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By Yen Duong

Dozens of children in bright blue t-shirts roared and bounced across the bleachers. Meanwhile, a handful of breakdancers somersaulted across the gym floor and froze in gravity-defying holds.

A minute later, the purpose of the last week’s rally in Charlotte became clear when a rapper yelled “We’re getting asthma under con….” and the school-age children screamed “troll!”

Managed care health insurance company AmeriHealth Caritas partnered with the American Lung Association to sponsor three free health education events last week in Elizabeth City, Charlotte and Raleigh. Charlotte’s program, held at the Marsh Road Salvation Army Boys & Girls Club, included a basketball clinic, health screenings, asthma education for children and parents, and a hot dinner. A handful of coaches and the Johnson C. Smith women’s basketball team ran drills with 96 attendees.

“We want to shatter the myth that if a child has asthma he cannot be involved in active sports or physical activity,” said health educator Glenn Ellis, who taught parents at the Charlotte event. “Nothing can be farther from the truth; we want them to do physical activity to strengthen their lungs. We can use Healthy Hoops as a way to do all of the above.

All about asthma

People with asthma, a lung disease, can find it hard to breathe and wheeze and cough uncontrollably when exposed to triggers. As of 2016, 8.3 percent of Americans have asthma, according to the Centers for Disease Control and Prevention website, but the proportion goes up for 5 to 19 year-olds: one in 10 school-age kids have asthma.

North Carolina tied for 12th place as the lowest percentage of people with asthma, but that still left 633,683 in the state struggling to breathe.

Common asthma triggers according to the CDC:

  •       tobacco smoke
  •       dust mites (miniscule insect-like creatures that live off of dead skin flakes)
  •       outdoor air pollution
  •       cockroaches
  •       pets
  •       mold
  •       smoke from burning wood or grass
  •       flu/viruses/colds
“Research has shown that as much as 82 percent of health outcomes are determined outside a clinical setting,” said Ellis, noting that many other contributors to disease get overlooked by health professionals.

These so-called “social determinants of health” include holding steady employment and income, living in adequate housing, having transportation, access to healthy food, and strong social networks. These and many other factors contribute to health outcomes such as asthma, diabetes and obesity, Ellis said, but education can help battle negative influences.

‘Introducing ourselves’

Event sponsor AmeriHealth Caritas is currently preparing a bid for one of the statewide contracts to manage care for North Carolina Medicaid recipients, spokesperson Robert Cooper said in an interview.

The company, based in Pennsylvania, runs Medicaid health plans in seven states. It also manages pharmacy benefits, not just for Medicaid recipients, in eight more states, including for some patients in North Carolina. According to the Medicaid Enrollment page run by the Kaiser Family Foundation, AmeriHealth Caritas manages care for at least 1.5 million Medicaid recipients nationwide.

In August, the state Department of Health and Human Services put out a call for proposals for companies who want to manage patients on Medicaid, the federally mandated health care program for low-income children, people with disabilities and seniors.

Once DHHS reviews the proposals, companies could start actively managing care of Medicaid recipients by late 2019. In theory, Medicaid recipients will be able choose between four statewide organizations and local provider-run organizations. But in other states with managed care companies, over half of recipients were auto-enrolled in a program without making their own choices.

“We’re working with providers and with the community introducing ourselves. We really want to give an opportunity for North Carolina to get to know who AmeriHealth Caritas is,” Cooper said. “Healthy Hoops is a program that we utilize to get into the community to create these partnerships.”

At the event, AmeriHealth Caritas also presented a giant $10,000 check to the Boys & Girls Club.

“We, quite frankly, cannot manage community care without stakeholders,” Cooper said. “I like to say that we’re the link between the community, us as a health plan, the providers and the community stakeholders.”

Teaching disease management

AmeriHealth Caritas has sponsored Healthy Hoops in nine states over the past 16 years. The one-day events sometimes include workshops for nurses and coaches in addition to the health screenings, basketball clinic and caregiver education programs.

Tips to control your asthma, from the CDC:
  • You can download a CDC Asthma Pamphlet by clicking here.

    Identify triggers with the help of a doctor.

  • Form an Asthma Action Plan with a doctor.
  • Avoid secondhand smoke—ask friends and relatives to smoke away from the asthma patient.
  • Wash and dry bedding once a week. Throw in stuffed animals too.
  • Vacuum carpets and furniture. Minimize exposure to pet hair.
  • Repair water leaks. Use air conditioning or a dehumidifier to fight mold.
“In Pennsylvania, we had a number of people that were part of our health plan that had asthma and they didn’t really understand how to manage the disease and would go to the emergency room,” said the company’s spokesperson Tom Lyman. “So we tried to come up with a concept where we could educate them.

“In the South, especially where we’ve done events like this in South Carolina and Louisiana, mold is a problem all the time. You’ve got the spores that trigger the asthma attacks, and that triggered emergency room [visits],” he explained.

A lot of the education has to do with simple cleaning techniques.

“Even if you clean the floors, a lot of people don’t clean their blinds. It’s simple concept and it’s why one of the social determinants of health is housing.”

Parents hold the keys to their children’s’ social determinants of health. Shanice Moore, who lingered for pickup after her shift as a home health nurse, watched with her 4-year-old while her 11-year-old daughter cheered a rapping educational performance.

“They’re our future, they really want to know,” Moore said. “This is very good for them.”

Much of the program actually targets moms like Moore.

While children play basketball and learn about health during the after-school portion of the program, parents can also attend a free class before meeting with the kids for dinner.

“There’s a disconnect between how people think their asthma is controlled and what’s true,” said asthma educator Maureen George, a medical consultant for Healthy Hoops who attended the Elizabeth City event.

“Parents tolerate too many symptoms in their kids, thinking that because they have asthma, of course they’re waking up at night, coughing for hours and need to stop playing ball before everybody else.”

George said she works to “redirect” parents’ goals and help them develop more accurate expectations of what kids can do if their asthma is controlled.

Kids from the Charlotte Salvation Army Boys & Girls Club watch as a member of Rapping About Prevention describes how smoking turns teeth yellow during the Healthy Hoops event on Sept. 27. Photo Credit: Yen Duong.

“Asthma control means the kid is competitive in sports and not taking a break, that they’re free of symptoms and not needing to rely on rescue medicine,” she said. “Then [parents] have the beginning skills to apply that information more broadly across the entire family.”

Asthma is a chronic disease which may be inherited, George said. One person with poorly managed asthma can affect the health of every other member of their family.

“Parents… are the ones who are the managers of their children’s care,” said Cooper. “We want to make sure they leave here with as much information on metabolism, obesity and proper nutrition as possible.”

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Yen Duong

Yen Duong covers health care in Charlotte and the southern Piedmont for North Carolina Health News.