Post on 09-Jun-2015
Massachusetts Department of Public Health, Tobacco Cessation and Prevention Program
Tobacco Cessation and Worksite Wellness
November 13, 2012
Context
• Massachusetts spends $4.3 billion on healthcare costs every year.
• 10% of all healthcare costs in the Commonwealth are attributable to smoking.
• In Massachusetts, 8,000 people die prematurely every year from smoking-related illnesses.
Smoking Prevalence (Age 18+): Massachusetts, 1986 to 2009
Source: Massachusetts Behavioral Risk Factor Surveillance System
22.9% 22.7%
20.2%
15.0%
18.5%
27.8%
0%
10%
20%
30%
1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
-2.2% APC
Other Tobacco Product Use* Among High School Students: Massachusetts, 1999-2009
• Other Tobacco Products (OTP) are beginning to surpass cigarette consumption among adolescents in MA
17.6%
16.0%
0%
10%
20%
30%
40%
1999 2001 2003 2005 2007 2009
Per
cent
of
Stu
dent
s
.
Other Tobacco Products
Cigarettes
Source: Youth Risk Behavior Survey 1993-2009
* Used one or more days during the past 30 days.
565 547510
466 465 451
406 388369 361 346 355
297 280 274 282 277 278
225 222 224
$0
$100
$200
$300
$400
$500
$600
Fiscal Year
Mil
lio
ns
of
Sta
mp
sNumber of Cigarette Packs Sold:
Massachusetts, FY 1991 to FY 2011
Data Source: Massachusetts Department of Revenue
Adult Smoking Prevalence Among Subgroups: Massachusetts, 2010
More Likely to Smoke Less Likely to Smoke
14.1%
30.3%
25.7%23.1% 22.6%
19.0%
11.2%8.7%
7.0%
MA Adults MassHealth* <$25Khousehold
income
High schoolor less**
Disabled LGBT* Privatehealth
insurance*
$75K +household
income
Collegedegree**
Source: Massachusetts BRFSS, 2010. * Adults, age 18-64 ** Adults, age 25+
Adult Smoking Prevalence By Race/Ethnicity: Massachusetts, 2008-2010
15%
18%
15%
0%
20%
White Black Hispanic
Source: Behavioral Risk Factor Surveillance System
Who Smokes in Massachusetts?
2008 Estimate
Why address tobacco use as an employer?
• At least $96 billion per year in direct medical costs in US1
• Businesses pay an average of $2,189 in workers‘ compensation costs for smokers, compared with $176 for nonsmokers2
• An estimated $96.8 billion per year in lost productivity due to sickness and premature death in US3
• Cost analyses have shown that tobacco cessation benefits, from an employer's perspective, are cost-saving.4,5
1, 3 CDC, MMWR , September 30, 2011/60(38);1305-1309
2, 4 National Business Group on Health, November 2011
5 US DHHS, Treating Tobacco Use and Dependence- 2008 Update
Comprehensive Approach
• Tobacco Free Policies• Benefits/Insurance Coverage• Workplace programs that include
evidence-based treatment options
Approach 1: Worksite Policies
• MA state law since 2004 – Review of basic requirements of SFWL – Employers have the discretion to implement
additional or stricter policies.
• Common additions:– Smoke-free outdoor spaces/campuses – Buffer zones– Tobacco-Free campus (smokeless, alternative
products)
Statistics on Quitting Post SFWL
• A Cochrane review found evidence that community interventions using "multiple channels to provide reinforcement, support and norms for not smoking" had an effect on smoking cessation outcomes among adults, including:
• Policies making workplaces1 and public places smoke-free
• Estimated that "comprehensive clean indoor laws" can increase smoking cessation rates by 12%–38%2
1. Lee CW, Kahende J (2007). "Factors associated with successful smoking cessation in the United States, 2000". Am J Public Health 97 (8): 1503–9. doi:10.2105/AJPH.2005.0835272. Lemmens V, Oenema A, Knut IK, Brug J (2008). "Effectiveness of smoking cessation interventions among adults: a systematic review of reviews". Eur J Cancer Prev 17 (6): 535–44. doi:10.1097/CEJ.0b013e3282f75e48
Approach 2: Employee Benefits
• PPACA Law – Beginning in 2014, all new health plans
will be required to offer smoking cessation benefits (both medications and counseling) to members free of co-pays.
• MassHealth Benefit (2006)
• Commonwealth Care Benefit (2012)
Recommended benefit for smoking cessation
• All 7 FDA-approved medications are covered for 2 courses of treatment in a calendar year with a prescription
• Brief and intensive counseling are a covered service
• 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.
• No copayments or coinsurance and not subject to deductibles, annual or life time dollar limits.
Federal Employees Health Benefits (FEHB) as of 2011
0
2,000
4,000
6,000
8,000
10,000
Apr-06 Jul-06 Oct-06 Jan-07 Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09
Num
ber
of C
laim
s
Promotion and Utilization
31%Consumer Awarenes
s
75%ConsumerAwareness
40% of all MassHealth
smokers
Total People Using Benefit 75,810
MTCP Promotions
Began
MTCP Promotions
Ended
Announcement to 20,000 providers 6/06. Announcement to all MassHealth subscribers 6/06. Additional outreach to health centers, hospitals, community agencies, and providers beginning 8/06. Articles placed in over 15 professional and MCO newsletters beginning 9/06. MTCP radio and transit campaign 12/06 – 5/07. MassHealth wellness brochures 7/07. MTCP cessation television campaign 11/07 – 1/08. Consumer awareness surveyed by MTCP in 10/06 and by University of Massachusetts in 1/08.
Declines in Smoking Prevalence
Annual percentage rate (APR) change for smoking prevalence among MassHealth uninsured adults in Massachusetts aged 18-64.Source: Massachusetts Behavioral Risk Factor Surveillance System, 1998 to 2008
Smoking Prevalence in Massachusetts Adults (18 - 64):MassHealth vs. No Insurance
25.0%
30.0%
35.0%
40.0%
45.0%
7/1/
1999
7/1/
2000
7/1/
2001
7/1/
2002
7/1/
2003
7/1/
2004
7/1/
2005
7/1/
2006
7/1/
2007
7/1/
2008
Sm
oki
ng
Pre
vale
nce
(6-
Mo
nth
An
nu
al R
olli
ng
A
vera
ge)
MassHealth (Point Estimates) No Insurance (Point Estimates)
MassHealth (Model Estimates) No Insurance (Model Estimates)
Over 33,000 MassHealth
smokers quit
26% drop in smoking
prevalence
Near-term health impact
• Study finds health impact within one year
– 46% decrease in probability of hospitalization for heart attack
– 49% decrease in probability of hospitalization for acute coronary heart disease
– Controlled for demographics, prior health risks, seasonality, statewide influenza rates, and the implementation date of the Massachusetts Smoke-Free Workplace Law
Actual costs of benefit
• Actual costs only exceeded $7 million allocation in one fiscal year
• Costs were primarily for medication; counseling had only a 1% utilization rate
• FY07 $3.9 million
• FY08 $7.023 million
• FY09 $5.9 million
• Costs decreased as use of Chantix decreased
Source: MassHealth encounter data
Return on Investment
• Studies of the MassHealth benefit found that a positive return on investment happens within one year.
• A study by George Washington University shows a $2.21 net gain for every $1.00 spent on the MassHealth smoking cessation benefit.
Building on the MassHealth experience
• Coverage for all FDA-approved medications
• Coverage for behavioral counseling• Low co-pays• Allow for repeated quit attempts• Consistency of benefit across plans• Promotion of available benefit
Supporting tobacco treatment in workplace
• Develop clear and concise communications• Frame communication as goal of better health
for employees, not cost saving• Create a "brand" around the cessation program• Use a variety of communication methods such
as: – Employer's intranet, Home mailings, Mass e-mails,
Posters, Employee newsletters
• Recruit employees to assist with support and encouragement for employees trying to quit
• Be patient — recognize that this kind of culture change can take time
http://www.businessgrouphealth.org/tobacco/casestudies/index.cfm
Massachusetts Department of Public Health, Tobacco Cessation and Prevention Program
• At least $96 billion per year in direct medical costs in US1
• Businesses pay an average of $2,189 in workers‘ compensation costs for smokers, compared with $176 for nonsmokers2
• An estimated $96.8 billion per year in lost productivity due to sickness and premature death in US3
• Cost analyses have shown that tobacco cessation benefits, from an employer's perspective, are cost-saving.4,5
1, 3 CDC, MMWR , September 30, 2011/60(38);1305-1309
2, 4 National Business Group on Health, November 2011
5 US DHHS, Treating Tobacco Use and Dependence- 2008 Update