1. Margaret Reid, RNDirector, Healthy Homes & Community Supports Boston Public Health Commission11/13/2012
2. Reasons to invest in tobacco policiesand benefits Influence of tobacco-free policies Importance of tobacco cessationbenefits Case study in Boston Questions
3. NonsmokersFormer Current SmokersSmokersMean days missed 4.4 days4.9 days 6.7 daysfor work d/t healthconditions/yearMean hours lost d/t35.2hours 39.2 53.6absenteeism/year hourshoursMean hours lost d/t42.8 hours56.0 76.5presenteeism/yearhourshours Journal of Occupational and Environmental Health, Volume 48, Number 10, October 2006.
4. Implement policies that discouragetobacco use◦ Increase taxes on tobacco and packaging◦ Create smoke-free public places Provide support for smokers who want toquit◦ Offer high-quality cessation benefits Prevent youth tobacco use◦ Disrupt tobacco marketing to youth
6. Smoke free policies are effective because◦ They make smoking inconvenient;◦ They change the norm around what is acceptablebehavior;◦ They convey the importance of protecting othersfrom secondhand smoke. SF policies result in less secondhand smokeexposure and increase the likelihood thatsmokers quit.
7. Policy change alone is notsufficient to achieve the goalof reducing tobacco use. A robust, barrier-freecessation benefit is a provenway to help people quit◦ Education and outreach topromote benefit is important
8. Cessation benefits work best when they:◦ Cover the cost of counseling, includingtelephone, individual and/or group counseling◦ Offer counseling sessions over a period of severalweeks and have high or no limit on sessions◦ Cover all FDA-approved cessation aids, includingprescription and over-the-counter drugs◦ Limit out-of-pocket expenses for those making aquit-attempt◦ Do not require preauthorization
10. Insurance PlanCessation Counseling BenefitCessation Pharmacy BenefitGold StandardOffers bi-lingual telephone Covers NRT and prescription counselingmedications; Will reimburse for 16 counseling$1-3 co-pay sessions every 12 months, PA for counseling beyond this limitMajor Insurer #1 Promotes Smokers Help Line andNo coverage for NRT; online support. $10 co-pay for generic drugs, Offers reduced rate for QuitSmart $25 co-pay Chantix and program WellbutrinMajor Insurer #2 Promotes Smokers Help Line andCovers NRT and prescription online support. medications; $10 co-pay for generics ; $25 for Chantix and Wellbutrin
11. The City of Boston has about 18,000 employees,including the schools, public health, fire, policeand other municipal departments Employee benefits are negotiated between thePublic Employee Committee and citymanagement The city is self-insured Boston currently contracts with NeighborhoodHealth Plan, Blue Cross/Blue Shield, HarvardPilgrim, and BMC HealthNet to offer insurance.
14. AmericanNot Indicated Indian Asian 10%0% 3% Hispanic8%WhiteBlack57%22%
15. Adult Current Smoking, 2010
16. The City was in a contract negotiationyear. Management understood the ROI onoffering a cessation benefit. Outside forces – municipal healthreform, interest in cost containment –contributed to readiness on both sides tonegotiate.
17. Public Employee Committee andManagement agreed to look at a 4-yearhealth benefit design, with a focus onreducing costs Reducing costs = improving preventivecare and increasing wellness benefits andchronic disease management Improved cessation aligned with thesegoals.
18. Once PEC and Management agreed oncessation benefit, negotiations began withInsurer For Insurer, big hurdle was whether theywould have to file with the Division ofInsurance to offer the change in benefit Since Boston was self-insured, the insurer didnot have to file, so the change was easier tomake.
19. Major Insurer #1Before AfterCessation Reduced rate for Added on-site cessationCounselingQuitSmart program. groups.BenefitContinues to promote Smokers Help Line and online support and reduced rate for QuitSmart programCessation No coverage for NRT; Added coverage for NRT,Pharmacy Benefit$10 co-pay for most at Tier 1 co-pay level of $10.generic drugs, $25 Continues coverage forco-pay Chantix and prescription medicationsWellbutrin
20. Outreach: Outreach to employees so they areaware of the new benefit and know how toutilize◦ Postcards to homes, city intranet sites◦ Department Human Resource Directors educated◦ Letter from Mayor Menino to every employee◦ Promotion for Great American Smoke Out
21. Evaluation: Will be asking the insurer fordata to assess uptake of the benefit byemployees.◦ Monitor adoption among other large Bostonemployers◦ Continue to monitor smoking rates amongresidents of Boston
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1. Margaret Reid, RNDirector, Healthy Homes & Community Supports Boston Public Health Commission11/13/2012
2. Reasons to invest in tobacco policiesand benefits Influence of tobacco-free policies Importance of tobacco cessationbenefits Case study in Boston Questions
3. NonsmokersFormer Current SmokersSmokersMean days missed 4.4 days4.9 days 6.7 daysfor work d/t healthconditions/yearMean hours lost d/t35.2hours 39.2 53.6absenteeism/year hourshoursMean hours lost d/t42.8 hours56.0 76.5presenteeism/yearhourshours Journal of Occupational and Environmental Health, Volume 48, Number 10, October 2006.
4. Implement policies that discouragetobacco use◦ Increase taxes on tobacco and packaging◦ Create smoke-free public places Provide support for smokers who want toquit◦ Offer high-quality cessation benefits Prevent youth tobacco use◦ Disrupt tobacco marketing to youth
6. Smoke free policies are effective because◦ They make smoking inconvenient;◦ They change the norm around what is acceptablebehavior;◦ They convey the importance of protecting othersfrom secondhand smoke. SF policies result in less secondhand smokeexposure and increase the likelihood thatsmokers quit.
7. Policy change alone is notsufficient to achieve the goalof reducing tobacco use. A robust, barrier-freecessation benefit is a provenway to help people quit◦ Education and outreach topromote benefit is important
8. Cessation benefits work best when they:◦ Cover the cost of counseling, includingtelephone, individual and/or group counseling◦ Offer counseling sessions over a period of severalweeks and have high or no limit on sessions◦ Cover all FDA-approved cessation aids, includingprescription and over-the-counter drugs◦ Limit out-of-pocket expenses for those making aquit-attempt◦ Do not require preauthorization
10. Insurance PlanCessation Counseling BenefitCessation Pharmacy BenefitGold StandardOffers bi-lingual telephone Covers NRT and prescription counselingmedications; Will reimburse for 16 counseling$1-3 co-pay sessions every 12 months, PA for counseling beyond this limitMajor Insurer #1 Promotes Smokers Help Line andNo coverage for NRT; online support. $10 co-pay for generic drugs, Offers reduced rate for QuitSmart $25 co-pay Chantix and program WellbutrinMajor Insurer #2 Promotes Smokers Help Line andCovers NRT and prescription online support. medications; $10 co-pay for generics ; $25 for Chantix and Wellbutrin
11. The City of Boston has about 18,000 employees,including the schools, public health, fire, policeand other municipal departments Employee benefits are negotiated between thePublic Employee Committee and citymanagement The city is self-insured Boston currently contracts with NeighborhoodHealth Plan, Blue Cross/Blue Shield, HarvardPilgrim, and BMC HealthNet to offer insurance.
14. AmericanNot Indicated Indian Asian 10%0% 3% Hispanic8%WhiteBlack57%22%
15. Adult Current Smoking, 2010
16. The City was in a contract negotiationyear. Management understood the ROI onoffering a cessation benefit. Outside forces – municipal healthreform, interest in cost containment –contributed to readiness on both sides tonegotiate.
17. Public Employee Committee andManagement agreed to look at a 4-yearhealth benefit design, with a focus onreducing costs Reducing costs = improving preventivecare and increasing wellness benefits andchronic disease management Improved cessation aligned with thesegoals.
18. Once PEC and Management agreed oncessation benefit, negotiations began withInsurer For Insurer, big hurdle was whether theywould have to file with the Division ofInsurance to offer the change in benefit Since Boston was self-insured, the insurer didnot have to file, so the change was easier tomake.
19. Major Insurer #1Before AfterCessation Reduced rate for Added on-site cessationCounselingQuitSmart program. groups.BenefitContinues to promote Smokers Help Line and online support and reduced rate for QuitSmart programCessation No coverage for NRT; Added coverage for NRT,Pharmacy Benefit$10 co-pay for most at Tier 1 co-pay level of $10.generic drugs, $25 Continues coverage forco-pay Chantix and prescription medicationsWellbutrin
20. Outreach: Outreach to employees so they areaware of the new benefit and know how toutilize◦ Postcards to homes, city intranet sites◦ Department Human Resource Directors educated◦ Letter from Mayor Menino to every employee◦ Promotion for Great American Smoke Out
21. Evaluation: Will be asking the insurer fordata to assess uptake of the benefit byemployees.◦ Monitor adoption among other large Bostonemployers◦ Continue to monitor smoking rates amongresidents of Boston