The initiative seeks to drastically reduce asthma hospitalizations for low-income children and demonstrate the cost savings to healthcare of investment in housing improvements.

In New York City, households with cockroaches are 50 percent more likely to have someone diagnosed with asthma compared to the general population, and those with mice are twice as likely. 1 While local law requires many New York City property owners to carry out pest control in the homes of people with asthma, landlords ultimately have little incentive to do so comprehensively.

Meanwhile, medical insurers have a strong financial incentive to mitigate asthma hospitalizations, but they have rarely paid for housing-related interventions like pest management because of an understandable reluctance to invest in an unfamiliar sector.

To bridge this disconnect and to demonstrate that healthcare investment in housing improvements can sustainably generate financial benefits to insurers, Enterprise and the New York City Department of Health and Mental Hygiene (DOHMH) launched a groundbreaking new initiative: the Medicaid Together Improving Asthma Program, in partnership with five Medicaid health plans and multiple New York City hospitals.

The program challenges the healthcare sector to invest in asthma-focused housing improvements, specifically Integrated Pest Management with Allergy Reduction (IPM-AR), which is expected to decrease asthma hospitalizations among low-income children.

Landlords are responsible for the home improvements of tenants, and both the healthcare sector and residents benefit from healthier housing environments. The Medicaid Together Improving Asthma Program acknowledges the benefit of healthy housing by creating a platform for the health insurance sector to invest in the reduction of asthma triggers without removing full responsibility from landlords. Five Medicaid managed care organizations (MCOs) – Empire Blue Cross Blue Shield HealthPlus, EmblemHealth, Fidelis Care, Healthfirst and MetroPlusHealth – are participating in the program and together insure 87 percent of the children on Medicaid in New York City. 2

A system that benefits patients and managed care organizations

IPM-AR is a proven intervention that removes existing pest allergens from the home and improves the home’s structural and sanitary conditions to deny pests food, water, harborage and movement, decreasing asthma symptoms among children without the side effects of traditional pest control. By addressing the underlying causes of asthma exacerbation, IPM-AR has the potential to generate healthier New Yorkers with fewer asthma exacerbations and health care cost savings for insurers and healthcare providers, who are at full risk for asthma-related healthcare costs.

While there is public health consensus that IPM-AR is likely to yield a financial return, we are committing a $1.2 million guarantee fund to mitigate the perceived risk of using healthcare dollars to pay for a treatment that is not established as an insurance benefit, and to make this treatment available across health plans. This funding serves as a profitability guarantee for the five MCOs participating in the Medicaid Together program. If insurers don’t realize the reductions in hospital use projected to result from IPM-AR interventions, they will be eligible to recoup all or part of their costs through the guarantee fund.

The program was launched to demonstrate that by investing in IPM-AR services, insurers will financially benefit through reductions in asthma hospitalizations. If successful, we expect that this kind of upstream housing intervention will be a model for future healthcare investments.

Another innovative component of the program involves the pooling of funding among five different private Medicaid insurers. All five organizations are funding the effort based on their respective share of members and a single centralized non-profit point of contact is coordinating the IPM services to individual households.

With the Affordable Care Act’s push towards payments that incentivize patient health outcomes over healthcare procedures, the healthcare sector has begun to look at investing in social determinants of health through direct interventions that lead to improved healthcare outcomes while lowering cost of care. The Medicaid Together Improving Asthma program supports this movement and incentivizes private investment by MCOs in the public good.

We thank the New York City Health Department for their partnership in this critical endeavor and we look forward to reporting on progress made in the program.

1 New York City Housing and Vacancy Survey (2002)
2New York State Medicaid managed care enrollment as of December 2021