1. TobaccoCessation andWorksite WellnessNovember 13, 2012Massachusetts Department of Public Health, Tobacco Cessation and Prevention Program
2. Context• Massachusetts spends $4.3 billion onhealthcare costs every year.• 10% of all healthcare costs in theCommonwealth are attributable tosmoking.• In Massachusetts, 8,000 people dieprematurely every year from smoking-related illnesses.
4. Other Tobacco Product Use* Among HighSchool Students: Massachusetts, 1999-2009• Other Tobacco Products (OTP) are beginning to surpass cigaretteconsumption among adolescents in MASource: Youth Risk Behavior Survey 1993-2009 * Used one or more days during the past 30 days.
6. Adult Smoking Prevalence Among Subgroups:Massachusetts, 2010More Likely to Smoke Less Likely to Smoke30.3% 25.7% 23.1%22.6% 19.0%14.1% 11.2%8.7%7.0%MA Adults MassHealth* <$25K High school Disabled LGBT*Private $75K +Collegehouseholdor less**health householddegree** income insurance*incomeSource: Massachusetts BRFSS, 2010. * Adults, age 18-64** Adults, age 25+
7. Adult Smoking Prevalence By Race/Ethnicity:Massachusetts, 2008-201020%18%15%15%0% White BlackHispanicSource: Behavioral Risk Factor Surveillance System
8. Who Smokes in Massachusetts?2008 Estimate
9. Why address tobacco use as an employer?• At least $96 billion per year in direct medical costs in US 1• Businesses pay an average of $2,189 in workers‘ compensationcosts for smokers, compared with $176 for nonsmokers2• An estimated $96.8 billion per year in lost productivity due tosickness and premature death in US3• Cost analyses have shown that tobacco cessation benefits, froman employers perspective, are cost-saving.4,51, 3 CDC, MMWR , September 30, 2011/60(38);1305-13092, 4 National Business Group on Health, November 20115 US DHHS, Treating Tobacco Use and Dependence- 2008 Update
10. Comprehensive Approach• Tobacco Free Policies• Benefits/Insurance Coverage• Workplace programs that include evidence-based treatment options
11. Approach 1: Worksite Policies• MA state law since 2004– Review of basic requirements of SFWL– Employers have the discretion to implement additionalor stricter policies.• Common additions:– Smoke-free outdoor spaces/campuses– Buffer zones– Tobacco-Free campus (smokeless, alternativeproducts)
12. Statistics on Quitting Post SFWL• A Cochrane review found evidence that communityinterventions using "multiple channels to providereinforcement, support and norms for not smoking"had an effect on smoking cessation outcomes amongadults, including: • Policies making workplaces1 and public places smoke-free • Estimated that "comprehensive clean indoor laws" can increase smoking cessation rates by 12%–38%21. Lee CW, Kahende J (2007). "Factors associated with successful smoking cessation in theUnited States, 2000". Am J Public Health 97 (8): 1503–9. doi:10.2105/AJPH.2005.0835272. Lemmens V, Oenema A, Knut IK, Brug J (2008). "Effectiveness of smoking cessationinterventions among adults: a systematic review of reviews". Eur J Cancer Prev 17 (6): 535–44.doi:10.1097/CEJ.0b013e3282f75e48
13. Approach 2: Employee Benefits• PPACA Law– Beginning in 2014, all new health plans will berequired to offer smoking cessation benefits(both medications and counseling) tomembers free of co-pays.• MassHealth Benefit (2006)• Commonwealth Care Benefit (2012)
14. Recommended benefit for smoking cessation• All 7 FDA-approved medications are covered for 2 courses of treatment in acalendar year with a prescription• Brief and intensive counseling are a covered service• Four tobacco cessation counseling sessions of at least 30 minutes for atleast two quit attempts per year. This includes proactive telephonecounseling, group counseling and individual counseling.• No copayments or coinsurance and not subject to deductibles, annual or lifetime dollar limits.Federal Employees Health Benefits (FEHB) as of 2011
15. Promotion and Utilization10,00040% of all75%MassHealth smokersConsumerAwareness 8,000 Total People UsingBenefit 75,810Number of Claims 6,000 31% Consumer Awareness 4,000 2,000 MTCPMTCP PromotionsPromotions Began Ended0 Apr-06 Jul-06 Oct-06 Jan-07 Apr-07 Jul-07Oct-07Jan-08 Apr-08Jul-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.
16. Declines in Smoking Prevalence Smoking Prevalence in Massachusetts Adults (18 - 64):MassHealth vs. No Insurance Over 33,000Smoking Prevalence (6-Month Annual Rolling 45.0% MassHealth smokers quit 40.0%Average) 35.0% 26% drop in 30.0% smoking prevalence 25.0%03 04 990001 0205 0607 08 2020 2020 20 20 19202020 1/1/1/ 1/1/ 1/1/ 1/1/ 1/ 7/7/ 7/7/ 7/7/ 7/7/ 7/ 7/ MassHealth (Point Estimates)No Insurance (Point Estimates) MassHealth (Model Estimates)No Insurance (Model Estimates) Annual percentage rate (APR) change for smoking prevalence among MassHealth uninsured adults in Massachusetts aged 18-64. Source: Massachusetts Behavioral Risk Factor Surveillance System, 1998 to 2008
17. Near-term health impact• Study finds health impact within one year– 46% decrease in probability of hospitalizationfor heart attack– 49% decrease in probability of hospitalizationfor acute coronary heart disease– Controlled for demographics, prior healthrisks, seasonality, statewide influenza rates,and the implementation date of theMassachusetts Smoke-Free Workplace Law
18. Actual costs of benefit• Actual costs only exceeded $7 million allocationin one fiscal year• Costs were primarily for medication; counselinghad only a 1% utilization rate• FY07 $3.9 million• FY08 $7.023 million• FY09 $5.9 million• Costs decreased as use of Chantix decreasedSource: MassHealth encounter data
19. Return on Investment• Studies of the MassHealth benefit foundthat a positive return on investmenthappens within one year.• A study by George Washington Universityshows a $2.21 net gain for every $1.00spent on the MassHealth smokingcessation benefit.
20. Building on the MassHealth experience• Coverage for all FDA-approvedmedications• Coverage for behavioral counseling• Low co-pays• Allow for repeated quit attempts• Consistency of benefit across plans• Promotion of available benefit
21. Supporting tobacco treatment in workplace• Develop clear and concise communications• Frame communication as goal of better health foremployees, not cost saving• Create a "brand" around the cessation program• Use a variety of communication methods such as: – Employers intranet, Home mailings, Mass e-mails, Posters, Employee newsletters• Recruit employees to assist with support andencouragement for employees trying to quit• Be patient — recognize that this kind of culture changecan take timehttp://www.businessgrouphealth.org/tobacco/cases tudies/index.cfm
22. Massachusetts Department of Public Health, Tobacco Cessation and Prevention Program
23. • At least $96 billion per year in direct medical costs in US1• Businesses pay an average of $2,189 in workers‘ compensation costsfor smokers, compared with $176 for nonsmokers2• An estimated $96.8 billion per year in lost productivity due to sicknessand premature death in US3• Cost analyses have shown that tobacco cessation benefits, from anemployers perspective, are cost-saving.4,51, 3 CDC, MMWR , September 30, 2011/60(38);1305-13092, 4 National Business Group on Health, November 20115US DHHS, Treating Tobacco Use and Dependence- 2008 Update
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1. TobaccoCessation andWorksite WellnessNovember 13, 2012Massachusetts Department of Public Health, Tobacco Cessation and Prevention Program
2. Context• Massachusetts spends $4.3 billion onhealthcare costs every year.• 10% of all healthcare costs in theCommonwealth are attributable tosmoking.• In Massachusetts, 8,000 people dieprematurely every year from smoking-related illnesses.
4. Other Tobacco Product Use* Among HighSchool Students: Massachusetts, 1999-2009• Other Tobacco Products (OTP) are beginning to surpass cigaretteconsumption among adolescents in MASource: Youth Risk Behavior Survey 1993-2009 * Used one or more days during the past 30 days.
6. Adult Smoking Prevalence Among Subgroups:Massachusetts, 2010More Likely to Smoke Less Likely to Smoke30.3% 25.7% 23.1%22.6% 19.0%14.1% 11.2%8.7%7.0%MA Adults MassHealth* <$25K High school Disabled LGBT*Private $75K +Collegehouseholdor less**health householddegree** income insurance*incomeSource: Massachusetts BRFSS, 2010. * Adults, age 18-64** Adults, age 25+
7. Adult Smoking Prevalence By Race/Ethnicity:Massachusetts, 2008-201020%18%15%15%0% White BlackHispanicSource: Behavioral Risk Factor Surveillance System
8. Who Smokes in Massachusetts?2008 Estimate
9. Why address tobacco use as an employer?• At least $96 billion per year in direct medical costs in US 1• Businesses pay an average of $2,189 in workers‘ compensationcosts for smokers, compared with $176 for nonsmokers2• An estimated $96.8 billion per year in lost productivity due tosickness and premature death in US3• Cost analyses have shown that tobacco cessation benefits, froman employers perspective, are cost-saving.4,51, 3 CDC, MMWR , September 30, 2011/60(38);1305-13092, 4 National Business Group on Health, November 20115 US DHHS, Treating Tobacco Use and Dependence- 2008 Update
10. Comprehensive Approach• Tobacco Free Policies• Benefits/Insurance Coverage• Workplace programs that include evidence-based treatment options
11. Approach 1: Worksite Policies• MA state law since 2004– Review of basic requirements of SFWL– Employers have the discretion to implement additionalor stricter policies.• Common additions:– Smoke-free outdoor spaces/campuses– Buffer zones– Tobacco-Free campus (smokeless, alternativeproducts)
12. Statistics on Quitting Post SFWL• A Cochrane review found evidence that communityinterventions using "multiple channels to providereinforcement, support and norms for not smoking"had an effect on smoking cessation outcomes amongadults, including: • Policies making workplaces1 and public places smoke-free • Estimated that "comprehensive clean indoor laws" can increase smoking cessation rates by 12%–38%21. Lee CW, Kahende J (2007). "Factors associated with successful smoking cessation in theUnited States, 2000". Am J Public Health 97 (8): 1503–9. doi:10.2105/AJPH.2005.0835272. Lemmens V, Oenema A, Knut IK, Brug J (2008). "Effectiveness of smoking cessationinterventions among adults: a systematic review of reviews". Eur J Cancer Prev 17 (6): 535–44.doi:10.1097/CEJ.0b013e3282f75e48
13. Approach 2: Employee Benefits• PPACA Law– Beginning in 2014, all new health plans will berequired to offer smoking cessation benefits(both medications and counseling) tomembers free of co-pays.• MassHealth Benefit (2006)• Commonwealth Care Benefit (2012)
14. Recommended benefit for smoking cessation• All 7 FDA-approved medications are covered for 2 courses of treatment in acalendar year with a prescription• Brief and intensive counseling are a covered service• Four tobacco cessation counseling sessions of at least 30 minutes for atleast two quit attempts per year. This includes proactive telephonecounseling, group counseling and individual counseling.• No copayments or coinsurance and not subject to deductibles, annual or lifetime dollar limits.Federal Employees Health Benefits (FEHB) as of 2011
15. Promotion and Utilization10,00040% of all75%MassHealth smokersConsumerAwareness 8,000 Total People UsingBenefit 75,810Number of Claims 6,000 31% Consumer Awareness 4,000 2,000 MTCPMTCP PromotionsPromotions Began Ended0 Apr-06 Jul-06 Oct-06 Jan-07 Apr-07 Jul-07Oct-07Jan-08 Apr-08Jul-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.
16. Declines in Smoking Prevalence Smoking Prevalence in Massachusetts Adults (18 - 64):MassHealth vs. No Insurance Over 33,000Smoking Prevalence (6-Month Annual Rolling 45.0% MassHealth smokers quit 40.0%Average) 35.0% 26% drop in 30.0% smoking prevalence 25.0%03 04 990001 0205 0607 08 2020 2020 20 20 19202020 1/1/1/ 1/1/ 1/1/ 1/1/ 1/ 7/7/ 7/7/ 7/7/ 7/7/ 7/ 7/ MassHealth (Point Estimates)No Insurance (Point Estimates) MassHealth (Model Estimates)No Insurance (Model Estimates) Annual percentage rate (APR) change for smoking prevalence among MassHealth uninsured adults in Massachusetts aged 18-64. Source: Massachusetts Behavioral Risk Factor Surveillance System, 1998 to 2008
17. Near-term health impact• Study finds health impact within one year– 46% decrease in probability of hospitalizationfor heart attack– 49% decrease in probability of hospitalizationfor acute coronary heart disease– Controlled for demographics, prior healthrisks, seasonality, statewide influenza rates,and the implementation date of theMassachusetts Smoke-Free Workplace Law
18. Actual costs of benefit• Actual costs only exceeded $7 million allocationin one fiscal year• Costs were primarily for medication; counselinghad only a 1% utilization rate• FY07 $3.9 million• FY08 $7.023 million• FY09 $5.9 million• Costs decreased as use of Chantix decreasedSource: MassHealth encounter data
19. Return on Investment• Studies of the MassHealth benefit foundthat a positive return on investmenthappens within one year.• A study by George Washington Universityshows a $2.21 net gain for every $1.00spent on the MassHealth smokingcessation benefit.
20. Building on the MassHealth experience• Coverage for all FDA-approvedmedications• Coverage for behavioral counseling• Low co-pays• Allow for repeated quit attempts• Consistency of benefit across plans• Promotion of available benefit
21. Supporting tobacco treatment in workplace• Develop clear and concise communications• Frame communication as goal of better health foremployees, not cost saving• Create a "brand" around the cessation program• Use a variety of communication methods such as: – Employers intranet, Home mailings, Mass e-mails, Posters, Employee newsletters• Recruit employees to assist with support andencouragement for employees trying to quit• Be patient — recognize that this kind of culture changecan take timehttp://www.businessgrouphealth.org/tobacco/cases tudies/index.cfm
22. Massachusetts Department of Public Health, Tobacco Cessation and Prevention Program
23. • At least $96 billion per year in direct medical costs in US1• Businesses pay an average of $2,189 in workers‘ compensation costsfor smokers, compared with $176 for nonsmokers2• An estimated $96.8 billion per year in lost productivity due to sicknessand premature death in US3• Cost analyses have shown that tobacco cessation benefits, from anemployers perspective, are cost-saving.4,51, 3 CDC, MMWR , September 30, 2011/60(38);1305-13092, 4 National Business Group on Health, November 20115US DHHS, Treating Tobacco Use and Dependence- 2008 Update