The planning project brought the health plans participating in the Wisconsin Medicaid program together to share information about their current tobacco cessation activities, identify potential systems changes that could be implemented to increase tobacco cessation, and document current health plan-initiated smoking cessation efforts and levels of smoker identification and treatment. Additionally, Medicaid recipients were surveyed about their tobacco use as part of the CAHPS Medicaid Recipient survey.

Fourteen of the eighteen health plans participating in the Wisconsin Medicaid Program in 1999 took part in the planning process. Four possible system changes were identified that could be implemented in all of the health plans:
· developing statewide initiatives to identify smokers by all health care providers;
· develop standard smoking cessation messages;
· develop new incentives for HMOs, providers, and/or recipients to encourage more smoking cessation treatment;
· address the impact of patient turnover by having treatment begun in a HMO continue even when the patient changes HMOs.

These suggested system changes were incorporated into a document that was disseminated to the management of the participating HMOs. The document continued the Tobacco Steering Committee formed through this project, and established an initial system change of including smoking cessation as one of the of the optional clinical areas as part of the contractually required quality improvement studies.

The chart audit and consumer survey conducted through this project further documented the high rates of tobacco use in the Medicaid population in Wisconsin. Both the chart audit and the consumer survey found an adjusted prevalence of smoking for adults of 45%, nearly twice the rate of the smoking rate of the general Wisconsin population (24%). It is expected that the Tobacco Steering Committee can use the data from the chart audit and consumer survey to inform future tobacco initiatives.

Collaboration between the Medicaid HMOs and the Department of Health Care Financing/Wisconsin Medicaid Program as equal partners took time to develop but resulted in a very positive spirit of cooperation and commitment by the HMO representatives and management. The level of cooperation illustrated possible benefits that might result from establishing similar partnerships for other medical issues of common interest.