Tobacco Cessation Coverage in X State Presentation Objectives Demonstrate the problem of tobacco use and gaps in cessation treatment for State employees Understand the costs of tobacco use ID: 787987
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Slide1
“Name” QuitlinE
Partnering to Improve
Tobacco Cessation Coverage in “X State”
Slide2Presentation Objectives
Demonstrate the problem of tobacco use and gaps in cessation treatment for State employees.
Understand
the costs of tobacco use
.
Demonstrate cost-effectiveness of
tobacco cessation
coverage.
Clarify
the ACA requirements for tobacco
coverage for insurers.
Share
the benefits
and options for partnering
with the
“State
Quitline
”.
Identify opportunities for collaboration to expand cessation coverage and treatment statewide.
Slide3Accelerating the National Movement to Reduce Tobacco Use
P
rovide
access to barrier-free proven tobacco use cessation treatment including counseling and medication to all smokers, especially those with significant mental and physical
comorbidities.
Expand
smoking cessation for all smokers in primary
and
specialty care settings by having health care providers and systems examine how they can establish a strong standard of care
for
effective
treatments.
U.S
. Department of Health and Human Services.
The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General.
Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
Slide4Tobacco Dependency in “State”
Slide5“
State”Tobacco
Users Want to Quit
(and need help)
“% of State”
tobacco users made a serious but failed attempt to quit smoking in
“ insert year”
Slide6Costs Associated with Smoking
Cost of Smoking-Related Illness
Smoking-related illness in the United States costs more than $300 billion each year,
including:
Nearly $170 billion for direct medical care for adults
1
More
than $156 billion in lost productivity,
in addition to $5.6 billion in lost productivity due to secondhand smoke exposure2
1Xu X, Bishop EE, Kennedy SM, Simpson SA, Pechacek TF. Annual Annual Healthcare Spending Attributable to Cigarette Smoking: An Update[PDF–157 KB]
. American Journal of Preventive Medicine 2014;48(3):326–33 [accessed 2015 Apr 7].
2
U.S. Department of Health and Human Services.
The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General
. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for
Chronic
Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2015 Apr 3
].
Slide7Tobacco Use Costs Employers
It is estimated
that
US businesses incur
excess costs in the range of $
5,816
per
year.
1On average, smokers miss 2.74 more days of work per year compared to non-smokers.2
The annual per smoker cost of lost productivity due to unsanctioned smoking breaks is $3,077.24.1Businesses pay an average of $2,289 in workers’ compensation costs for smokers, compared to $176 for nonsmokers.3
1
Berman
M., Crane R.,
Seiber
E.,
Munur
M. Estimating the cost of a smoking employee.
TobControl
2013; 0:1-6.
2
Weng
S.F.,Ali
S.,
Leonardi
-Bee J. Smoking and absence from work: Systematic review and meta-analysis of occupational studies.
Addiiction
2012; 108: 307-319
.
3
Musich S, Napier D,
Edington
D. The association of health risks with worker’s compensation costs.
JOEM
. 2001:43 (6):534-541.
Slide8Cessation Coverage: Benefits
Over
time, tobacco-use cessation benefits generate financial returns for employers in four ways:
Reduced health care costs
1,2
Reduced absenteeism
1,3
Increased on–the–job productivity 1,3 Reduced life insurance costs
1,3Coverage of tobacco-use cessation treatment (counseling and medications) increases the chance of a successful quit.4Cost analyses have shown that tobacco cessation benefits, from
an
employer perspective, are
cost-saving.
5
1
Warner
KE, Smith RJ, Smith DG, Fries BE. Health and economic implications of a work-site smoking-cessation program: a simulation analysis.
Journal of Occupational and Environmental Medicine
1996;38(10):981–92.
2
Wagner
EH, Curry SJ,
Grothaus
L, Saunders KW, McBride
CM. The
impact of smoking and quitting on health care use.
Archives of Internal Medicine
1995;155(16):1789 015 015–95.
3
Halpern
MT,
Shikiar
R,
Rentz
AM, Khan ZM. Impact of smoking status on workplace absenteeism and productivity.
Tobacco Control
2001;10:233–8.
4
Moehle McCallum D,
Fosson
GH,
Pisu
M. Making the case for Medicaid funding of smoking cessation treatment
programs:an
application to state-level health care savings. Journal of Health Care for the Poor and Underserved, 2014; 25(4): 1922-1940.
5
Campbell
KP,
Lanza
A, Dixon R,
Chattopadhyay
S,
Molanari
N, Finch RA, editors.
A purchaser’s guide to clinical preventive services: moving science into coverage.
Washington, DC: National Business Group on Health; 2006
.
Slide9“Paying
for an employee’s tobacco cessation treatment provides more return on investment than any other adult treatment or prevention
benefit.”
–
National Business Group on Health
Slide10Massachusetts Medicaid Program
After two and half years of offering comprehensive coverage for pharmacotherapy and counseling…
smoking rates dropped from 38% to 28%
1
hospital claims for acute heart attacks dropped by 46% and
coronary heart disease dropped by 49%
2
Medical savings to the Medicaid program of $3.12 for every $1.00 spent (ROI of $2.12)
31
Land, T, Warner, D,
Paskowsky
, M, et al. Medicaid coverage for tobacco
dependence treatments
in Massachusetts and associated decreases in smoking prevalence.
PLoSONE
2010 March;5(3): e9770
.
2
Land
, T,
Rigotti
, NA, Levy, DE, et al. A longitudinal study of Medicaid coverage
fortobacco
dependence treatments in Massachusetts and associated decreases in
hospitalizations for
cardiovascular disease.
PLoS
Med 2010 Dec;7(12): e1000375
.
3
Richard
, P, West, K, Ku, L. The return on investment of a Medicaid tobacco
cessation program
in Massachusetts.
PLoS
ONE 2012 Jan;7(1): e29665.
Slide11Return-On-Investment for an Employer
Tobacco-dependence treatment is highly cost-effective and
cost-saving.
1
The return-on-investment for tobacco cessation treatment has been shown to be positive after one year due to increases in employee productivity alone.
2
Recent studies have shown that medical cost savings within 18 months for smokers who quit compared to those who continued smoking.
3,4
Up to 70% of current smokers' excess medical care costs is preventable by quitting.5
1
Fiore
, MC, Jaen, CR, Baker, TB, et al. Treating tobacco use and dependence: 2008 update. Clinical Practice Guideline. Rockville, MD:
U.S. Department
of Health
and Human
Services. Public Health Service, 2008. Available at: www.surgeongeneral .
gov
/ tobacco/ treating_tobacco_use08 .
pdf
.
2
American Health Plan Insurance
. Making the Business Case for Tobacco Cessation.
Retrieved from
http://www.businesscaseroi.org
3
Hockenberry
, JM, Curry, SJ, Fishman, PA, et al. Healthcare costs around the time
ofsmoking
cessation. Am J
Prev
Med 2012 Jun;42(6): 596– 601.
4
Richard
, P, West, K, Ku, L. The return on investment of a Medicaid tobacco
cessationprogram
in Massachusetts.
PLoS
ONE 2012 Jan;7(1): e29665.
5
Maciosek
M., Xu X.,
Butani
A.,
Pechacek
.
Smoking-attributable medical expenditures by age, sex, and smoking status estimated using a relative risk approach.
Prev
Med
2015;
77:162-167.
Slide12Partnering with
Quitline
Makes Good Sense
Slide13ACA : Tobacco Cessation Coverage
ACA –
Since 2010, most insurers are required to provide tobacco cessation coverage
May 2014 -
Guidance issued by the U.S. Departments of Health and Human Services, Labor and Treasury stating…
To comply with ACA, cessation benefits should include:
Screening
for tobacco use.
Two quit attempts per year, consisting of:
Four sessions of telephone, individual and group cessation counseling lasting at least 10 minutes each per quit attempt; and, All medications approved by the FDA as safe and effective for smoking cessation, for 90 days per quit attempt, when prescribed by a health care provider. Cost-sharing (i.e., copays) and prior authorization for any of these treatments should not be required.
Slide14Current State Employee Benefits
Add coverage in format of ACA recommendation (previous slide
Identify gaps
For example:
Reliance
on
QuitLine
Tobacco cessation drugs not in formulary
Plans don’t include specific tobacco cessation coverage
Slide15We Know What Works
Research indicates the most effective tobacco treatment is a combination of:
evidence-based coaching and
FDA approved medications.
Quitline
is
evidence-based
Slide16Cessation Benefits
Cessation Benefits Should Include ALL of These Treatments:
MEDICATIONS
COUNSELING
Nicotine
Gum
Individual
Nicotine
Patch
Group
Nicotine
Lozenge
Phone
Nicotine Nasal Spray
Nicotine Inhaler
Bupropion
Varenicline
Barriers to Avoid:
Co-pays
Prior authorization
Duration limits
Annual limits on quit attempts
Dollar limits
Requirements to try one medication before another
Requirements to pair medications with counseling
Helps meet ACA criteria
Slide17Mechanism to Meet the Need
Quitline
helps meet ACA requirements
Quitlines: Evidence-Based and Effective
Quitlines
are telephone-based tobacco cessation services that help tobacco users quit through a variety of services,
including:
Counseling
FDA-approved medications
Information
and self-help materialsQuitlines reach many smokers, even underserved and rural populations
Quitline counseling can more than double a smoker’s chances of quitting. 1Quitline counseling combined with medication can more than triple the chances of quitting.
1
1
Fiore
MC, et al. Treating Tobacco Use and Dependence: 2008 Update – Clinical Practice Guideline, US Public Health Service, May 2008,
http://www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf
.
Slide19Quitlines: Evidence-Based and Effective
Face-to-face
counseling and interactive telephone counseling are more effective than services that only provide educational or self-help
materials.
1,2
The effectiveness of counseling services increases as their intensity (the number and length of sessions)
increases.
1
Smokers are more likely to use telephone counseling than to participate in individual or group counseling sessions.2,31
Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence: Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service; 2000.2McAfee T, Sofian N, Wilson J, Hindmarsh M. The role of tobacco intervention in population-based health care. American Journal of Preventive Medicine
1998;14:46–52.
3
McAfee T. Increasing the population impact of
quitlines
. Paper presented at the North American
Quitline
Conference, Phoenix, AZ, 2002.
Slide20Quitline Telephone Counseling
C
onvenient
More flexible than a group counseling session
Accessible regardless of location
L
ess expensive than individual face-to-face counseling
Counselors trained specifically for tobacco cessation treatment based on latest research
Slide216 Month Quit Rates Comparison
10%
Physician Advice Alone
*
(
)
% (
QuitlineName
)Counseling
**
( )%
Quitline
***
Counseling & NRT
*Fiore,
Treating Tobacco Use and Dependence, Clinical Practice Guidelines
2008 Update
** (Reference)
*** (Reference)
Quitline
is high quality and effective
Slide22“State” Quitline Services
Consists of five outbound coaching sessions and unlimited support
calls.
Special protocol and treatment sessions
for pregnant women
Highly
trained, professional
Quit Coaches
Coaching supported in multiple languages
NRT mailed directly to tobacco user’s home
Accessible
(
add state’s
quitline
hours
)
Integrated with an
interactive web
based tobacco treatment program
Online
registration
Slide23Quitline
Infrastructure: No Capitol Outlay
Financial
Benefits
Infrastructure in
place
Quit Line set-up fees are minimal (one-time $) and minimal annual maintenance fees
($).
Reporting – No charge for monthly utilization reports.Plans or Employer Groups may have their members/employees
who call warm transferred directly to the Plan’s internal program. The charge for this is $ () /warm transfer.Plans or employer groups are charged only when a service is provided compared to a pmpm
fee.
It is easy to partner with
Quitline
Slide24Quitline Infrastructure: No Capitol Outlay
Service
Benefits
Externally validated 6/7 month quit rate of XX percent for “insert state” callers.
Ability to use 1-800-QUIT-NOW which has high consumer and health care provider recognition.
Individual meetings upon request
.
High referral rates by health care providers.
Statewide quitline media campaigns and national campaigns provide free advertisement to your employees.
It is easy to partner with the Quitline
Slide25Coaching Services
For no more than $() per member, evidence-based comprehensive integrated telephone and internet coaching services will be provided.
Quitline
is very cost effective
Slide26Nicotine Replacement Therapy Costs are no more than:
Four weeks $
Eight weeks $
Four weeks $
Eight weeks $
Four weeks $
Eight weeks $
Quitline
is very cost effective
Slide27In Summary
Providing a tobacco cessation benefit for employees is cost-effective and shown to be cost-saving.
The Affordable Care Act requires insurers, including self-insured employers to provide tobacco use treatment (counseling and medication).
Quitlines
are an cost-effective resource for providing an evidence-based cessation treatment.
Quitlines
provide a wide array of services to meet an individual’s need.
Quitlines
are accessible and have excellent outcomes.
Slide28It’s Easy to Participate
Agree to contract with the
“ vendor or agency”.
Promote “
State
Quitline
” to your employees with the assistance of our professional marketing staff.
AND WE DO THE REST!
It is easy to partner with the
Quitlne
Slide29Contact Us
Add Contact Information