Trends in Coverage of Tobacco Dependence Treatments

1
Trends in Coverage of Tobacco Dependence
Treatments

• Helen Ann Halpin, PhD
• Professor of Health Policy
• University of California, Berkeley
• School of Public Health
• November 21, 2006

2
U.S. Health Plan Coverage of TDTs 1997-2003

• 160 plans (74) with 60 million members.

Source McPhillips-Tangum, et al. Prev Chron
Disease July 2006 3(3).
University of California, Berkeley
3
Medicaid Coverage, 2000-05

Source MMWR Nov. 9 2001 MMWR Nov. 10, 2006,
CDC
4
CA Firms Covering TDTs, 2000-2005

among firms offering employer health benefits
Source manuscript under review - do not quote or
cite
5
Covered Workers by Firm Size, CA 2005

Source manuscript under review - do not quote or
cite
6
CA Workers Covered for TDT by Type of Employer
Plan

Manuscript under review - do not quote or cite
Source California Employer Health Benefit
Survey, 2000, 2005
7
Cochrane Review Pooled Effects of Coverage

• Full Benefits (no direct cost to smoker) have
  the
• greatest effects on abstinence rates.

Source Kaper, Sagena, Severens, Van Schayck. The
Cochrane Database of Systematic Reviews January
24, 2005
University of California, Berkeley
8
Effects of Different Benefit Designs

• A common benefit design in commercial health
  plans and in 9 Medicaid programs is to cover both
  drugs and counseling and link the benefits, such
  that coverage of drugs is conditional on
  participation in counseling.
• 1. What is the effect of adding telephone
  counseling to a pharmacotherapy benefit?
• 2. What is the effect of making coverage of the
  pharmacotherapy benefit conditional on enrollment
  in counseling (linking benefits)?

Source Halpin, McMenamin, Rideout, Boyce-Smith.
2006. Inquiry 4354-65.
University of California, Berkeley
9
Use of Benefits by Design
Source Halpin, McMenamin, Rideout, Boyce-Smith.
2006. Inquiry 4354-65.
University of California, Berkeley
10
Adjusted Odds of Quitting

• Controlling for made a quit attempt in
  lifetime, cigarettes smoked/day, age started
  smoking regularly, stage of readiness, ever used
  drugs in a quit attempt, gender, age, race,
  income, and visited doctor during study period.
• Results did not change using an Intent-to-Treat
  model.

University of California, Berkeley
11
Effects of Linking Drug and Counseling Benefits

• Linking access to drugs to enrollment in
  telephone counseling did not affect use of the
  drug benefit.
• Smokers with linked benefits had significantly
  higher use of counseling services than those with
  unlinked benefits.
• There were no significant differences between
  smokers with linked or unlinked benefits in quit
  attempts, drug use, quit rates or prevalent
  abstinence at 8 months.
• Costs per quit are nearly 2X higher for the group
  with linked benefits with no added value.

Source Halpin, McMenamin, Rideout, Boyce-Smith.
2006. Inquiry 4354-65.
University of California, Berkeley
12
Coverage is not Enough

• Only 36 of Medicaid enrollees in states with
  comprehensive coverage for pharmacotherapy and
  counseling are aware of their coverage.1
• Only 60 of Medicaid MDs know that cessation
  treatments were covered in their state. 1
• In WI, lt2 of adult Medicaid FFS patients who
  smoke had used covered pharmacotherapy for
  tobacco dependence treatment in the last year. 2

Sources 1. McMenamin, Halpin, Ibrahim, Orleans.
AJPM 20042699-104. 2. Burns, Fiore. WI Med J.
200110054-58.
University of California, Berkeley
13
Incentives and System Change in US Physician
Groups, 2001

• National survey of medical groups/IPAs with gt20
  MDs (2001).
• 70 offer some support for smoking cessation.
• Medical groups, larger groups, primary care
  groups more likely to support cessation.
• 17 require MDs to provide smoking interventions.
• 39 offer cessation programs.
• Significantly more likely to support cessation
  if
• Income or public recognition for quality
• Financial incentives for smoking cessation
• Requirements to report HEDIS measures
• Aware of Clinical Practice Guidelines

Source McMenamin, Schauffler, Shortell et al.
Med Care. 2003411396-1406.
University of California, Berkeley
14
Medicaid Adoption of System Strategies for TDT,
2005

Source manuscript under review - do not quote or
cite