Expanding Comprehensive Coverage for Tobacco Cessation to Ensure Access to Evidence-Based Treatment in North Carolina Ruth Petersen MD MPH; Chief, Chronic Disease and Injury Section NC.
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Expanding Comprehensive Coverage for Tobacco Cessation to Ensure Access to Evidence-Based Treatment in North Carolina Ruth Petersen MD MPH; Chief, Chronic Disease and Injury Section NC Division of Public Health Welcome and Greetings! Meeting purpose Goals for today Context to help inform our discussions • Scope of the Problem • Current tobacco treatment services in NC • Quitline reach and funding available • Gallery Walk for further illustrations Meeting Purpose PURPOSE: In order to bolster access to existing tobacco cessation treatment options and leverage current opportunities resulting from healthcare reform, the Tobacco Prevention and Control Branch of the Division of Public Health will convene representatives from diverse systems that play a role in ensuring the health and wellbeing of North Carolinians to explore strategies for incrementally reaching 8% or 123,200 of current NC tobacco users with evidence-based treatment. For the first time, this collaborative summit will bring together the public health, insurance, healthcare delivery and business sectors to create a shared vision for expanding and sustaining comprehensive coverage for tobacco cessation treatment. Our Challenge for Today • Given that 62% of NC tobacco users make a serious but failed attempt to quit smoking each year; and • Given that we are currently reaching a little over 1% of NC tobacco users who want to quit with the current funding available; • Given that CDC Best Practices now recommends that state Quitlines work to reach 8 % of tobacco users who want to quit; • What do we need to set in motion today? • Can we work together to assure that 4-6% of current tobacco users who want to quit have access to QuitlineNC through public-private partnerships? Director, NC Division of Public Health PENNY SLADE-SAWYER Paradigm for Tobacco Control Making tobacco addiction easy and accessible: Tobacco Advertising Low price New tobacco products Individual Evidenced Based Interventions change social norms: Quitlines and FDA approved medications covered for all Price/Economic Incentives Smoke-free workplaces and public places laws T o b a c c o Regulation/Liability A d d i c t i o n S o c i e t y More Diseases, More Deaths caused by Smoking New Evidence from the Surgeon General is in red - 2014 Smoking Causes… Secondhand Smoke causes… • 12 kinds of cancer including 87% of lung cancers the new findings of colon and liver cancers. • Chronic Diseases, including coronary artery disease, COPD, stroke, diabetes, TB, asthma, atherosclerosis • Immune function disorders, macular degeneration, blindness, cataracts, hip fractures, rheumatoid arthritis • Reproductive effects in women and men, including LBW, ectopic pregnancy, erectile dysfunction, reduced fertility. • Overall diminished health. In Adults: • Stroke • Lung Cancer • Coronary heart disease • Reproductive effects – LBW In Children: • SIDS • Lower respiratory illness • Impaired lung function • Middle ear disease NC Smoking Rates in Disparate Populations Overall NC Smoking Rate 21.80% Medicaid 41% Uninsured 36% Heavy Drinker 41% Native American 27% <HS Education 33% HS Diploma/GED 26% <$15,000 39% $15,000 - $24,999 28% 0% NC BRFSS 2011 5% 10% 15% 20% 25% 30% 35% 40% 45% What does smoking cost NC? • $3.8 billion per year in excess medical care costs (CDC Best Practices 2014) – Of that, at least $769 million per year in excess health care costs for Medicaid (2006). • $3.3 billion per year in productivity costs (2006). We Know What Works Research indicates the most effective tobacco treatment is a combination of: evidence-based coaching and FDA approved medications. NC Tobacco Users Want to Quit (and need help) 62% of NC tobacco users made a serious but failed attempt to quit smoking in 2011. An evidence-based telephone tobacco treatment service Consists of four treatment sessions Special 10 treatment sessions and protocol for pregnant women Highly trained, professional Quit Coaches Available to all North Carolina residents Accessible 24 hours a day, 7 days a week Integrated with an interactive web based tobacco treatment program Online registration Web only treatment program Two week starter nicotine patches to uninsured, Medicaid and Medicare recipients Eight weeks of patches, gum or combination therapy to State Health Plan members WHO USES QUITLINENC? Insurance Coverage of QuitlineNC Enrollees (FY 2012) Insurance Coverage 1% 85% Medicaid 41% Private insurance 25% 11% Medicare 21% Uninsured 4% 15% Other Private Insurance 22% State Health Plan 15% of Private Insured callers are paid by Insurance Plan - SHP Number of Quitline Enrollees by Commercial Health Plans – FY 2012 WellPath, 111, 2% UHS Medical Plan - MedCost, 126, 2% Aetna, 177, 3% United Health Care, 497, 9% BCBS of NC, 1653, 31% State Health Plan, 820, 15% Other, 1710, 32% Cigna, 294, 6% FirstCarolina Care, 15, 0% HealthChoice 11, 0% Demographics FY 2013 GENDER • AGE 16,507 enrollees 2.3% 0.3% 0.3% Male 36.9% 11.8% 17 years old and under 7.1% 8.1% 18 to 24 25 to 30 31 to 40 15.6% 28.8% 41 to 50 51 to 60 61 to 70 Female 63.1% 25.7% 71 to 80 Over 80 Education 16,507 enrollees 1.4% 2.5% Less than grade 9 5.0% Grade 9-11, no degree 12.6% 19.0% GED High School Degree 7.2% 25.4% Some College or University College or University Degree 26.8% Some Technical/Trade School Technical/Trade School Degree NC Current QuitlineNC Enrollment by Race/Ethnicity 70% 63% 60% 50% 40% 31% 30% 20% 10% 3% 3% 3% American Indian Hispanic Other 0% White Black or African American Mental Health Conditions Collected from QuitlineNC Enrollees : FY 2013 3% 4% 7% 4% 15% ADHD Anxiety Bi-Polar Depression Drug or Alcohol Abuse PTSD Schizophrenia 22% 9% 51% of QuitlineNC enrollees reported one or more mental health conditions Most Quitline Enrollees Have One or More Chronic Health Conditions FY 2013 14% 16% Arthritis 9% Asthma CAD 14% Cancer 5% COPD Diabetes High Blood Pressure 3% High Cholesterol None 11% 20% 8% 84% of QuitlineNC enrollees reported one or more chronic health condition 84% of QuitlineNC enrollees reported one or more chronic health condition Chronic Disease Referrals QuitlineNC Enrollments January 2011 – June 2013 4000 3735 3381 Statewide Media Campaign CDC TIPS April 23 – June 30 2 3397 3500 2950 2945 3000 CDC TIPS I 2500 2268 2102 2159 2381 2000 State Campaign 1500 1294 719 1219 792 962 500 806 1244 Free NRT 957 921 |- --Jan 1 – May 21------| 527 715 699 587 624 542 NRT provided to all QuitlineNC state NRT toreinstated all funding 776 SHP funding only NRT to uninsured only 43 0 1443 CDC TIPS 946 1000 1732 1679 SHP only QuitlineNC WHAT IS GOING WELL? QuitlineNC Annual Enrollments 25000 20588 20000 16814 15000 9835 10000 5980 5000 6537 7624 4096 0 FY 2007 FY 2008 FY 2009 FY2010 FY2011 FY2012 FY2013 QuitlineNC Services for Physician Network • Quitline Fax Referral Program • Physician training on incorporating QuitlineNC into tobacco treatment services • Physician resources on integrating tobacco treatment • HIPAA compliant • Physician support line for assistance in tobacco treatment questions • Physicians support for quitlines as a referral source QuitlineNC meets a critical need of service providers Health Professionals Are the Number One Referral Source to QuitlineNC in FY2013 6000 5000 4000 3000 2000 1000 0 QuitlineNC meets a critical need of service providers NC Division of Public Health Tobacco Prevention and Control Branch QuitlineNC Monthly Data Reports 2013 98% satisfaction rate by SHP members with over 2/3 being very satisfied. “Thank you so much! I have been quit for almost 3 months. I can taste foods now. I can breathe again! I have COPD and my doctor was so happy when she listened to my lungs that she cut down on my other medications. My home smells good again and I am so happy. It’s affected my whole family as well. My daughter also quit for her new baby and she has been quit for 3 months now too!” “I couldn’t have done this without your help. I have not smoked in exactly one year and just having someone to talk to throughout my quit has really helped.” A.P., Harnett County Caller from Wayne County Participants are satisfied with QuitlineNC services “This program works! You all have made my life better. It feels so good to live life again and not give up. I really appreciate what you have done.” Caller from Forsyth County QuitlineNC Has Worked for the State Health Plan for Teachers and State Employees 30 day point prevalence at 7 months from initial call Responder Quit Rate Intent to Treat Quit Rate SHP Member 41.8% 21.1% Non-SHP Members 36.9% 15.0% QuitlineNC is high quality and effective QuitlineNC is high quality ad effective 6 Month Quit Rates Comparison 10% Physician Advice Alone* 30% QuitlineNC Counseling** 42% QuitlineNC*** Counseling & NRT 51%**** ****NC State Health Plan Quit Rates from members who completed four or more counseling calls plus used all 8 weeks Nicotine Patches *Fiore, Treating Tobacco Use and Dependence, Clinical Practice Guidelines 2008 Update ** Alere Wellbeing, QuitlineNC Comprehensive Evaluation Report, 2011 ***State Health Plan for Teachers & State Employees, Evaluation Report, 2010-2011 Responder rates at 30 days point prevalence Six Months Quit Rates and Number of Successful Quits (30 day point prevalence1)- 5,109 Total Quitline Enrollment SHP Allocation Intent-to-Treat Quit Rate2 Respondent Quit Rate3 Median Number of Quitters $1,080,972 21.1% (1078) 41.8% (2136) 1607 1. Respondents being tobacco free for the last 30 days or more at the time of the 7-month survey. 2. This measure regards non-respondents and those who responded “don’t know” or “refused” as continued tobacco users, and thus provides a more conservative quit rate. 3. This measure includes only those respondents reached reporting successful tobacco cessation and thus provides a higher quit rate QuitlineNC is very cost effective State Health Plan Costs vs. Benefits $4,274,620 $4,500,000 $4,000,000 $3,500,000 $3,000,000 $2,500,000 $2,000,000 $1,080,972 $1,500,000 $1,000,000 $500,000 $0 SHP Allocation Cost Avoidance "Benefit" Annual per Capita Medical Costs of Tobacco Use $2,660 Number of individuals presumed to quit due to Quitline NC x 1,607 Estimated cost avoidance “benefit” $4,274,620 QuitlineNC is very cost effective Annual Health Care Costs per Tobacco User and QuitlineNC Services $3,000.00 $2,660.00 $2,500.00 $2,000.00 $1,500.00 $673.00 $1,000.00 $212.00 $500.00 $Medical Costs QuitlineNC is very cost effective Cost per Enrollment Cost per Quit Cost Benefit Analysis Benefit ---------Cost = $4,274,620 --------------$1,080,972 = $3.95 -------$1.00 = ~ 4:1 ROI For every dollar SHP spent on QuitlineNC services, SHP saved $3.95. QuitlineNC is very cost effective Helping NC tobacco users who want to quit RESOURCES Total QuitlineNC Funding and Enrollment $3,500,000.00 25000 21728 $3,000,000.00 20000 $2,500,000.00 16871 15000 $2,000,000.00 Funding Enrollment $1,500,000.00 10000 9739 8321 $1,000,000.00 6616 5000 $500,000.00 $- 0 FY09 FY10 FY11 FY12 FY13 FY14 Most Current QuitlineNC Year (2013) Compared to Goals for QuitlineNC Reach 1540000 1600000 1400000 1200000 1000000 800000 600000 400000 200000 1.4% 22025 6% 92400 8% 123200 0 Current Reach in Public-Private 2013 Partnerships Goal CDC Best Practices Goal Number of Tobacco Users in North Carolina Partnering with QuitlineNC Makes Good Sense Helps meet ACA criteria QuitlineNC is high quality and effective Participants are satisfied with QuitlineNC services QuitlineNC meets a critical need of service providers QuitlineNC is very cost effective It is easy to partner with QuitlineNC Coming soon - QuitlineNC – New Resources for Public Private Partnerships Fiscal Agent NC Public Health Foundation • Chuck Bridger – Key Contact Operations Manager Phone: (919) 707-5237 [email protected] • Elizabeth MacLachlan Executive Director Phone: (919) 707-5237 [email protected] Expert Advice and Technical Assistance Tobacco Prevention and Control Branch • Joyce Swetlick – Key Contact Director, Tobacco Cessation Phone: 919-707-5402 [email protected] • Sally Herndon Branch Head Phone: 919-707-5401 [email protected]