Transcript Employers and Prevention: Shaping the Future

Tobacco Cessation:
The Business Perspective
Maris Ann Bondi, MPH
Partnership for Prevention
Alliance for Tobacco Cessation
National Conference on Tobacco or Health
November 19, 2002
Employers and Health Care
 Primary sponsors of private health
insurance for more than 152 million
Americans
 More than 80 percent provide worksite
health programs
 Manage worksite environments for
working adults
Effect of Tobacco on
Employers
Tobacco users (compared to non-users):
 Have higher annual medical costs
 Have higher life insurance premiums
 Miss more days of work
 Have lower productivity
Effect of Tobacco on
Employers
Tobacco use at work:
 Risk of fires, accidents, smoke damage
 Higher maintenance costs
 Dirtier environment
 Risk of liability if nonsmokers are
exposed
Employers and Tobacco
Cessation: Current Activities
 National survey of employers, 2001
 Health plan tobacco cessation services
 Worksite tobacco cessation services
 Focus groups with employers, 2002
 Perceived roles in tobacco cessation
 Barriers to expanded involvement
 State mandates requiring tobacco cessation
coverage in health plans, through 6/2001
National Survey: Tobacco
Cessation Services, 2001
35
Average Percent of
Employers Offering
Tobacco Cessation
30
25
20
15
10
5
0
All plans
PPO
POS
HMO
National Survey:
Type of Tobacco Cessation
30
Average
Percent
All Plan
Types
25
20
15
10
5
0
Counseling
Rx
OTC
Self-help
National Survey:
Type of Tobacco Cessation
Average
Percent
in PPOs
Average
Percent
in POSs
Average
Percent
in HMOs
35
30
25
20
15
10
5
0
Counseling
Rx
OTC
Self-help
National Survey:
Worksite Tobacco Services
Only 5 percent of employers
surveyed nationwide have tobacco
cessation services offered at their
worksite (outside of health plans)
Employer Focus Groups,
2002: Tobacco Programs
 Primarily, larger employers offer worksite
services and telephone counseling
 EAPs are useful for support and referral
services
 Some employers pay directly for tobacco
cessation pharmaceuticals not covered
through health plans
Employer Focus Groups:
Tobacco Policies
Most employers have strict non-smoking
policies in the workplace and where
employees can smoke outside
 Some areas still allow smoking in
workplace
 Employers follow local ordinances
 Employers with strong union presence
often allow smoking “on the line”
Employer Focus Groups:
Tobacco Cessation
 Employers are aware that tobacco users
may see “benefits” such as stress
reduction and work breaks
 Participants view available cessation
programs as ineffective, but still believe
them to be good investments
 Employers see cost-effectiveness as
difficult to measure/assess
Employer Focus Groups:
Tobacco Cessation Role
 Participants said employers should not
be involved because:
 Employees are adults and make own
decisions
 Tobacco is not a workplace issue
 Intrusion into employees’ lives
 Primary employer role is to offer
services so that if employee wants
them, they are available
Employer Focus Groups:
Motivation for Involvement
 “The right thing to do”
 Improved internal and community morale
 It’s a need because many employees use
tobacco
 Breaks interrupt work time and
productivity
 Safety and hygiene concerns
 Reduce health premium costs
Employer Focus Groups:
Important Program Factors





Cost
Credibility
Success with high participation
Not “too intrusive”
Easy to implement
Employer Focus Groups:
Tobacco Cessation Benefits
Employers understand the benefits to
implementing tobacco cessation programs:
 Lower health premiums
 Better health
 Fewer breaks
 Higher productivity and less sick time
Employer Focus Groups:
Tobacco Cessation Barriers
Barriers exist to prevent employers from
expanding tobacco cessation programs:





Cost
No ROI information
Takes away from work time
Intrusion
Non-smokers find money spent on smoking is
unfair/should spend on something for all
Employer Focus Groups:
New Roles
Participants want to expand their role:
 Offer variety of programs
 Offer services, do not force them
 Make all events “smoke-free”
 Provide telephone counseling
 Utilize EAP services
Employer Focus Groups:
Information Needed





Successful program models
ROI statistics
Marketing and communications kits
Educational materials
Programs provided by health plans and
pharmaceutical companies
Employer Focus Groups:
Potential Strategies
 Testimonials from employees that are
former tobacco users
 Compassionate messages (no negative)
 Health plans to provide educational
materials directly to employees
 Email and voicemail broadcasts
Employer Focus Groups:
High Smoking Region
Participants in high smoking regions
conveyed four themes:
1)
2)
3)
4)
Employees take too many smoking breaks
Tobacco use more accepted/allowed
Employers should not intrude
Programs must be proven and costeffective
Employer Focus Groups:
Low Smoking Region
Participants in low smoking regions
conveyed four themes:
1) Tobacco use causes tension because of
breaks and higher premiums
2) Cleanliness is problem
3) Fear of intrusion is strong
4) Smokeless tobacco is big problem, often
overlooked
Employer Focus Groups:
Large/National Employers
Large, national employer participants
conveyed four themes:
1) Feel obligated to intervene because of
negative effect of tobacco
2) Best to offer programs, not force them
3) Programs will be used more often if they are
discrete and confidential
4) Programs must be proven and cost-effective
for implementation to occur
State Requirements 2001
versus USPSTF
The US Preventive Services Task Force
(USPSTF) recommends:
1) Counseling for tobacco users, pregnant
women, parents;
2) Nicotine patches or gum for selected
patients; and
3) Health promotion with anti-tobacco
messages.
States partially match USPSTF.
State Requirements:
Tobacco Cessation Services
Three states mandate some type of tobacco
cessation service:
 California: Requires group health plans to offer
nicotine treatment
 Iowa: Requires HMO plans to provide wellness
education, including smoking cessation
 New Jersey: Requires group health plans and
HMO plans to provide annual lifestyle
counseling, including smoking control
State Requirements:
Tobacco Cessation Services
States often require a basic or standard
plan to be offered through health insurers.
Tobacco cessation is offered in these plan
types in four states:
 Colorado
 New Jersey
 North Dakota
 South Carolina
ATC: Related
Recommendations for HHS
1) Partner with employers and health plans
to expand coverage of tobacco
cessation services
2) Work with employers to facilitate
expansion of tobacco cessation services
offered through employers
3) Develop model federal legislation to
mandate tobacco cessation service
ATC: Related
Recommendations for HHS
4) Work with employers and health plans to
decrease/eliminate out-of-pocket costs
for tobacco cessation treatment by 2004
5) Partner with employers and health plans
to develop performance measures on
tobacco service delivery
6) Work with employers and health plans to
increase cost of tobacco products
Employers:
Health Policymaker Role
Healthy policymakers can assist employers
to expand tobacco control and prevention
by:
1) Providing ROI and effectiveness
information in a useful format
2) Creating programs that are effective,
but not intrusive
Employers:
Health Policymaker Role
3) Disseminating information about tobacco
and the effect it has on the workplace and
health
4) Convening business and union groups to
cultivate support for tobacco restrictions in
public places
5) Strengthening linkages between worksite,
public, and voluntary health efforts to
promote cessation
Working Together
Employers, with assistance from HHS,
health plans, and health policymakers,
can expand tobacco control and
prevention activities. Barriers exist, but
can be overcome with information,
education, and research. Supportive
partnerships and a dedication to tobacco
control are necessary.
More Information
(202) 833-0009, extension 102
[email protected]
www.prevent.org
References
 National Survey Data:Insurance Coverage of Clinical
Preventive Services in Employer-sponsored Health Plans:
Preliminary Results of a Partnership for Prevention/Mercer
Human Resource Consulting National Survey.
Washington, DC: Partnership for Prevention; 2001.
 Focus Group Data: Groups conducted by Sally Johns
Design, Raleigh, NC; 2001.
 State Mandate Data: Collected by National Conference of
State Legislature’s Health Policy Tracking Service; 2001.
 Alliance for Tobacco Cessation: Draft
Recommendations. American Cancer Society,
Center for Tobacco Cessation; 2002.