PUTTING OUT THE ADDICTION:

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1 PUTTING OUT THE ADDICTION: Tobacco Cessation and Prevention Programs INDUSTRY PULSE FROM THE HEALTHCARE INTELLIGENCE NETWORK TM White paper analysis of HIN monthly e-survey results on trends shaping the healthcare industry. Written by: Laura M. Greene, HIN Communications Editor FEBRUARY 2009 President Obama recently signed legislation that will cover an additional 4 million children under State Children s Health Insurance Plan, or SCHIP. To fund this expanded coverage, federal tobacco taxes have been raised 61 cents per pack, a move that will not only help uninsured children seek healthcare, but hopefully deter current smokers from continuing the habit and prospective smokers from starting altogether. With this two-birds-with-one-stone move, the U.S. government is doing their part in the crusade for tobacco cessation and prevention. Now, the Healthcare Intelligence Network (HIN) examines how over 220 wellness companies, behavioral healthcare providers, primary care providers (PCPs), disease management (DM) organizations, employers, health plans and hospital/health systems are contributing to the area of tobacco cessation and prevention. Of the 221 organizations responding to HIN s December e-survey on tobacco cessation and prevention, more than threefourths do offer such programs, and 95 of the survey s total number of respondents have adopted smoke-free policies within their organizations. Of the 24 percent that do not offer cessation and prevention programs in their organizations, 40.4 percent plan to implement one in the next 12 months. Twenty-six respondents who do not offer programs and do not plan to within the next year cite cost (19.2 percent), staffing (19.2 percent), time (11.5 percent), need (7.7 percent) and C-suite resistance (7.7 percent) as the greatest barriers to launching a tobacco cessation program in the coming year. One respondent from a substance abuse program whose organization is launching a cessation and prevention program in the coming year noted that their 10-session program with follow-up is targeted to high school students. Another respondent representing a wellness company said their program will be for white and blue collar workers and will be via a wellness coaching portal, where wellness coaches are used to engage with the individuals via , teleconsultation and face-to-face consultation. Other organizations planning to launch tobacco cessation and prevention programs in the next 12 months plan to target their programs at state employees, adults and patients with chronic diseases. Plans include health education, stress management, nicotine withdrawal support, nicotine replacement therapy and monetary credits to singles and couples who do not smoke. While some organizations are new to tobacco cessation and prevention in the last year (8.7 percent), more than half of respondents 52.4 percent have been offering their programs from one to five years, 23.8 percent have been offering their programs for six to 10 years and 15.1

2 # of Respondents Intervention Methods Included in Responding Organizations Tobacco Cessation and Prevention Programs Go to product.asp?itemid=3826 to order Promising Outcomes: The Impact of Positive Psychology on Health and Wellness Coaching and view other useful resources for making a difference for you, your team and your organization. Figure 1 Methods Source: December 2008 HIN e-survey on tobacco cessation programs Disclaimer: HIN survey results are not based on a scientific sampling but on the number of responses to the HIN monthly online survey at percent of survey respondents note their programs have been in existence for more than 10 years. Nearly 55 percent of 128 organizations responding to this question note that their cessation and prevention programs are integrated programs, while 38.3 percent say theirs are stand-alone. Ninety-one respondents whose organizations already have cessation and prevention programs in place direct their programs toward adult populations, while 40 organizations direct their efforts at high-risk individuals with multiple comorbidities, 39 aim their programs at disease-specific (diabetes, coronary artery disease, congestive heart failure) patients and 31 organizations direct their programs toward pregnant women. Forty-four organizations direct their programs toward all of the aforementioned groups as well as adolescents/children. One health plan respondent even noted that they direct their tobacco cessation and prevention program toward the gay, lesbian, bisexual and transgender/transsexual (GLBT) community, and a behavioral healthcare provider focused on patients with mental illnesses. Using Incentives for Tobacco Cessation Incentive use in tobacco cessation and prevention programs is helpful in getting both healthcare providers and employees alike to participate. Forty-four of 58 respondents employ reimbursement as a healthcare provider incentive for their programs, 15 use withholds and 6 use quality bonuses. Among incentive types for participants are fee-free programs, (71 respondents), coverage of over-the-counter smoking cessation aids (70 respondents), 2

3 coverage of prescription smoking cessation drugs (64 respondents), reduced premiums (26 respondents) and cash incentives (18 respondents). Overall among all types of respondents, self-referrals was the number one method for identifying candidates for tobacco cessation programs. This finding does not differ much when analyzed by sector: Self-referral was the number one method for identifying candidates for tobacco cessation programs among behavioral healthcare providers, employers, health plans and hospital/health systems. PCPs identified health risk assessments (HRAs) and screening/assessments during outpatient visits as their main method, while wellness companies rely mainly on HRAs for identifying candidates. Disease management (DM) organizations surveyed noted that self-referrals and HRAs were equally employed to identify program participants. Program Components: Advice, Delivery and Interventions Of the 128 respondents who identified the location of intervention, 79 offer tobacco cessation advice to their patients at the workplace, 47 respondents offer advice to their patients during outpatient visits, 34 during hospital stays, 79 at the workplace, 18 upon hospital discharge and 10 respondents do not offer tobacco cessation advice at all. Additional responses included offering advice telephonically, at health fairs, via DM programs, as part of EAP assessment, through newsletters, through health coaches, via Web support and upon identification. Some respondents also noted that they offer advice at not just one point in time or through one medium, but at every patient encounter. Nearly 50 percent of the respondents to this question noted that average length of enrollment in their organization s tobacco cessation and prevention program was four or more sessions lasting longer than 10 minutes each, though some organizations noted that length of enrollment depends on other factors including the specific health coach and the needs and situations of the specific individuals. The responding organizations take advantage of the various methods available to them to deliver tobacco cessation programs. Eight-seven respondents deliver their programs by means of printed materials, while 81 deliver their programs in person. Telephonic coaching is used by 77 respondents. Thirty-three respondents noted that they deliver their programs using all three of those methods. Webbased programs are used by 48. A much smaller number 23 respondents rely on tailored letters mailed home to deliver their programs, and 21 respondents rely on pharmacist support. Seven respondents are using cell phone reminders to deliver their tobacco cessation and prevention programs. Interventions included in the tobacco cessation/prevention programs of responding organizations included: Employee education/awareness (89 respondents) Health coaching (84 respondents) Quitlines (75 respondents) Family support/education (56 respondents) Motivational interviewing 3

4 # of Respondents Cessation Modalities Employed by Responding Organizations Methods Figure 2 (55 respondents). Source: December 2008 HIN e-survey on tobacco cessation programs among these challenges were: (For a complete list of interventions included in the tobacco cessation and prevention programs of responding organizations, see Figure 1 on page 2.) Patients compliance with behavior changes Participation compliance Nicotine replacement methods such as a patch, gum or nasal spray are the most popular smoking cessation modalities, employed by 99 responding organizations. Behavioral methods were another common modality, used by 95 of the 126 respondents to this question. Pharmaceutical cessation aids are employed by 75 of the question s respondents. (For a complete list of cessation modalities employed by responding organizations, see Figure 2.) Relapse Enrollment Employee acceptance Insurance coverage for participants Time constraints Physical space Challenges & Benefits of Programs As with any health and wellness programs, organizations surveyed have faced their share of challenges and resistance. Chief One responding health plan said, Our greatest challenge has been the physician referral to the smoking cessation program. Recently we added the smoking status 4

5 # of Respondents Measuring Outcomes & ROI Methods Figure 3 question to our electronic health record, making the screening obligatory in every outpatient visit. Other challenge is to increase inpatients counseling and smoking cessation treatment. We are working in engaging all hospital team and implementing the program in other hospitals. Benefits that responding organizations are reaping as a result of their tobacco cessation and prevention programs include: Creating a culture of health Source: December 2008 HIN e-survey on tobacco cessation programs Decrease in absenteeism Increase in awareness Increased interest in wellness programs Decrease in long-term medical costs Decrease in ER visits A responding hospital/health system noted that they saw a major reduction in the number of patients, visitors and associates who smoke on our hospital campus. Healthier patients Member satisfaction Increase in productivity Measuring Outcomes To measure return on investment (ROI), quality and outcomes associated with their tobacco cessation and prevention programs, responding organizations are using a variety of methods including: 5

6 Patient/member evaluations/ surveys (57 respondents) Health claims analysis (33 respondents) Healthcare service utilization (18 respondents) that PCPs school themselves in health promotion and make coaching a team effort to foster behavior change in members and patients. But for this effort to be successful, physicians need a dose of their own medicine, embracing healthy habits themselves walking the walk so they can effectively talk the talk with patients. Self-report (58 respondents) Annual changes in HRA (35 respondents) ROI calculator (14 respondents) (See Figure 3 on page 5.) Related Resources Relationships are important in healthcare perhaps none more so than the physician-patient bond. Until now, these encounters have largely been focused on treating illness, not preventing it. But as healthcare acknowledges the clinical and cost benefits from health coaching in disease and health management, some experts say that primary care is ripe for the same change. In addition to dispensing clinical advice, it may also be time for PCPs to prescribe physical activity, smoking cessation and other healthy habits to guide patients toward self-efficacy. In Health Coaching in Primary Care: Persuading Physicians to Prescribe Behavior Change and Self-Efficacy, three health coaching thought leaders detail their models for incorporating health coaching into the primary care paradigm. While acknowledging existing demands on busy physicians, they recommend In this 41-page special report, Dr. Rick Botelho, professor of family medicine at the URMC Family Medicine Center, Margaret Moore, CEO, Wellcoaches Corporation and Dr. Edward Phillips, director of outpatient medical services at Spaulding Rehabilitation Hospital Network and assistant professor of the Department of Physical Medicine and Rehabilitation at Harvard Medical School, detail their models for incorporating health coaching into the primary care paradigm. While acknowledging existing demands on busy physicians, they recommend that PCPs school themselves in health promotion and make coaching a team effort to foster behavior change in members and patients. For more information, please visit: store.hin.com/product.asp?itemid=3826. Contact us: Healthcare Intelligence Network 1913 Atlantic Avenue, Suite 201 Manasquan, NJ Phone: (888) Fax: (732) info@hin.com Healthcare Intelligence Network is a trademark of the Healthcare Intelligence Network. 2009, Healthcare Intelligence Network. All Rights Reserved. 6