tobacco cessation, why it maters for employers

8/8/2019 Tobacco Cessation, Why It Maters for Employers

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Tobacco Cessation:Why it Matters for Employers

Briefing to the Tobacco Free Hospital Forum

August 26, 2009

Claire v.S. Brockbank, Segue Consulting, STEPP consultant


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Tobacco Cessation & SustainabilityPartnership

Multidisciplinary group convened by Colorado Department of Public

Health and Environment (CDPHE) Employers/purchasers, private and public health insurers, physicians, public health,

advocates

Encourage private and public health plans to provide comprehensiveand effective tobacco cessation benefits.

Identify opportunities to increase sustainability for cessation services,including the Colorado QuitLine.

Focus on collaboration and education as mechanisms to promotechange.


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Todays Objectives

Educate the Forum about the impact of tobacco on employee

health care costs

Present benefit coverage recommendations

Identify cost impact of reducing the toll of tobacco onemployers


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Economic Impact of Tobacco on Employers Health care resources

Higher average insurance payments ($1145 v $762)

Tobacco users cost company pharmaceutical plans 2x as much

Smokers are 50% more likely to be hospitalized (800 v 381 days/1000)

Over a lifetime women smokers incur $21,500 and men $19,400 more inmedical expenses

Absenteeism

Smokers average 2 additional sick days a year compared to nonsmokers Productivity

On average smokers spend up to 8% of a workday on smoking-relatedactivities, which equals 4 weeks of paid lost time a year.


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Tobacco cessation costs employers, tobacco use costemployers much more

Paying for an employees tobacco cessation treatment provides more

return on investment than any other adult treatment or preventionbenefit. National Business Group on Health

Smoking cigarettes is the single most important determinant ofhealth, and thus, the single greatest driver of healthcare costs.

Tobacco cessation treatments are more cost effective than highblood pressure and high cholesterol treatment and routine cancerscreenings (i.e. mammography, pap exams). Partnership for Prevention


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Current Coverage: Private Payers

Preventive ServicesCoverage

SmallEmployer 10- 199

MediumEmployer200 - 999

LargeEmployer1,000+

Priority Ranking forImpact & Value

Tobacco Cessation 4% 4% 2% Highest

Alcohol Screen 21% 22% 19% High

Mammogram 88% 91% 95% Medium

Colorectal Screen 73% 78% 79% High

Pap exam 85% 90% 92% Medium


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Current Coverage: Public Payers

Historically poor but seeing a new commitment Medicaid

State as employer

Federal


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Colorado Health Plan Coverage

Health planscoverage of and

support fortobaccocessation haslots of room forimprovement

eValue8 data provided by theColorado Business Group on

Health

and the National Business Coalitionon Health


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Scope of Health Plan Services (12/07) United PPO reports 0.3% of its members are identified as tobacco

dependent and 3.5% of those 0.3% participate in smoking cessationprogram.

Cigna HMO/PPO reports 0.04% of its members participate insmoking cessation program.

Anthem HMO/PPO doesnt track participation rates but reports 1,743participants (~ 0.4%).

Kaiser reports 0.5% of members participate in smoking cessationprogram.

eValue8 data provided by the Colorado Business Group on Health

and the National Business Coalition on Health


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Why Coverage is so Poor

Public health historically has mitigated the need for private

investmentQuitLine

Tobacco tax funding

Knowledge gaps

Lack of awareness

Employers perception about effectiveness

Health plans assumed a 5-7 year ROI


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Coverage Recommendations

Counseling Offered but not required, multiple courses/year

Pharmacotherapy All FDA-approved, counseling not a prerequisite, at least 2 courses of Rx per

year

Frequency At least 2 quit attempts/year, no lifetime limits

Out-of-pocket At least 1 course of Rx per quit attempt is free, minimal out-of-pocket expense

for other coverage


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H.B. 1204

Mandates coverage of all U.S. Preventive Services

Task Force A & B recommendations Tobacco use screening of adults and tobacco cessation

interventions by primary care providers

Effective January 1, 2010

Regulatory interpretation appears to track with tobaccoguideline comprehensive coverage


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Tobacco Cessation Works

70% of smokers say they want to quit, 40% of smokers attempt to quit

Quitting tobacco is difficult but absolutely feasible if assistance isprovided

Quit rates with willpower alone 4%

Pharmacotherapy (NRT) alone 22%

Colorado QuitLine coaching plus NRT = 36%

Chantix 44% Smokers are more than twice as likely to quit with coverage


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Tobacco is cost effective for healthplans

The PMPM cost for a comprehensive smoking cessationbenefit ranges from $0.02 to $0.45 Milliman Consultants &Actuaries, 2006

AHIP ROI calculator shows a positive impact for Statescontracted health plans during Year Two in terms of cashoutlay. Few other benefits can make that claim.


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State of CO ROI per participant for Years 1 - 5for each intervention


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Health Plan Net ROI per member per month forYears 1 - 5 for each intervention


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TCSP Resources for Employer Efforts

RFP Process Summary Plan Description Language

RFP questions developed specific to tobacco coverage

ROI calculation for benefit options

Enrollment Process Employer and employee resources

QuitLine

www.cohealthproviders.com


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QuitLine Opportunities

ID savings opportunities from working with QL topurchase NRT on behalf of employees and theirhealth plans

Use Ohio as a model and in partnership withQuitLine, develop an employer and health planshared tobacco program


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Questions?

Claire v.S. Brockbank

[email protected]

303-316-2655

tobacco cessation, why it maters for employers

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