Managed Care - June 2008 - (Page 41)

ties around the country, seeking to get employers to pressure their health plans to offer smoking cessation programs. In the last few years, she has gone from begging employers to discuss smoking cessation programs to finding employers eager for assistance to develop a program. “People are very interested in seeing what we can do over the long term to reduce health care costs,” she says. “I think that smoking cessation is the big one.” Like insurers, employers are also motivated by the economics of tobacco cessation, although they look at a different equation. “Employers understand that some of their medical costs, and loss of productivity among their em- below the national rate of 21 percent. Californians are reaping the rewards: Lung and bronchus cancer rates in California are declining nearly three times as fast as in the rest of the country. By proving that tobacco use can be curtailed, pressure builds on other states, employers, insurers, and individuals. “As smoking becomes more and more denormalized and stigmatized, patients are more motivated to try to quit,” Schroeder says. First tip At the end of 2006, a Seattle company that is the nation’s biggest provider of tobacco cessation coaching services announced that the uphill battle was turning into a downhill slide, thanks to two milestones: The number of former smokers in the Group Health, a health plan integrated with a physician practice, has made smoking cessation a part of each physician’s work. ployees, result from health behaviors that should be addressed now. Rather than wait until someone has developed a chronic disease, it makes sense to get the right behaviors in place earlier on,” says Christine Paige, senior vice president for marketing and Internet services at Kaiser Permanente. Indeed, research now suggests that the payoff for reducing heart disease is counted in months, not years. “There’s good evidence that the return on investment in the short run is pretty good for cardiovascular disease,” says Steven Schroeder, MD, director of the Smoking Cessation Leadership Center at the University of California – San Francisco. “I think it used to be, ‘We’re going to spend all this money so that [workers] won’t die 20 years later from lung cancer, and we don’t profit from that.’” The center, which works to decrease smoking, is a national program of the Robert Wood Johnson Foundation. Schroeder was the foundation’s president and CEO for 12 years before the Smoking Cessation Leadership Center was established. He believes the United States is approaching a “tobacco tipping point — a state of greatly reduced smoking prevalence.” Schroeder takes encouragement from the fact that some population groups are showing how to beat tobacco addiction. The smoking rate in California, for example, is 13.3 percent — considerably United States exceeds the number of current smokers, and more than half of Americans live in states or cities with no-smoking legislation. The company, Free & Clear, uses the Quit for Life coaching program developed by researchers at Group Health Cooperative and at Duke University. The subject of many research studies, the Quit for Life program was instrumental in showing that telephone coaching can improve a smoker’s odds of quitting. Free & Clear’s client list includes major employers such as Boeing and Campbell Soup, health plans, and 17 state tobacco quitlines — smokingcessation coaching services that smokers can reach via a toll-free number. Although Group Health spun off Free & Clear a few years ago, it has included tobacco cessation counseling as a covered benefit since the early 1990s. “It’s the right thing to do,” says Suzanne Swadener, Group Health’s medical support services manager. The plan, unlike most, has provided nicotine replacement therapy as a covered benefit for many years. However, until this year, members were required to make a copayment to get the therapies. In January, Group Health Cooperative began waiving copayments for nicotine replacement therapy purchased through the insurer’s mail-order pharmacy. At the same time, the plan started covering varenicline (Chantix), a nicotine replacement JUNE 2008 / MANAGED CARE 41

Table of Contents Feed for the Digital Edition of Managed Care - June 2008

Managed Care - June 2008 Editor’s Memo Contents Viewpoint Letters News and Commentary Legislation & Regulation Medication Management Compensation Monitor Plans Chart Course in Rough Waters A Conversation With Barbara Starfield, MD Smoke Signals from Payers Slow Going for Clinical Decision Support Back Pain and Physical Therapy Formulary Files PlanWatch Outlook

Managed Care - June 2008

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