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Planning a Tobacco Control Strategy in a Medicaid Managed Care Organization
This planning grant evaluated the feasibility of a systems-level strategy to increase the use of both smoking cessation services and a pharmaceutical benefit in a Medicaid managed care organization. Several processes that comprise a comprehensive tobacco control strategy were implemented. New enrollees were asked a standardized tobacco use screening question as part of a health needs assessment. Smokers were informed of the managed care organization’s tobacco cessation benefits and asked if they were interested in making a quit attempt. If an enrollee was interested in quitting, s/he was contacted by the managed care organization’s smoking cessation coordinator for follow-up. Nurse case-managers serving priority populations (e.g., people with asthma, diabetes, and pregnant women) were trained to deliver the 5 A’s and refer patients to the smoking cessation coordinator. A computerized system (Exper_Quit) was implemented to help the smoking cessation coordinate track referrals for smokers and the outcomes of such services; the system also provides evidence-based decision support for enrollees who consent to a formalized assessment and can be used for quality improvement activities. Neighborhood Health Plan had provided coverage for NRT since 1997; utilization of the pharmacy benefit was monitored before and after implementation of these systems changes to measure changes in use of pharmacotherapy. The small number of needs assessments that were completed limited direct outreach to new enrollees. Only 7.2% of new adult enrollees (1,683/23,453) in the six-month time period under study completed the health needs assessment. Of those contacted, 290 (17%) were current smokers; 201 (69%) wanted help with quitting. The smoking cessation coordinator was able to reach 126 (63%) of those who wanted help with quitting and provide tools and information to assist in a quit attempt. Nurse case-managers referred an average of 29 patients/month to the smoking cessation coordinator for intervention and assistance. The health plan’s pharmacy claims database was utilized to monitor claims for NRT patch, gum and inhaler prescriptions. On a plan-wide basis, utilization of NRT increased 48% after the intervention was implemented. Implementation of systems changes to facilitate identification of smokers and referral for treatment (both counseling and pharmacotherapy) led to a significant increase in utilization of pharmacotherapy that is proven to increase quit rates. Further, computerized systems have simplified and streamlined the routine delivery of evidence-based tobacco cessation interventions on an ongoing basis for all identified smokers. Citation: Winickoff JP, Berkowitz AB, Brooks K, Tanski SE, Geller A, Thompson C, Lando HA, Curry S, Muramoto M, Prokhorov AV, Best D, Weitzman M, Pbert L. For the Tobacco Consortium* State- of-the-Art Interventions for Office-Based Parental Tobacco Control. Pediatrics 2005; 15(3):750-760. Winickoff JP, Glauber JH, Perrin JM, Bock BC, Rigotti NA. Improving tobacco dependence medication use in a Medicaid managed care organization: A practical systems-level approach. JCOM 2003; 10(10): 535-9.
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