1. Terry R. Reid, MSW Quitline Funding & Budget Considerations

2. Learning Objectives Identify potential sources of funding Describe how budget relates to services and reach Explain how budget aligns with program goals Discuss how to manage budget in a changing policy and fiscal environment Identify strategies to sustain support and funding

3. Quitline Funding Sources Government public health funds Tobacco product taxes Public and private health insurance Businesses and employers Individuals

4. Shared Cost Models To serve the entire population a shared cost arrangement is often necessary Shared cost arrangements can be formal and intentional or they can evolve as an informal arrangement The goal should be a model that ensures Quitline access to all tobacco users

5. Washington States Shared Cost Model In 2000: Started with a single source of state government funds and one private health insurance Businesses and private insurance purchased enhanced Quitline services In 2008: Publicly funded insurance (Medicaid) added Quitline services State funds became more targeted to the uninsured and under- insured population

6. Reach of Washingtons Model 40015 residents were served by the Quitline in 2010 Caller types by contract:

7. Quitline Budget Service Considerations What type of services (single call, multiple calls, proactive call-backs, medications)? Are start-up costs a factor? What data reporting is needed? What type of quality assurance is desired?

8. Quitline Budget Service volume is a key consideration in setting a budget. What is the desired reach? Estimated annual reach may range from 1% to 6% of adult tobacco users. Is the budget based on service for the general population or targeted to a specific population?

9. Service Volume Factors What is the public awareness of the Quitline? Will there be a paid advertising campaign? If so, how frequently will it be running? What other promotion strategies will be used to enhance awareness? Is a free NRT promotion planned?

10. Service Volume Factors Health care providers can be a major source of referrals. What is their awareness of the Quitline services? What questions need to be addressed to increase their confidence in making a Quitline referral? Are patients routinely asked about tobacco use?

11. Service Volume Factors Tobacco control policy is a driver of quitting. Depending on awareness level, new policies can substantially impact service volume. Tax increases affecting price may prompt a surge of calls for up to three months. Smoke-free laws will increase calls less dramatically but over a longer period of time. Quitline is an important complement to tobacco control policy change

12. Tobacco Control Policies Yield Immediate Demand Calls to the Quitline 2004-2010 Federal tobacco tax increase State tobacco tax increase Medicaid benefit and free medication promotion Smoking in Public Places law Young adult promotion State tobacco tax increase 2004200520062007200820092010

13. Tobacco Control Policies Yield Immediate Demand Calls to the Quitline have increased periodically due to policy changes - like tobacco tax increases and the Smoking in Public Places law. Calls doubled among people on Medicaid when cessation benefits became available. Partnership with DSHS/HRSA sustains and expands access to cessation services.

14. Service Volume Factors Several other factors influence service volume. Only some are predictable. New Years resolutions New medical research findings Celebrity deaths caused by tobacco use Promotions by other organizations

15. Service Volume Factors What are typical barriers for reaching service volume objectives? There may be questions about what the Quitline service is all about. There may be cultural and language barriers. There may be time schedule limitations. Building and maintaining awareness is an ongoing challenge.

16. Managing the Quitline Budget With multiple factors influencing service volume monitoring data is essential. Track the call volume at least monthly. Note who is calling and how they heard about the Quitline. Adjust promotion strategies to turn volume up or down. Try to avoid changes in types of service if at all possible.

17. Sustaining Support and Funding Educate Educate public health leaders and policy makers about who is receiving services. Evaluate Evaluate the impact of the Quitline. What is the return on investment? Encourage Encourage stakeholders to advocate and explain Quitlines role in supporting tobacco control policy. Support Support a mandate that insurance plans include cessation benefits.

18. Final Thoughts Managing a Quitline budget requires making good estimates of service levels and cost. Service volume is dynamic. Monitor it closely and have a plan for adjusting volume. Free NRT promotions can easily get out of control. Use them with caution.

19. Final Thoughts The Quitline is easily understood by policy makers. Advocates need to make the case that if policies are making it more expensive and difficult to smoke, a Quitline is necessary. Maintain partnerships with other organizations sharing in the cost of Quitline services. Strive for creating a Quitline system of services where all tobacco users will have access.

20. ? Discussion Questions How is your Quitline being funded? Are others sharing costs? What challenges have you encountered in setting and managing a budget? What strategies have you found effective in sustaining support for the Quitlines operation?

21. Thank You