Let s Kick It! CO & IA Quitline Processes and Advice to Help Your Patients

Transcription

1 Let s Kick It! CO & IA Quitline Processes and Advice to Help Your Patients March 8, 2017 Speakers: Alyssa Reichelt, Hilary Baca, and Michelle Lynch Facilitator: Frann Otte

2 Quitline Iowa Provider Referral Update: The Brief Tobacco Intervention March 8, 2017

3 Who We Are The American Lung Association in Iowa serves as a community partner for the Iowa Department of Public Health Division of Tobacco Use Prevention & Control grant. We serve Polk, Dallas, Jasper, Marshall, Warren, Madison, Union and Adair Counties. Three Overall Goals from the CDC: 1. Reduce exposure to secondhand smoke 2. Prevent youth initiation of tobacco use 3. Promote cessation in the community 4. Identify and eliminate tobacco-related disparities 3

4 Objectives By the end of this presentation you will: Understand tobacco use rates and disparities in Iowa Be able to use the Ask, Advise, Refer Brief Tobacco Intervention to connect your patient s with the resources they need to successfully quit tobacco Understand the Quitline Iowa referral process based on the patient s health insurance status 4

5 Tobacco use is the leading cause of preventable death and disease in the US. The good news is 80% of Iowans indicated they want to quit tobacco. Three minutes of your time during your patient s clinic visit could add years to their life. The CDC s guide Best Practices for Comprehensive Tobacco Control Programs addresses promoting a health systems change and integrating the brief tobacco intervention into care. 1 Today this webcast will address tobacco use statistics, the brief tobacco intervention that you can complete during your patient s visit, and Quitline Iowa. This webcast will also provide an update on the Quitline Iowa referral process and the MCO prior authorization process. 1.

6 Tobacco use Statistics 6

7 The Brief Tobacco Intervention Nearly 1 of every 5 deaths each year in the United States is tobacco related 1. Lung cancer is the leading cancer killer in both men and women in the US 2. Smoking, including exposure to secondhand tobacco smoke, causes 87% of lung cancer cases 2. 1 in 10 people with lung disease have never smoked 2. Over 5,000 Iowans die each year of a tobacco related disease 3. The estimated annual health care costs in Iowa directly related to tobacco use now total $1 billion 3. The portion covered by the Iowa Medicaid program is $365 million American Lung Association df 7

8 Tobacco use causes substantially more deaths each year than: alcohol car accidents suicides AIDS homicides, and illegal drugs combined. 1) pdf American Lung Association Tobacco Free Kids Centers for Disease Control and Prevention

9 Higher tobacco usage rates are seen in: The low income population: 32% of Iowans making less than $20,000 smoke Low education level population: 32% of Iowans whose highest education level is a high school diploma smoke Persons with a mental illness, intellectual disability, or a substance abuse disorder: 40%-90% Nationally depending on diagnosis LGBT community: 35% of Adult LGBT Iowans smoke Adults who experienced Adverse Childhood Experiences: 35% of Iowans who had 4+ ACEs smoked Disparities are also seen by race in Iowa: 30% of African-Americans 18% of Caucasians 17% of Hispanics 41% of Multi-race (data is still being gathered on refugee and immigrant tobacco use rates in Iowa) BRFSS

10 Brief Tobacco Intervention Training 10

11 The Brief Tobacco Intervention: ASK every patient about tobacco use at every visit Ask what kind of tobacco use (including electronic smoking devices) and how often Document use status Health care systems can work with the Iowa Department of Public Health, Division of Tobacco Use Prevention and Control Department to build these questions into the EMR if not done already 11

12 The Brief Tobacco Intervention: ADVISE all tobacco users to quit Give a clear, strong, and personalized message Explain how quitting will benefit his/her specific health concern or reason for visit 12

13 The Brief Tobacco Intervention: REFER those patients ready to quit to Quitline Iowa Ask if they are ready to quit in the next 30 days Tell them about the Quitline Iowa program Explain medication options and Quitline Iowa requirements Ask if you can complete a referral to Quitline Iowa so Quitline can proactively call them 13

14 Quitline Iowa 14

15 What is Quitline Iowa? Quitline Iowa services are provided by National Jewish Health and administered for and paid for by the Iowa Department of Public Health, Division of Tobacco Use Prevention & Control. Research shows that patients are twice as likely to participate in Quitline Iowa if they are referred by their provider. Research also shows that patients who use Quitline services are three times more likely to successfully quit than smokers who try to quit on their own. National Jewish Health is the nation s leading respiratory hospital and is the largest nonprofit provider of tobacco cessation services in the United States. 15

16 What is Quitline Iowa? Trained coaches work closely with individuals to develop coping skills to quit tobacco use and remain tobacco-free. Quitline Iowa provides: Personalized, telephone coaching and text program for phone and web participants Mobile friendly website Population specific pregnancy and postpartum program with dedicated coaches Educational materials Patient progress reports to the provider The phone counseling program has scheduled calls and unlimited inbound calls. 16

17 Iowa Managed Care Organizations Update April 1 st, 2016 Iowa implemented the Iowa High Quality Healthcare Initiative, also known as Medicaid Modernization. Iowa now operates Medicaid with managed care organizations (MCO s). In addition to that, a new Quitline Iowa vendor, National Jewish Health, started as of July 1, 2016, and the fax number has changed on the forms to submit a referral. The number for callers has not changed. There is a NEW online referral option: under the provider referrals tab Additional support materials are available here: 17

18 MCO Update For Medicaid members enrolled with an MCO, providers should contact the member s MCO for prior authorization requirements. Referral to Quitline Iowa is still required for Medicaid Fee-for-Service members. Please use the Request for Prior Authorization forms provided for these member s prescription benefit. For all other patients (uninsured, Medicare, and privately insured) please use the general fax referral form 18

19 The Referral Process 19

20 The Quitline Iowa Web Referral 1) Visit rg 2) Click the tab provider referrals Find valuable information here: 20

21 The Quitline Iowa Web Referral 3) Complete this in its entirety 4) On the last screen, check the box to receive status updates about your patient. *All languages are available to your patients using Language Line so please indicate their preferred language. *Their signature is not required for this web referral, so it can be completed at a different time than the patient visit. 21

22 The Quitline Iowa Generic Fax Referral Form Find under the provider referral tab at Provider Information can be filled out once and make copies or use office sticker Patient Information Patient Initial & Signature 22

23 The Quitline Iowa Medicaid Fee-for-Service Prior Authorization Forms Smoking Cessation Therapy-Oral Nicotine Replacement Therapy Find these forms on the Medicaid PDL Portal 23

24 Quitline Iowa Referral Process Based on Insurance Status Medicare or Uninsured Patients Fee-for-Service Medicaid Patients All 7 FDA approved medications are covered Managed Care Organization Patients: AmeriHealth Caritas, Iowa Inc. UnitedHealthcare Amerigroup Iowa, Inc. All 7 FDA Approved medications are covered Private Health Insurance generic fax or web referral *Quitline will provide 8 weeks free NRT s without a prescription to the patient. prior authorization forms: smoking cessation therapy-oral nicotine replacement therapy MCO specific prior authorization forms submitted to the respective MCO generic fax or web referral *All MCO patients should be directed to their MCO customer service line in order to receive their medication benefit. 24

25 Motivational interviewing based on the patient s stage of change: eliciting change talk 25

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27 State of Tobacco Control Report 27

28 American Lung Association State of Tobacco Control Report 2017-Iowa 28

29 American Lung Association State of Tobacco Control Report 2017-Iowa 29

30 American Lung Association State of Tobacco Control Report 2017-Iowa 30

31 American Lung Association State of Tobacco Control Report 2017-Iowa 31

32 American Lung Association State of Tobacco Control Report 2017-Iowa 32

33 American Lung Association State of Tobacco Control Report 2017-Iowa 33

34 Additional Resources 34

35 Training for Providers on Quitline website: Complete a more in-depth training about Quitline Iowa and the Ask, Advise, Refer Process Some modules are available for continuing education credit. Find this training on the Quitline Iowa website under the provider referrals tab Scroll down to the header Educational Resources and click on the training link to register for free! 35

36 Lung Helpline A toll-free number to call and speak with an expert Provides immediate, clear, accurate lung health & disease information ANY Lung health topic Staffed with Registered Nurses, Respiratory Therapists, and Tobacco Addiction Specialists LUNGUSA 36

37 Our Credo We will breathe easier when the air in every American community is clean and healthy. We will breathe easier when people are free from the addictive grip of tobacco and the debilitating effects of lung disease. We will breathe easier when the air in our public spaces and workplaces is clear of secondhand smoke. We will breathe easier when children no longer battle airborne poisons or fear an asthma attack. Until then, we are fighting for air. 37

38 The Colorado QuitLine

39 Participants can enroll by Calling QUIT-NOW Fax-referred by a health care provider Enroll online at COQuitLine.orgwww.coquitline.org 7 day per week, Bilingual Call Center 5 am to 11 pm MST 5 Call Program 1 Intake Call (Inbound) Up to 5 Coaching Calls (Outbound at scheduled times) Unlimited inbound calls for support Program Overview

40 All Colorado residents are currently eligible for QuitLine services Coaching available to those 14 and up Eligibility NRT and Chantix available only to those 18 and up The QuitLine will still ask every caller for insurance status- this helps us bill certain health plans for their own members services and helps to sustain QuitLine funding

41 Colorado QuitLine NRT All participants medically screened- Uncontrolled HBP, Pregnancy and Heart disease require MD consent Patches, Gum and Lozenges offered to all eligible participants Combination Therapy available Up to 8 weeks of NRT available twice per year Shipped directly to the participant s home Only available to those 18 and older Nicotine Replacement Therapy

42 New Chantix Benefit Chantix now offered as of November 2016 Up to 3 months of product available Participant must be active in coaching to receive all three months of product $0 co-pay currently Participant must obtain prescription Shipped directly to the participant s home from Ridgeway Pharmacy Only available to those 18 and older

43 Referral Forms Fax Referral Program Online at COQuitLine.org Web Referral form and fillable PDF form available on website NJH receives referral form Call within 24 hours Up to 3 attempts in the requested time frames or over a 10 day period Fax back to provider (only those HIPAA covered) When referral is received When patient enrolls (or is unreachable) When patient receives NRT When patient completes the program If patient declines to participate in the QuitLine

44 Fax Referral Program Common Reasons for not receiving fax-backs Provider information is illegible Provider information (fax number) is not filled out Error in data entry- all fax referrals are entered by hand at the QuitLine Transmission error- fax machines are not very reliable! The QuitLine did not receive the referral If your referral form looks to have all the proper information but you haven t received the referral received fax-back, please re-fax once 3 attempts will be made to reach the patient over approximately 2 weeks. It s common not to get an update for several weeks.

45 Form will not be processed unless the following is completed: 1. Physician information 2. Participant information **Incomplete or illegible information on form is the #1 reason physicians do not receive a fax-back Participant Updates- Only Health Care Providers (HIPAA Covered entities) will be sent fax-back forms

46 Active vs. Passive Referrals Passive QuitLine Referral Simply giving the QuitLine number to a patient so that they can enroll on their own, when they are ready Fast, easy for the medical staff Downside: No reporting Waiting for the patient to get the motivation to call Counting on the word of the patient that they have enrolled Active QuitLine Referral Fax referral, provider web referral or e-referral directly to QL Providers can receive reporting back on progress with QL CDPHE can see where referrals are coming from across CO Keeps up momentum of provider visit- QL will call within 24 hours of referral and patient should be expecting the call QL reaches out to each referral 3 times

47 Online Referral Form Online Referral Form is available under the PROVIDER tab on Using this form eliminates data entry at the QuitLine Referral processed faster Progress reports will still be send back via fax

48 Special Programs NJH offers several special programs for QuitLine callers Pregnancy and Postpartum Program: Dedicated female coach Incentives for call completion Tailored text and messages 9 coaching calls American Indian Commercial Tobacco Program (AICTP) Dedicated American Indian coaches Extra coaching calls- up to 10 available Culturally appropriate services NJH is also starting a pilot shortly for those that identify with certain mental health conditions such as anxiety and depression

49 New website for QuitLine participants What s new at the QuitLine Online program to help a tobacco user through the quit process Forums and chat with a coach functionality Provider and local resources Coming soon! ereferral NJH working with Denver Health to implement statewide See upcoming slides for more detail

50 Contacting the QuitLine For any questions regarding the QuitLine, please contact the Colorado QuitLine Client Relationship Manager: Hilary Baca

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52 Using Technology to Improve Access to Tobacco Cessation Services QuitLine Linkage and Information Network for e-referral Project (QLINe) 52

53 WHAT IS THE PROBLEM? Tobacco use remains the leading cause of preventable death Provider advice can improve cessation outcomes Quitlines provide low or no cost cessation resources but are underutilized Federal investments in electronic health records, interoperability requirements, and data standards make an electronic referral or e-referral feasible.

54 WHAT IS AN E-REFERRAL? An e-referral is a rapid, secure, electronic message sent from a healthcare provider to the Colorado QuitLine through the patient s EHR during a routine office visit. Using the same e-referral system, the Colorado QuitLine can send updates directly to the EHR, allowing the provider to stay abreast of their patient's progress toward quitting smoking.

55 WHAT ARE THE ESSENTIAL SYSTEM REQUIREMENTS? High burden of tobacco use among patients Organizational commitment to tobacco cessation Practicing AAR or 5A s and R including referring patients to the Quitline Collecting structured information on tobacco use within the EHR (where the e-referral process starts) Has the EHR functionality to send a secure message to an external provider (needed to send a message to the QuitLine)

56 HOW CAN I LEARN MORE? Click on the screen shots below

57 TAKE AWAYS WHY IS THIS VALUABLE? e-referral can: Save time for providers and patients Improve referral data quality to increase successful cessation initiation Increase information sent back to providers WHERE HAS E-REFERRAL BEEN IMPLEMENTED? Salud Clinica Campesina Integrated Physicians Network (IPN) MCPN UC Health (All Campuses) Sunrise (2017) Denver Health (2017)

58 Contact Information Emily McCormick, MPH Denver Public Health

59 Q&A 59

60 Resources Colorado: Devin Detwiler Iowa: Frann Otte 60 This material was prepared by Telligen, the Medicare Quality Improvement Organization for Colorado, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.