A Brief Tour of Massachusetts

Transcription

1 A Brief Tour of Massachusetts from Medicaid to Meaningful Use June 11, 2012 Thomas Land, PhD Director, Office of Statistics and Evaluation Bureau of Community Health and Prevention Massachusetts Department of Public Health Senior Scientist, Multi-State Collaborative for Health Systems Change

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3 A Brief Tour of Massachusetts from Medicaid to Meaningful Use June 11, 2012 Thomas Land, PhD Director, Office of Statistics and Evaluation Bureau of Community Health and Prevention Massachusetts Department of Public Health Senior Scientist, Multi-State Collaborative for Health Systems Change

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5 It s All About the Curve Post Cessation Risk Reduction 100% Excess Cancer Risk HARBINGER Risk Reduction 75% 50% 25% Excess Cardiovascular Risk Reductions in Tobacco-Related Cardiovascular Risk Foreshadow Reductions in Tobacco-Related Risk of Cancer 0% Quit Date 5 Years 10 Years 15 Years 20 Years

6 A Brief Tour of Massachusetts n Mass Health Benefit poster FINAL 1106 copy2 Design Promotion Utilization and Prevalence Health Outcomes n Other Initiatives (briefly) All Payer Claims Database PopMedNet Community Transformation Grants Meaningful Use n Lessons Learned

7 LegislativeMandate n Smoking Cessation Benefit included in Massachusetts Health Reform legislation, April 2006 n Legislation mandated: Two-year smoking cessation pilot $7 million per year for Medicaid Report to Legislature each year reviewing benefit utilization, clinical outcomes (quit rates), and cost savings

8 MassHealth Benefit Design n Two treatment/quit attempts per year n 16 counseling sessions per year, any combination of individual or group 45-minute intake/assessment sessions 30-minute individual counseling session 60-minute group session n All FDA-approved medications and any combination n 90-day supply per treatment attempt; two treatments per 12 month cycle n More supply with MD prior authorization n Prior authorization for Zyban and for nasal spray, inhaler

9 Demographic Comparison Demographic Comparison (FY 2009): Benefit Users, All MassHealth, and Massachusetts 100.0% 83% 82% 75.0% 62% 50.0% 25.0% 0.0% 18% 18% 13% 14% 8% 6% 8% 7% 8% White Non-Hispanic Black Non-Hispanic Hispanic Speak English less than "very w ell" MassHealth Tobacco Cessation Benefit Users MassHealth (Adults 18-64) Massachusetts Source: MassHealth eligibility data FY 2009 and US Census ( ACS estimates)

10 MassHealth Benefit Utilization 7/2006 4/2009 Number of Claims 10,000 8,000 6,000 4,000 2,000 40% of all MassHealth smokers Total People Using Benefit 75,810 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 11/07 1/08. Consumer awareness surveyed by MTCP in 10/06 and by University of Massachusetts in 1/08.

11 Declines in Smoking Prevalence Smoking Prevalence in Massachusetts Adults (18-64): MassHealth vs. No Insurance Smoking Prevalence (6-Month Annual Rolling Average) 45.0% 40.0% 35.0% 30.0% 25.0% 25.0% 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) Citation: Land T, Warner D, Paskowsky M, Cammaerts A, Wetherell L, et al. (2010) Medicaid Coverage for Tobacco Dependence Treatments in Massachusetts and Associated Decreases in Smoking Prevalence. PLoS ONE 5(3): e9770. doi: /journal.pone

12 Cardiovascular Claims Decrease n 46% decrease in probability of hospitalization for acute myocardial infarction n 49% decrease in probability of hospitalization for acute coronary heart disease n Controlled for demographics, prior health risks, seasonality, statewide influenza rates, and the implementation date of the Massachusetts Smoke-Free Workplace Law Citation: Land T, Rigotti NA, Levy DE, Paskowsky M, Warner D, et al. (2010) A Longitudinal Study of Medicaid Coverage for Tobacco Dependence Treatments in Massachusetts and Associated Decreases in Hospitalizations for Cardiovascular Disease. PLoS Med 7(12): e doi: /journal.pmed

13 Cost Savings Estimate n Fewer hospitalizations for: heart attacks ($26,044 per event) atherosclerosis ($12,760 per event) non-specific chest pain ($7,367 per event) n Total Expenditures: $20,178,210 (FY07-09) n Return on Investment: $2.12for every $1 spent Citation: Richard P, West K, Ku L (2012) The Return on Investment of a Medicaid Tobacco Cessation Program in Massachusetts. PLoS ONE 7(1): e doi: /journal.pone

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15 New Initiatives n All Payer Claims Database (APCD) Part of Massachusetts Health Reform First live queries July 2012 n PopMedNet Atrius Health and Community Health Centers First live queries October 2012 n Community Transformation Grants QI based on Million Hearts Measures Electronic linkage to Community Resources n Meaningful Use Tobacco Use Obesity Blood Pressure Cholesterol

16 n What is Atrius Health Multi-site primary care network with 500K+ patients Located in suburban Boston Original partner PopMedNet Analysis based on evaluation 2.6 million clinical encounters n Definition of systems change patterned after meaningful use measures for tobacco use n Impact: Reductions in self-reported smoking behavior Reductions in the number of smoking related office visits

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