DHHS Asthma Control Program staff facilitated discussions between one MIH provider and one Medicaid managed care organization to develop a pilot project. This collaborative effort, currently in the developmental stages, will serve as a proof-of-concept designed to demonstrate the program’s value and encourage broader adoption.
This strategy builds on existing relationships developed through the statewide Asthma Learning Collaborative, led by the DHHS Asthma Control Program, which includes representatives from each of the state’s three MCOs. As LuAnn Speikers of the DHHS Asthma Control Program explained, “This is going to save money. And it’s going to save people from going back to the emergency department, in some cases, multiple times.”
Key Lessons from New Hampshire
- Leverage existing infrastructure; build on what’s already working rather than creating entirely new systems and use established partnerships/collaborative structures to facilitate program expansion.
- Tailor approaches to individual community characteristics and strive to address multiple health and social needs simultaneously.
- Balance standardization with local flexibility; provide core standardized elements (training, tools, procedures) and allow for local adaptation. One size does not fit all.
- Create strategic pilot projects; develop proof-of-concept demonstrations that encourage broader adoption by other stakeholders.
RAMP and NCHH thank the New Hampshire Asthma Control Program at the New Hampshire Department of Health and Human Services for contributing to the development of this excerpt.
The information shared here and in the complete document reflects the work of the various programs, as reported to us by the partners listed throughout. This product aims to amplify the dedicated efforts of these programs and their partners; all descriptions of the work of the highlighted program/community are based on the information provided.
Contact NCHH at askanexpert@nchh.org or RAMP at TA@rampasthma.org with any potential corrections. We are committed to ensuring that the work is presented transparently. The final determination of content accuracy and representation will be made by the highlighted program/community.