Vermont

1
Vermont Third Party partnership with private
insurance

• Todd Hill, LiCSW, LADC
• January 7 9, 2009

2
In 1997 the Vermont Banking, Insurance,
Securities and Health Care Administration
(BISCHA) created Rule 10

• VT - BISCHAs Rule 10 reporting includes scores
  they achieve on smoking cessation questions that
  are asked on CAHPS (Consumer Assessment of
  Healthcare Providers and Systems)
• Advice to quit, Recommendations of Medication
  and Strategies

3

• Vermont Quit Network
• Established in 2001 Quitline and face-to-face
  counseling at all 13 hospitals in the state of
  Vermont. (www.vermontquitnetwork.org)
• Contract with QuitNet was added in 2004.
• In 2002 funds were dedicated from the tobacco
  control program budget to provide NRT to those
  smokers who were enrolled in Medicaid, Medicare
  or were uninsured.
• QuitBucks was developed A voucher system where
  smokers redeemed them at local pharmacies.
• Quitline callers were referred to hospitals for
  the vouchers but stayed with the quitline for
  counseling.

4

• 3 insurance companies make up 95 of the
  private market share in Vermont. (Blue Cross-Blue
  Shield of Vermont, Mohawk Valley Plan (MVP) and
  Cigna)
• Our face to face counseling program
  (administered through Fletcher Allen Health Care
  VTs teaching hospital) had a relationship with
  Quality Improvement (QI) people at Blue Cross and
  MVP
• The NRT subsidy developed with these three plans
  was based on the premise of making NRT more
  readily available, healthcare providers will be
  more willing to discuss smoking cessation and
  offer a referral to the Vermont Quit Network
  services
• Both the plans and hospital would provide
  academic detailing to promote this new program

5

• 20 subsidy for fully insured members only.
• Because Rule 10 is a government mandate -
  insurance plans did not include self-insured
  programs
• Required counselors to call in to verify type of
  insurance
• 2005 Quitline begins to provide NRT starts
  with uninsured and Medicare
• 2006 VT authorizes quitline to provide NRT to
  all Vermont smokers
• 2007 Quit In-Person program contracts with
  GlaxoSmithKline (GSK) to provide medication at
  close to wholesale price
• Insurance companies increase subsidy to cover
  the full cost of NRT

6

• 2008 Blue Cross/Blue Shield expands program to
  self insured businesses as well
• 2008 All insurance companies agree to pay for
  NRT that is provided through the Vermont Quitline
• 2009 VT will get data from Quitline to begin
  to bill insurance companies for NRT they supply
• 2009 Cigna drops out of plan as of January 1.
• Reason The QuitBucks program is duplicative as
  they have their own quitline and direct ship NRT
  program

7

• This measure reports the aggregate experience of
  the MCOs in assisting smokers to quit by
  combining the performance levels for the three
  separate smoking cessation services advising
  smokers to quit, discussing strategies, and
  discussing medications. Evaluation of the 2008
  Rule 10 Managed Care Organization Data Filing (VT
  BISHCA Dec 2008)
• Major Findings
• Performance of all the plans is consistent with
  national average.
• BCBS performance from 2006 to 2008 is
  significant compared to the level of performance
  of the other plans.
• Absolute performance for all plans is low.

8

• This measure is a two-year rolling average of the
  percentage of adults who are currently smokers,
  and who were seen by a practitioner and received
  advice to quit. Evaluation of the 2008 Rule 10
  Managed Care Organization Data Filing (VT BISHCA
  Dec 2008)
• Major Findings
• CIGNAs performance level is significantly above
  the national average.
• The other plans performance levels are consistent
  with the national average.
• MVPs and TVHPs performances are significantly
  below the regional average.
• The levels of performance for all plans remain
  unchanged over time.

9

• This measure is a two-year rolling average of the
  percentage of adults who are currently smokers,
  and who were seen by a practitioner who discussed
  medication options with them. Evaluation of the
  2008 Rule 10 Managed Care Organization Data
  Filing (VT BISHCA Dec 2008)
• Major Findings
• BCBS and CIGNAs performance levels are
  significantly above the national average.
• The performance levels of the other plans are
  consistent with both the national and regional
  averages.
• BCBS performance improvement between 2006 and
  2008 is significant compared to the performance
  levels of the other plans

10

• This measure is a two-year rolling average of the
  percentage of adults who are currently smokers,
  and who were seen by a practitioner and received
  advice on strategies to quit smoking. Evaluation
  of the 2008 Rule 10 Managed Care Organization
  Data Filing (VT BISHCA Dec 2008)
• Major Findings
• The performance levels of all plans are
  consistent with both the national and regional
  averages.
• The performance levels of all plans remain
  unchanged between 2006 and 2008.
• The absolute levels of performance by all plans,
  is low.

11

• Conclusions
• Opportunity presents itself in a variety of
  ways. There is not one way to tackle the issue of
  reimbursement.
• While it did not provide the QI improvement they
  were looking for, it gave us a foot in the
  door.
• Program proved that offering NRT doesnt break
  the bank.
• While imperfect, this relationship now allows us
  to provide NRT for every Vermont smoker who
  enrolls in our counseling program.
• Changing healthcare provider behavior continues
  to require a multi-faceted approach.