Managed Care - June 2008 - (Page 42)

heavily advertised on television. The result: Enrollment in Group Health’s smoking cessation program almost doubled in January 2008 compared to a year earlier. Swadener thinks both new features reeled in new participants, but she suspects that the waived copayment might have the stronger pull. She says research has shown that even though copayments are typically less than the amount a smoker spends on tobacco each month, they are viewed by smokers as a barrier that keeps them from trying to stop. “If you have a good program and provide coverage for medication, removing copayments . . . will strongly encourage people to come on board,” she says. Beyond that, Group Health, a health plan integrated with a physician practice, has made smoking cessation a part of each physician’s work. “We make tobacco a vital sign, which means that, when physicians pull up our electronic medical record, not only do they see temperature, blood pressure, and pulse, but they see smoking status as one of the vital signs that has to be checked at every visit,” Orchard says. worked with other health plans and organizations that offer quitlines in the state to develop a new Minnesota Clinic Fax Referral Program to encourage physicians to refer patients to stop-smoking programs. The incessant message If a patient is identified as a tobacco user, physicians are to offer advice to quit at every encounter. Brochures are stocked in each exam room so the provider can offer information about the Free & Clear program. Meanwhile, the EMR spits out an after-visit summary for the patient with words that reinforce the advice to quit and a reminder that Free & Clear coaching is a covered benefit. Blue Cross & Blue Shield of Minnesota, which contracts with Free & Clear for phone coaching services, says the combination of societal trends and the availability of individual support seems to have an effect. The state’s Freedom to Breathe Act went into effect last fall, banning smoking in most indoor public places and in all indoor places of employment. Demand soared for smoking-cessation help. The insurer’s quitline enrollments increased to 525 that month, nearly 43 percent over the previous month. Meanwhile, Blue Cross tallied a threefold increase in claims for over-the-counter quitsmoking medications in October 2007 compared to October 2006. Hoping to catch a wave, the Minnesota Blues For-profits getting on board Aetna is also drawing physicians into the fight against tobacco. “We realize that the doctor-patient relationship is very valuable. There is power in someone’s personal physician saying ‘I care about you and I want you to stop smoking and here’s why,’” says Dexter Campinha-Bacote, MD, Aetna’s medical director for the North Central region, citing studies that show smokers are almost twice as likely to quit for five or more months if they have a physician involved in the process. Aetna’s physician outreach follows the January 2007 introduction of the insurer’s Quit Tobacco program, a one-year program that offers personal coaching by tobacco cessation counselors that work for a subcontractor and a six-week supply of nicotine replacement therapy. In late 2007, Aetna distributed “Advising Smokers to Quit” toolkits to more than 8,500 primary care physician offices in southern New Jersey, Ohio, Pennsylvania, and Texas. The kits are intended to prompt physicians to tell their patients to stop smoking and to provide tools that help, such as an action plan sheet on which to document the patient’s quit date, medication protocol, and support strategies. Meanwhile, Jodi Aronson Prohofsky, PhD, senior vice president for operations at Cigna Behavioral Health, says her company hired and trained its own counselors to support the Quit Today program. When a smoker agrees to quit, a Cigna coach uses a motivational interview to identify the smoker’s internal reason, his external motivation, such as a nagging family member, or an environmental motivation, such as an employer offering a cash bonus for behavior change. “It is not just about, ‘Can you pick a date to quit smoking? On that date throw all of your cigarettes out, slap your patch on, and good luck,’” Prohofsky says. “It is about understanding what is really internally motivating them.” MC 42 MANAGED CARE / JUNE 2008

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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