Partners for Better Health 2005: Partners for Better Health 2005: One HMO’s Approach to Tobacco ControlOne HMO’s Approach to Tobacco Control

Dr. Gail Amundson, M.D., F.A.C.P.Dr. Gail Amundson, M.D., F.A.C.P.Associate Medical DirectorAssociate Medical Director

HealthPartners, Inc.HealthPartners, Inc.Minneapolis, MinnesotaMinneapolis, Minnesota

Learning ObjectivesLearning Objectives

Describe the Partners for Better Health Describe the Partners for Better Health (PBH)2005 Tobacco Control Goal, Objectives and (PBH)2005 Tobacco Control Goal, Objectives and StrategiesStrategies

Learn about successes/challenges in Learn about successes/challenges in developing a health plan wide tobacco control developing a health plan wide tobacco control agendaagenda

Learn about how to work with health plans on Learn about how to work with health plans on this issuethis issue

HealthPartners OverviewHealthPartners Overview Non-Profit, Consumer DrivenNon-Profit, Consumer Driven

680,000 Members680,000 Members

Mixed Model HMOMixed Model HMO HPMG and HPDG ClinicsHPMG and HPDG Clinics Regions Hospital/Contracted HospitalsRegions Hospital/Contracted Hospitals Contracted medical and dental groupsContracted medical and dental groups

Range of insurance productsRange of insurance products

Partners for Better Health (PBH) 2005Partners for Better Health (PBH) 2005

PBH 2005

DiabetesHeart Health

PhysicalActivity

Tobacco Control

HealthyEating

Depression

PBH 2005PBH 2005Tobacco Control GoalTobacco Control Goal

Reduce the prevalence of tobacco use and Reduce the prevalence of tobacco use and

reduce childhood and adolescent exposure to reduce childhood and adolescent exposure to

tobacco among HealthPartners members and tobacco among HealthPartners members and

patientspatients

PBH 2005PBH 2005Tobacco Control ObjectivesTobacco Control Objectives

Reduce prevalence of tobacco use among Reduce prevalence of tobacco use among adults, age 18 years of age and older, from 25% adults, age 18 years of age and older, from 25% to 15%to 15%

Reduce the prevalence of tobacco use among Reduce the prevalence of tobacco use among adolescents, 13-17 years of age, to 15% and adolescents, 13-17 years of age, to 15% and secondhand smoke exposure to 12%secondhand smoke exposure to 12%

Reduce secondhand smoke exposure among Reduce secondhand smoke exposure among children, birth through 12 years from 24% to children, birth through 12 years from 24% to 12%12%

PBH 2005 PBH 2005 Tobacco Control StrategiesTobacco Control Strategies

Identified comprehensive tobacco Identified comprehensive tobacco control strategies:control strategies:

Tobacco cessationTobacco cessation Tobacco preventionTobacco prevention Public policyPublic policy System wide integration (5As)System wide integration (5As)

PBH 2005PBH 2005Tobacco Control StrategiesTobacco Control Strategies

Care Delivery/Health PlanCare Delivery/Health Plan Outcomes Recognition Program (primary Outcomes Recognition Program (primary

care/specialty)care/specialty) System-wide integration (5As) - case System-wide integration (5As) - case

management, hospitals, OB/GYN, dental, management, hospitals, OB/GYN, dental, specialty care-Ortho, ENT, Cardiospecialty care-Ortho, ENT, Cardio

Performance DataPerformance Data Corporate, Regions and clinics-tobacco free Corporate, Regions and clinics-tobacco free

grounds policygrounds policy

PBH 2005 PBH 2005 Tobacco Control StrategiesTobacco Control Strategies

Employer GroupsEmployer Groups

Increase employers knowledge/use of Increase employers knowledge/use of our tobacco product benefit our tobacco product benefit

Increase worksites with tobacco free Increase worksites with tobacco free policies and cessation referral policies and cessation referral

PBH 2005PBH 2005Tobacco Control StrategiesTobacco Control Strategies

Community(in partnership):Community(in partnership):

Increase the cigarette excise tax ($1.00)Increase the cigarette excise tax ($1.00) Support local and state clean indoor air Support local and state clean indoor air

lawslaws Keep the tobacco endowment intactKeep the tobacco endowment intact

Success and ChallengesSuccess and Challenges

SuccessesSuccesses

Health plan wide initiativeHealth plan wide initiative Top management supportTop management support Willing to step “out of the box” (policy)Willing to step “out of the box” (policy) Leveraging other goal areasLeveraging other goal areas Collaboration (internal/external)Collaboration (internal/external)

Successes and ChallengesSuccesses and Challenges

ChallengesChallenges

ResourcesResources

Keeping the PBH 2005 Agenda visibleKeeping the PBH 2005 Agenda visible

Engaging other departments who Engaging other departments who have not focused on this issuehave not focused on this issue

Tobacco Use as a Vital SignTobacco Use as a Vital Sign

38,30038,300 have quit have quit smoking since 1997smoking since 1997

158,000158,000 more asked more asked about tobacco useabout tobacco use

43,70043,700 provided provided assistance to quit in assistance to quit in 2001.2001.

Adult prevalence Adult prevalence nownow 17.9% 17.9%

N=497,127N=497,127

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

AskAssistTobacco Prevalence

Tobacco Exposure:A Pediatric Vital Tobacco Exposure:A Pediatric Vital SignSign

0%10%20%30%40%50%60%70%80%

1997 1998 1999 2000 2001

2nd Hand Smoke ExposureCounseling

22ndnd Hand smoke puts Hand smoke puts children at riskchildren at risk

For every 1000 For every 1000 children children 9090 fewer fewer exposed in 2001 exposed in 2001

138138 of every 1000 of every 1000 still exposed to 2still exposed to 2ndnd hand tobaccohand tobacco

9999 avoiding 2 avoiding 2ndnd hand hand smoke discussedsmoke discussed

Working with Health PlansWorking with Health Plans

Health plans are important partnersHealth plans are important partners Identify key championsIdentify key champions Find out what health plans are doingFind out what health plans are doing

Tobacco product benefit?Tobacco product benefit? Cessation programming?Cessation programming? Provide appropriate incentives?Provide appropriate incentives? Delivery system assessed?Delivery system assessed?