Massachusetts Department of Public Health, Tobacco Cessation and Prevention Program. Massachusetts spends $4.3 billion on

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1 Massachusetts Tobacco Cessation and Prevention Program Winnable Battles Initiative June 6-8 Massachusetts Department of Public Health, Tobacco Cessation and Prevention Program Context Massachusetts spends $4.3 billion on healthcare costs every year. % of all healthcare costs in the Commonwealth are attributable to smoking. Reducing costs and promoting health are key to Health Care and payment reform 1

2 Hot off the presses we re down to 14% Percent of Adults Who Are Current Smokers Percent Year How we did it 2

3 Not really: It was a lot of things (1991 to 2009) 30% 20% % 0% 22.9% $0.25 tax increase (1992) $0.25 tax increase (1996) 22.7% 19.9% MTCP begins (1993) $0.75 tax increase (2002) Smoke-free Workplace Law (2004) 18.5% MassHealth Benefit implemented and promoted (2006) -2.2% APC $1.00 tax increase (2008) 15.0% Source: Massachusetts Behavioral Risk Factor Surveillance System Contributing factors Maintained public health comprehensive program Increased cigarette taxes Passed strong smoke-free workplace law Implemented Health Care Reform MassHealth s low-barrier cessation benefit More residents have access to NRT Protected promising partnerships 3

4 Tobacco prevention cuts Funded at $52 million in FY 1994, shortly after passage of the voter tax referendum After the Master Settlement Agreement in 1998, funding was increased to a high of $54 million. Substantial cuts began in FY01 culminating at a low of $2.5 million in FY04. Current funding is $4.5 million 1. Public health program Local programs Surveillance/Evaluation Legal/policy experts Quitline Communications Specialized cessation campaigns all contribute to promoting sustainable policy change. 4

5 Addressing the Retail Environment Data collection: retail environment Web-based Retail Data Management System (RDMS) allows collection of retail store data. (ARRA supported) We collect data about pricing, advertising, and illegal sales to minors. Data is instantly available. Local Boards of Health and evaluation vendor are primary data collectors. 5

6 Partnering: retail environment Assessing retail environment Engaging young people Working with municipalities on zoning and other legal reforms Educating parents about issues Engaging concerned adults in voluntary change 2. Four tax increases in 20 years 30% $0.25 tax increase (1992) $0.25 tax increase (1996) -2.2% APC 22.9% 22.7% $1.00 tax increase (2008) 20% 19.9% 18.5% 15.0% % $0.75 tax increase (2002) 0% Source: Massachusetts Behavioral Risk Factor Surveillance System 6

7 Smoke-free Workplace Law Policies passed first in communities Local health dept. promotes in communities State health dept. provides TA and support Surveillance/evaluation Communication strategy Quitline available for those who want to quit Statewide law Communicate local experience to stakeholders Key state legislators lead effort Quitline available for those who want to quit Surveillance/evaluation ongoing Massachusetts AMI Deaths 1999 through 2006 (acute myocardial infarction, commonly known as a heart attack) erved difference between the predicted* and the obse cumulative sum of the d % fewer AMI deaths beginning 1 year after implementation Boston law State law No local comprehensive smoking ban Local comprehensive smoking ban implemented 5/2003-6/ Data Source: Massachusetts death records

8 4. Massachusetts Health Care Reform creates new opportunities MassHealth Cessation Benefit: Original Mandate Massachusetts passed Health Care Reform in 2006 Initially discussed as a tobacco cessation benefit for pregnant women only Ultimately, passed a legislative mandate for all Medicaid subscribers 8

9 Public health partnership with MassHealth DPH ran media campaigns promoting benefit. DPH used existing QuitWorks communication channels to medical professionals. Local programs disseminated posters and materials. Collaboration on benefit design Access to all FDA-approved medications 90-day supply ppy per treatment attempt twice per year Any combination NRT, Chantix, Bupropion Up to 16 face-to-face counseling sessions No prior approvals Medication not tied to counseling Low co-pay of $1-3 9

10 MassHealth cessation benefit Promotion and Utilization Number of Claims,000 8,000 6,000 4,000 2,000 40% of all MassHealth smokers TtlP Total People Using Ui Benefit 75,8 31% Consumer Awareness MTCP Promotions Began MTCP Promotions Ended 75% Consumer Awareness 0 Apr-06 Jul-06 Oct-06 Jan-07 Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Announcement to 20,000 providers 6/06. Announcement to all MassHealth subscribers 6/06. Additional outreach to health centers, hospitals, community agencies, and providers beginning 8/06. Articles placed in over 15 professional and MCO newsletters beginning 9/06. MTCP radio and transit campaign 12/06 5/07. MassHealth wellness brochures 7/07. MTCP cessation television campaign /07 1/08. Consumer awareness surveyed by MTCP in /06 and by University of Massachusetts in 1/08.

11 Declines in Smoking Prevalence Smoking Prevalence in Massachusetts Adults (18-64): MassHealth vs. No Insurance ing Prevalence (6-Month Annual Roll Average) Smoki ing 45.0% 40.0% 35.0% 30.0% 25.0% 25.0% 50% 7/1/1999 7/1/1999 7/1/1999 7/1/1999 7/1/2000 7/1/2000 7/1/2000 7/1/2000 7/1/2001 7/1/2001 7/1/2001 7/1/2001 7/1/2002 7/1/2002 7/1/2002 7/1/2002 7/1/2003 7/1/2003 7/1/2003 7/1/2003 7/1/2004 7/1/2004 7/1/2004 7/1/2004 7/1/2005 7/1/2005 7/1/2005 7/1/2005 7/1/2006 7/1/2006 7/1/2006 7/1/2006 7/1/2007 7/1/2007 7/1/2007 7/1/2007 7/1/2008 7/1/2008 7/1/2008 7/1/2008 MassHealth MassHealth (Point (Point Estimates) Estimates) MassHealth MassHealth (Model (Model Estimates) Estimates) No No Insurance Insurance (Point (Point Estimates) Estimates) No No Insurance Insurance (Model (Model Estimates) Estimates) Annual percentage rate (APR) change for smoking prevalence among MassHealth uninsured adults in Massachusetts aged Source: Massachusetts Behavioral Risk Factor Surveillance System, 1998 to 2008 To examine if health improved 21,656 members who used the benefit studied Longitudinal design; Pre-post individual s use of benefit August 2003-June 2008 Must have used the benefit by Nov diagnostic categories with over 200 hospitalizations

12 Cardiovascular Claims Decrease 46% decrease in of hospitalization for acute myocardial infarction 49% decrease in of hospitalization for acute coronary heart disease Controlled for demographics, prior health risks, seasonality, influenza rates, and the implementation date of the Massachusetts Smoke-Free Workplace Law 5. Efforts with Special Populations at Higher Risk 12

13 Patch Promotion for Veterans Challenges: Veterans population 33% higher rate of smoking than general population Diverse population united by one common experience Additional challenges include higher rate of PTSD. 13

14 Engaging Veterans with systems Goal is to give Veterans a good start, then connect tthem with existing systems to sustain quit. Veterans have a range of health benefits, including private and public civilian plans and TriCare, VA, and military coverage. Health plan coverage of cessation varies widely. Partnership: Promotion Materials design Focus groups of Veterans Collaboration with Dept. of Veterans Services Promotion: no paid media Press events Publicized at Veterans services events Mailings to local Veterans entities Family members included Quitline provides patches and counseling 14

15 Veterans: Promising results 4,000 respondents during the 7½ months of the 2008 campaign 4 out of 5 made a serious quit attempt lasting 24 hours or more 25% of serious quit attempts had quit for a month or more Attention to the issue of Health Equity ASTHO Presidential Challenge: eliminate disparities and promote health equity Why? The pattern of greater burden of illness & injury and premature death in communities of color Tobacco use had been an exception with smoking rates and lung cancer rates higher among whites 15

16 New Developments New development Whites quitting tobacco at faster rate so Blacks for the first time have high rates (e.g. whites: former smokers 32% & current smokers 14% vs. blacks: former smokers 18% % current smokers 16%) Needed response targeted campaigns for Black population This is a winnable battle. We are focused on sustainable policies. We have core infrastructure in place to support strong policy strategies. Key partnerships help us achieve goals efficiently. 16

17 Massachusetts Department of Public Health, Tobacco Cessation and Prevention Program 17