Transcript SETTING OUR COMPASS QuitlineNC: Partnering to Improve Tobacco Cessation in North Carolina We Know What Works Research indicates the most effective tobacco treatment is a combination.

SETTING OUR
COMPASS
QuitlineNC: Partnering to Improve Tobacco
Cessation in North Carolina
We Know What Works
Research indicates the most
effective tobacco treatment
is a combination of:
evidence-based coaching
and
FDA approved
medications.
QuitlineNC is
high quality and
effective
Cessation Benefits
Cessation Benefits Should Include
ALL of These Treatments:
Barriers to Avoid:
MEDICATIONS
COUNSELING
× Co-pays
 Nicotine Gum
 Individual
× Prior authorization
 Nicotine Patch
 Group
× Duration limits
 Nicotine Lozenge
 Phone
× Annual limits on quit attempts
 Nicotine Nasal
Spray
× Dollar limits
 Nicotine Inhaler
medication before another
× Requirements to pair
medications with counseling
 Bupropion
 Varenicline
Helps meet
ACA criteria
× Requirements to try one
What increases success rates?
Clinic:
Clinicians Using 5 A’s
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Ask - Identify and document tobacco use status for every patient at every visit. (You may wish to develop your own vital
signs sticker, based on the sample below).
Advise - In a clear, strong, and personalized manner, urge every tobacco user to quit.
Assess - Is the tobacco user willing to make a quit attempt at this time?
Assist - For the patient willing to make a quit attempt, use counseling and pharmacotherapy to help him or her quit. (See
Counseling Patients To Quit and pharmacotherapy information in this packet).
Arrange - Schedule follow-up contact, in person or by telephone, preferably within the first week after the quit date.
Counseling plus FDA Approved tobacco treatment
Using combination therapy tailored to the need (e.g. Patch +
buproprion; patch + gum)
Using the full course of medications
Community:
Smokefree workplaces and public places/social norm changes
Price increases (at least 10% of the price of a pack of cigarettes)
Mass media campaigns (especially when combined with local programs
like QuitlineNC)
Federal-Level Cessation
Puzzle Pieces
Affordable
Care Act:
private
insurers
Medicaid
Quitline
Guideline
Federal
Employee
Health Benefit
CDC’s
Resources:
Tips from Former
Smokers
Campaign and
Quitline Capacity
funding
Affordable
Care Act:
public
insurers
Joint
Commission
Tobacco
Treatment
Performance
Measure
Set
Meaningful
Use
Patient Protection and
Affordable Care Act (ACA)
• Signed into law on March 23, 2010
• Multiple provisions that increase access to clinical
preventive services
• Required private health plans to cover all U.S. Preventive
Service Task Force (USPSTF) A and B Recommendations
Helps meet
ACA criteria
Patient Protection and
Affordable Care Act
• Eliminate cost sharing requirements for preventive
services
• Applies to insured group and individual plans and self
insured plans, but does not apply to grandfathered plans
• Generally required of all new plans beginning on or after
September 23, 2010
Helps meet
ACA criteria
Tobacco “A” Recommendation
• The USPSTF recommends that clinicians ask all
adults about tobacco use and provide tobacco
cessation interventions for those who use
tobacco products.
Tobacco use counseling: pregnant women
• The USPSTF recommends that clinicians ask all
pregnant women about tobacco use and provide
augmented, pregnancy-tailored counseling to
those who smoke.
Tobacco Cessation benefits under the
Affordable Care Act Updated May 2, 2014
The Obama Administration recently issued guidance
recommending comprehensive quit smoking benefits
available through the Affordable Care Act (ACA).
Specifically, this includes coverage* of:
• All medications approved by the FDA as safe and effective for
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smoking cessation;
Individual, group and phone cessation counseling;
These quit smoking benefits should be offered at least twice a year
to smokers, recognizing not everyone quits on their first try;
Plans should not require prior authorization for these benefits; and
These benefits are to be provided at no cost to the patient – so no
co-pays, coinsurance or deductibles should be charged.
* Applies to private – non-grandfathered; does not apply to traditional Medicaid or
Medicare; they are still allowed to charge a co-pay.
The Joint Commission
An independent, not-for-profit organization, The Joint Commission accredits
and certifies more than 20,500 health care organizations and programs in the
United States. Joint Commission accreditation and certification is recognized
nationwide as a symbol of quality that reflects an organization’s commitment
to meeting certain performance standards.
The Joint Commission Performance measure set includes:
1. Screening for tobacco use from all patients entering in the
hospital.
2. Treating or offering tobacco treatment to all tobacco users in
the hospital.
3. Treating or offering tobacco treatment to all tobacco users
upon discharge of the hospital.
4. Following up within 30 days to determine tobacco use status
of tobacco users after discharge from hospital.
Meaningful Use
Meaningful Use* is an incentive plan that eligible health care
professionals and hospitals can qualify for through Medicare and/or
Medicaid when they adopt certified Electronic Health Record (EHR)
technology and use it to achieve specified objectives.
Meaningful use core objective for tobacco use:
a. Percentage of patients aged 18 years and older who have been seen
for at least 2 office visits who were queried about tobacco use one or
more times within 24 months; and
b. Percentage of patients aged 18 years and older identified as tobacco
users within the past 24 months and have been seen for at least 2
office visits, who received cessation intervention.
* The Recovery and Reinvestment Act of 2009 (ARRA) established the Health Information Technology for
Economic and Clinical Health (HITECH) Act. Meaningful Use came out of regulations from the HITECH Act.
Center for Medicare and Medicaid
Services - CMS
• Medicaid Quitline Guideline – CMS sent a letter out to all
state Medicaid directors (June 2011) that:
• Encourages states to offer evidence-based telephone
Quitline services to all Medicaid beneficiaries; and
• States that tobacco cessation Quitlines are Allowable as
Medicaid Administrative Activities; that Medicaid can
provide a 50% administrative match for Quitline services
through the Federal Financial Participation (FFP)
Agreements; and
• Prohibiting cost sharing for services provided to pregnant
women which includes “counseling and pharmacotherapy
for cessation of tobacco use by pregnant women.”
Federal Employee Health Benefit:
Special Initiative: Quit Smoking
“There has never been a better time to quit smoking. All FEHB plans now offer 100%
coverage to help you quit once and for all.”
Beginning in plan year 2011, all FEHB plans must cover:
• Four tobacco cessation counseling sessions of at least 30
minutes for at least two quit attempts per year. This
includes proactive telephone counseling, group
counseling and individual counseling.
• All 7 Food and Drug Administration (FDA) -approved
tobacco cessation medications with a doctor's
prescription.
• These benefits must be provided with no copayments or
coinsurance and not subject to deductibles, annual or life
time dollar limits.
North Carolina’s Comprehensive Cessation
Puzzle Pieces
Blue Cross/
Blue Shield
NC largest
Payer
NC Medicaid
Covers…
QuitlineNC
Gets $1.2m
from NCGA
CDC
Quitline
Capacity
Grants and
Tips from
Former
Smokers
Affordable
Care Act:
Recommendations
State Health
Plan for
Teachers and
Employees gets
$3.95 ROI for
Every $1
invested
???
Creative
Collaborative
Solutions