Public-Private Partnerships: Sustaining and Expanding Access to Quitlines Deb Osborne, MPH NAQC Public-Private Partnership Manager May 29, 2014

Session Objectives Participants will be able to identify strategies to increase access to quitline services for all North Carolina tobacco users wanting to quit. To help guide the direction of North Carolina’s cost-sharing efforts, participants will learn about other state’s experiences cost sharing and the different models employed.

Why Cost Share? “By themselves, public health agencies have insufficient funding and capacity to deliver tobacco use treatment services, create an environment that supports tobacco-use treatment, and manage other aspects of a comprehensive tobacco-use treatment program.” Centers for Disease and Prevention. A Practical Guide to Working with Health Care Systems on Tobacco-Use Treatment.

What is Cost Sharing? “Cost sharing is defined as the sharing of the financial burden of providing tobacco cessation quitline services between a state agency and other entities which have a vested interest in the provision of cessation services.” Florida Quitline Evaluation Ad Hoc Report: Quitline Cost Sharing Models --Professional Data Analysts, Inc.

Potential Cost Sharing Partners Commercial or private health plans Large employers State and County governments Unions Public Insurance Plans Medicaid, Medicare and other public funded plans Foundations and Trusts

Making the Case Recommended CDC Best Practice ACA – requires provision of cessation treatment by all insurance plans and employers (exception grandfathered plans) Return on investment for tobacco cessation Improve HEDIS scores for tobacco cessation

Making the Case Quitline: Cost-Effective Evidence-based intervention provided by trained counselors High consumer and health care provider recognition Coaching supported in multiple languages Media and marketing provided nationally and state-level

Making the Case Quitline: Cost-Effective Special programs: teens, pregnant women Validated quit rates Utilization reports No infrastructure costs

Barriers to Cost-Sharing Why do employers and insurers choose not to purchase quitline services for their employee/insured members?

“WHY Pay for something that is FREE?”

Leverage Quitline funding cuts CDC Best Practices – limit services to highest-risk populations ACA requires cessation treatment State legislation (CO, NH, MA bills) Quitline reach (CDC goal 8%) Strategies to Build Cost-Sharing Partnerships

Leverage: Model State and Medicaid coverage ACA – premium differential/ reasonable alternative Tobacco-Free policies Political will

In Practice: Colorado’s Leverage Funding cuts State legislation and ACA Political will Support: health plan association, health department administration, governor and stakeholder group July 1, 2010 limited services to uninsured, Medicaid and pregnant women

Partnership reimbursement model Package of services at state rate offered to health plans and large employers Nine health plans partner to cover costs for members Contracts established between each health plan and the quitline vendor Service variation is minimal between plans Reach, utilization and effectiveness data captured In Practice: Colorado

Health plan/employer internal services Health plan/employer use their own quitline, website, wellness program or clinician counseling No relationship with the state-funded quitline Expands the reach of cessation services with no costs to state Reach, utilization and effectiveness not known In Practice: CO United Health Care

In Practice: Centura Health Independent contract model Third largest CO employer – tobacco-free campus policy Contracts directly with state quitline vendor Incorporates cessation in wellness program Health risk assessments – blood draw for tobacco use Premium differential – uses quitline for the “reasonable alternative” Quitline tracks participation

In Practice: Minnesota Triage and transfer model State-funded quitline screens all callers for insurance status and transfers caller to health plan’s quitline Insurer provides funding for the quitline vendor to conduct the transfer Some callers are lost in transfer Services can vary between state and private payer leading lower satisfaction and quit rates

In Practice: Massachusetts Medicaid Partnership Legislative mandate to provide comprehensive cessation coverage FDA pharmacotherapy and counseling Cover costs of quitline services ROI – $3.12 saved in medical costs for every $1 spent State as an Employer Employees have comprehensive coverage Demonstrated disparity of coverage among health plans

In Practice: Ohio Partnership Reimbursement Model Similar structure to Colorado Services provided by state quitline and private payers billed Baseline package of services at state rate Can purchase higher level of services 6 health plans and 13 employers participate in cost-sharing

In Practice: Hawaii Triage and Transfer Model Transferred to 2 large plan’s internal services State served Medicaid, uninsured, pregnant women with “4 Call Program” plus NRT Callers from smaller plans received “1 Call Program” and no NRT Outcomes and satisfaction for health plan and “1 Call Program” very poor State abandoned transfer model and now provide “4 Call Program” and tiered NRT to all callers

Payment Mechanisms Flat fee Private payers provide an annual set fee to support specific quitline services, such as fax referral systems, triage and transfer systems, or utilization reports on covered callers. Per member per month charge Employers or health plans may pay the state quitline a small charge per insured member per month.

Payment Mechanisms Reimbursement for actual costs This may cover all costs, intake costs only, partial counseling costs, all or part of NRT costs. Some private payers may reimburse quitlines or states for data and outcome reports. Per registrant charge This involves a set fee per individual registrant, regardless of utilization level.

Contractual Agreements Quitline vendor can contract directly with the payer State contracts with the quitline vendor and the employer and/or health plan

Recommendations Identify strategic approach for North Carolina Budget, reach, mandate, public good, etc. Focus on largest health plans and employers Consider limiting quitline services to uninsured and other high-risk populations and use as leverage to bring insurers and employers to the table. Use a reimbursement model vs triage and transfer unless plan or employer has evidence-base cessation service

Conclusions States can effectively partner with private payers Extending the state rate and restricting services to the uninsured can engage employers and health plans in purchasing quitline services States and their partners play an important role in educating insurers/employers about the ACA requirements and quitline is a cost- effective cessation resource.

Conclusions Providing varying levels of services creates lower levels of satisfaction and quit rates Data sharing is important to assess reach Vendor contracting directly with plan/employer simplifies process

Contact Information Deb Osborne, MPH North American Quitline Consortium Public-Private Partnership Manager x 706