How Oregon’s response to wildfire smoke could improve health outcomes

When Canadian wildfire smoke flooded the East Coast and the Midwest in June and caused poor air quality, it sparked headlines and health concerns as officials—who were largely unaccustomed to dealing with the rare haze—were forced to quickly revamp their public health playbooks.

But on the West Coast, where large and deadly wildfires have become an all-too-common occurrence in recent years, public health officials are well versed in dealing with the crisis. Some states, like Oregon, have even taken steps—with the help of new technology—to ensure that residents most at risk for smoke-related health conditions are not subjected to poor air quality.

“Oregon is very on the forefront,” Robin Traver, VP of clinical operations for Umpqua Health, which operates one of 15 coordinated care organizations that serve Oregon Health Plan members, told Healthcare Brew. “It’s really based on what we know: The correlation between those social determinants of health, your environment, and the impact [of these two factors] on health.”

That proactive approach could be adopted by other jurisdictions as wildfire smoke and other climate-related emergencies threaten to exacerbate existing public health disparities, she said.

Oregon lawmakers approved legislation in 2022 to help communities prepare for extreme weather and wildfires, including $5 million to help offset the costs of purchasing, installing, or improving air filtration systems. The air filtration device distribution part of the program, which began in June 2023, will distribute about 4,700 devices to residents most at risk for health issues due to wildfire smoke.

But first officials had to identify the residents with respiratory or cardiac conditions, like asthma and heart disease, which can worsen due to smoke and poor air quality. The program prioritized distribution of the devices to residents ages 65+, medically fragile children, and those with disabilities or health conditions that make them vulnerable to wildfire smoke, including diabetes, hypertension, and obesity.

“Historically, this would have been a pretty daunting task,” Traver said.

Umpqua, which received slightly more than 400 air purifiers, had to decide who among its 40,000 Medicaid beneficiaries in Oregon’s Douglas County met the criteria to get one of the units.

The organization contracted with healthcare data analytics company Arcadia to comb through indicators like patient claims and health equity and demographic data to narrow down the list of Medicaid recipients who were most at risk for smoke-related illnesses.

“Once we had the list from Arcadia, we went through, one by one, the first probably 50 people on the list and tried to validate and make sure, ‘Are these really the riskiest people?’” Traver said. “We pulled up their charts and saw, ‘Oh, yes, this person has been in and out of the hospital for [chronic obstructive pulmonary disease] or emphysema.’ That gave us peace of mind that this is a valid tool; these are the people that we need to reach out to.”

As of June 8, the Medicaid manager had already distributed nearly all of the 400+ air purifiers (and filters) to members. Traver noted that Umpqua was only unable to reach about 150 of those deemed eligible for the devices, and almost everyone it reached accepted an air purifier.

Those interactions allowed Umpqua’s care coordinators and community health workers to take stock of other factors that may be influencing a member’s health—like if they had housing or nutrition-related needs—and connect them with services, Traver said. She estimated that Umpqua enrolled about 10%–15% of those members in care management programs because of the intervention.

The company will now track those patients’ outcomes over the coming months to see whether the devices (and case management) led to fewer emergency department visits or declines in inhaler use, among other things.

Mary Kuchenbrod, VP of data operations at Arcadia, said the Oregon program underscores how data analytics can improve healthcare.

“We have immense amounts of data that we don’t use effectively in healthcare: A single hospital produces 50 petabytes of data every year, but as much as 97% of that is going unused,” she said. “There’s immense potential that we’re beginning to tap into as an industry to make sure that data is collected, aggregated, and also analyzed and surfaced in a way that makes it really useful for setting the right actions.”