Transcript Document
Minnesota: Reaching Beyond the Helpline October 25, 2007 National Conference on Tobacco or Health
•
Presenters
Theresa Leonard
ClearWay Minnesota SM
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Deborah Dora
Park Nicollet (PN)
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Sandra Peterson
Northwest Medical Center (NWMC)
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Carolyn Peterson
Park Nicollet (PN)
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Christine Melko
Park Nicollet (PN)
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Susan Kalgren
Beckman Coulter
ClearWay Minnesota
SM Our Mission: Enhance life for all Minnesotans by reducing tobacco use and exposure to secondhand smoke through research, action and collaboration.
ClearWay Minnesota
• Funded with 3% of State’s tobacco settlement monies • Reports to Ramsey County District Court • Funds may not be used to reduce or substitute for benefits available from other programs
QUITPLAN
®
Services
• QUITPLAN Helpline 1-888-354-PLAN • quitplan.com
• QUITPLAN Centers • QUITPLAN at Work • Community-Tailored QUITPLAN Centers
QUITPLAN
®
Helpline
• One-on-one professional counseling • Help with creating a personalized plan • Support and tools including NRT • Multilingual service – En español – For hearing impaired, 1-877-777-6534 – Interpretation available in many languages
quitplan.com
• Over 30,000 Minnesotans enrolled since launch (August 2003) • Provides 24/7 interactive cessation advice and social support at all stages of readiness to quit • Professional smoking cessation counseling available • Other unique features (clubs, forums, etc.)
Community-tailored Centers
• Five centers provide services for priority populations – African American – Chicano Latino – American Indian – Southeast Asians including: Vietnamese, Hmong, Cambodian, Laotian, Karen
QUITPLAN
®
at Work
• Administered through the Park Nicollet Institute • Provides group counseling at workplaces • Qualifying workplaces have 8 or more employees wanting to quit smoking
QUITPLAN
®
Centers
• Provide face-to-face counseling services • Located within existing health care facilities • Locations throughout greater Minnesota and metro area • Focus on people making a quit attempt in the next 30 days
Competitive Grant-Making Process
• QUITPLAN Centers funded since 2003.
• Grant parameters: – Focus on clients who want to quit in the next 30 days – Provide a minimum of 35 hours of counseling per week – Provide medical oversight for NRT dosing – Collect and provide data to ClearWay Minnesota
QUITPLAN Centers
Differences in delivering rural versus urban cessation services in a clinical setting
Sandra Peterson
Northwest Medical Center (NWMC)
Christine Melko
Park Nicollet (PN)
Deborah Dora
Park Nicollet (PN)
Presentation Outline
• Location and Clinic set-up –
Site selection
–
Documentation
– –
Provider relationship Pharmacotherapy
• Marketing • Our patients • Reimbursement • Counseling • Success
Rural: Northwest Medical Center
QUITPLAN Sites: 1) Thief River Falls - Hospital 2) Karlstad - Clinic 3) Hallock - Clinic 4) Roseau – Dental clinic
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Small farming communities
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Long distances to travel
Rural Site Selection
• Originally 2 sites selected – NWMC in Thief River Falls and Kittson Memorial Clinic of Karlstad. • Roseau added 1 year later – Dentist is strong advocate • Sites selected to minimize travel distances • Kittson Memorial Healthcare Clinic of Hallock - 4 th added to reach western Minnesotans site • Population density in region considered; larger communities selected from each region
Documentation
• Site specific appointment scheduling • Documenting visits – paper files • Communication – phone, paper • Billing – site specific
Provider Relationships
• Introducing the program and educating all providers on cessation • Mayo training for counselors and education for all providers • Building trust • Lunch and learns • Quarterly newsletters
Rural Outreach and Marketing
• Lunches with providers • Quarterly newsletters • Inpatient visits to all smokers • Business outreach • Limited local media – radio, community paper, local cable TV • Special events and venues: e.g. curling center • Word-of-mouth
Rural - Who are we serving?
• Small farming communities • Caucasian/Scandinavian descent • Very independent • High rate of co-morbidity – physical and behavioral • Heavy smokers • Chew tobacco users
NWMC Reimbursement Rates
Payer
Health Plans
INDIVIDUAL COUNSELING
Number of Clients Amount Billed Amount Received 219 $32,280 $ 16,679 Medicaid 17 $5,171 $ 3,681 Medicare Other
TOTALS
31 27 294 $ 4,755 $ 3,946 $ 46,152 $ 5,644 $ 1,227 $ 27,231
Overall reimbursement = 59%
Counseling - Rural
• Two counselors: - One MSW, with licensure to bill independently - One MA bills “
incident to
” • Primarily individual counseling – 3-4 sessions Challenges: – Chew tobacco – Hesitation to complete pharmacotherapy – Co-morbidities – No-show rate high
Motivational Display in QUITPLAN Center Money saved by quitting smoking
Key Successes/Rural
• Physicians see QUITPLAN counselors as “experts” in tobacco cessation • 26% of referrals are family/friends who have gone through the program • Excitement of past clients when they meet a milestone in their lives being tobacco free (calling or e-mailing to let counselor know of their success)
Urban: Park Nicollet Center
Urban Site Selection
• Geographic representation of Park Nicollet clinics • Smoking rates higher in specific communities • Greatest provider interest and support • Strive to accommodate patients’ geographic preferences
Documentation
• Electronic Medical Record –
Scheduling
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Documentation of visits
• Email communication • Multiple users: decentralized!
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Call centers
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Administration and billing
Provider Relationships
• Champion physician • Coordinated team of providers –
Medical oversight
–
Counselors bill “incident to
” • Large health care system –
Decentralized
–
Internal e-communication
–
Clinic in-services
Pharmaceuticals
• Educate providers to include prescription with referral • Patient follow-up required –
Check insurance coverage
–
Follow-up with provider for prescription
• If no insurance coverage, counselors order NRT to be fulfilled through direct mail
Urban Outreach and Marketing
Urban - Who are we serving?
Female Age (years)
• 18-24 • 25-54
Race/Ethnicity
• White/Caucasian • Black/African American
Education
• Grade 11 or less, no degree • GED or High school degree • Some college (but no degree) • College or university degree
Health Insurance At what age did they start?
• <18 years 58% 4% 73% 84% 12% 5% 24% 43% 28% 88% 65%
PN Reimbursement Rates
Payer
Health Plans
INDIVIDUAL COUNSELING
Number of Clients Amount Billed Amount Received 254 $23,475 $7,074 Medicaid 11 $1,004 $235 Medicare Other
TOTALS
52 59 356 $3,255 $4,649 $32,383 $1,015 $0 $10,748
Overall reimbursement = 33.2%
PN Counseling
• Two counselors – neither with licensure to bill independently – MSW – RN • Primarily one to two visits
Type of visit Number of visits % Total visits
1 st 2 nd 3 rd >3rd
TOTAL
368 161 59 38
626
59 26 9 6
100%
PN visit data as of October 17, 2007
PN Counseling Challenges
• No show rate • Co-morbidity • Working in a large system • Working with many medical doctors • Amount of time spent on documentation required by Clearway Minnesota and Park Nicollet
Key Successes/Urban
• Success of patients quitting • Patient satisfaction with services • Patient referrals • Consistent referral from doctors • Pharmacy arrangement for Chantix
Comparison Summary of Urban and Rural QUITPLAN Centers
Comparison: Clinic Set-Up
Rural-NWMC
• One hospital, 2 clinics, 1 dental office • Paper scheduling and documentation • Few providers – close relationships • Counselor work closely with provider for treatment plan
Urban- PN
• Metro area – 6 clinics • Electronic documentation • Rely heavily on internal referral system • Patient has shared responsibility
Comparison Rural/Urban Marketing
Rural-NWMC Urban-PN • Limited local media • Word-of-mouth • Community events • In-patient visits to all smokers • Being creative!
Types of tobacco:
Cigarette Light (1<14) Moderate (15-24) Heavy (25+) Chew/Snuff
How did you hear about QUITPLAN?
Referral from medical provider Family/Friends Workplace
Race/Ethnicity
White Black/African American
Education
Grade 11 or less GED or high school Some college
Rural
93% 19% 44% 37% 8% 28% 26% 15% 98% 0% 7% 37% 28%
Urban
99% 22% 53% 24% 1% 50% 5% 4% 84% 12% 5% 24% 43%
Comparison: Reimbursement Rates
•
Overall reimbursement
– NWMC – Park Nicollet 59% 33% •
Percent uninsured
– NWMC – Park Nicollet 14% 12%
Comparing counseling
Rural-NWMC
• Counselors MSW’s • 3-4 individual sessions • Chew tobacco • Co-morbidities • Lengthy documentation • Few providers • No-show rate high
Urban-PN
• Counselors MSW, RN • 1-2 visits • Few use chew tobacco • Co-morbidities • Lengthy documentation • Multiple providers • No show rate high
QUITPLAN
®
at WORK
Minnesota Statewide Worksite Cessation Program
Presenter: Carolyn Peterson
Copyright © 2007 Park Nicollet Institute
Program Overview
November 1, 2003 through October 31, 2008 • Primary objective: Reduce tobacco use by providing worksite cessation classes in more than 50 worksites throughout Minnesota each year • Secondary objectives include: - Create awareness of tobacco cessation resources - Assist worksites with tobacco policies
Park Nicollet HealthSource
• Park Nicollet Institute, the health education and research arm of Park Nicollet Health Services in Minneapolis • Provider of worksite health promotion since 1979 • Consultant to companies on a wide range of health improvement areas including tobacco cessation and tobacco policy development • Created network of Regional Partners in each of the 6 regions of the state
Northwest Medical Center, Thief River Falls Northeast North Country Regional Hospital, Bemidji Northwest Range Mental Health Center, Virginia St. Joseph’s Area Health Services, Park Rapids Lake Region Hospital, Fergus Falls F and F Enterprises, Sauk Center St. Joseph’s Medical Center, Brainerd CentraCare Health System, St. Cloud Central Regional Partners Southwest Affiliated Community Medical Center, Willmar Worthington Regional Hospital Park Nicollet Institute, Minneapolis Immanuel St. Joseph, Mankato Mayo Clinic, Rochester Metro Southeast
Counselor Training
• Counselors must hold a degree in a medical or health and human services field • Counselors must have a minimum of two years of appropriate related counseling experience • Counselors must complete the training sponsored by ClearWay Minnesota • Counselors must use standardized curriculum prepared by Park Nicollet HealthSource
Standardized Curriculum
Program Overview • Understand benefits of quitting Early Maintenance • Introduce lifestyle changes Preparation for Quit Day • Explore effective coping skills The Quit Day!
• Learn stress management techniques Long-Term Success • Identify and implement relapse prevention strategies
Participants Receive:
• Five weeks of group-led support by a trained professional • Detailed information about Zyban, Chantix and Nicotine Replacement Therapy • Stop smoking tools • Seven additional weeks of relapse prevention cards/emails to each participant • Connection to additional resources
Quit Tools Include:
Quit Week – Build Your Survival Kit
Getting the Word Out to Minnesota Companies • Exhibiting – Midwest Worksite Conference – SHRM – MAOHN – MAHU – Minnesota Safety Conference • Networking – EAPs – Insurance Brokers – Insurance Companies • Regional Partners • Direct Mail • Websites
Successful Implementation
• Application process • Communication tools for companies • Minimum number of participants required • Adult family members included • Grant parameters
Programs
240 classes offered through July 2007
Northwest 23 Northeast 18 Southwest 15 Central 28 Metro - 132 Southeast 25
Metro – 132 Out State - 109
Participants Served
• Average class size of 8 participants • Additional employees reached though Resource Center materials (includes promotion of QUITPLAN Helpline, QUITPLAN Treatment Centers and quitplan.com)
Evaluation Professional Data Analysis Outcomes Report December, 2006
Evaluation Report
Information and advice provided by the program can be trusted
0% 0% 1% 37% 62% Strongly agree Agree Disagree Strongly disagree Missing
Evaluation Report
The program gave me a new way to think about quitting
9% 0% 0% 41% 50% Strongly agree Agree Disagree Strongly disagree Missing
Evaluation Report
I was treated with respect
12% 0% 0% 0% Strongly agree Agree Disagree Strongly disagree Missing 88%
Company trends
• Providing health insurance incentives for non-smokers • Classes filling, requiring need for additional program(s) • Implementing a more restrictive tobacco policy (campus tobacco-free) • As city and state ordinances change, more interest in cessation programs
2007 NATIONAL CONFERENCE ON TOBACCO & HEALTH
SMOKING CESSATION PROGRAMS AT THE WORKSITE: BECKMAN COULTER, INC .
Beckman Coulter
• Worldwide medical diagnostics business • Corporate offices: Fullerton, CA • 11,000 employees • Simplify, Automate, Innovate • “We make a difference in people’s lives”
Smoking Cessation and Corporate Policy
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July 1, 2007
– Tobacco-Free Workplace Policy: Tobacco use disallowed on Beckman Coulter campuses and vehicles – – – –
Employee Health:
Smoking remains the leading preventable cause of death in the U.S. accounting for 1 of every 5 deaths each year
Aesthetics & Hygiene:
Designated smoking areas frequently a mess; numerous complaints regarding policy infractions – smoking in building entrances and between buildings
Corporate Image:
A tobacco-free workplace is in alignment with our corporate social responsibility and image as a health care company and recognized leader in early disease diagnosis
Public Policy:
Clean Indoor Air Act; other state restrictions
Smoking Cessation at the Worksite
• As policy restricts – more people quit • Greater influence over a worksite population – Understand individual needs and what motivates for change – Site leadership support – Ease of communications – Recognition among peers – Ease of access
Implementation
• QUITPLAN at Work – professional, credible, personable • Superior program materials: researched, colorful, easily understood • Communications: sample pieces for managers/employees • Program design: onsite, free, with lunch provided • Post-program: 7 weekly e-mails sent to all participants
Results
• 5-week programs offered January and May, 2007 • Twenty-three participants in total • Twenty-two completed the program • 55% quit rate to date • Employee comments: – “Thanks so much for making it harder to smoke…it’s what I needed to get me to quit!” – “Can we continue to get free lunches through you?” – “It helped me to know that my smoking buddies at work were going through this with me…helps to quit together, since we smoked together.” – “Even though I don’t like this, it’s great that Beckman Coulter cares about employees enough to support our quitting.”
Quit Rates – QUITPLAN Centers
• Through June 2007, over 3,100 clients were provided counseling services at QUITPLAN Centers.
• Centers showed a 26.1% quit rate of respondents at 7 month follow-up • The more conservative “Intention to Treat” quit rate at six months was 20.1%
Quit Rates – QUITPLAN at Work
• Has provided service to over 231 sites and almost 200 participants since January 1, 2004. • Worksite program showed a 36.8% quit rate of respondents at 7 month follow-up • The more conservative “Intention to Treat” quit rate at six months was 26.5% • High level of satisfaction from participants
Summary
• ClearWay Minnesota's QUITPLAN programs are customized to meet the various needs of Minnesota's smokers.
• Programs are tailored to meet the challenges of tobacco users in rural/urban/and worksite settings.
• These programs have been very successful, as shown in in patient satisfaction, quit rates and giving smokers options "Beyond the Helpline."
Questions?