1. Strategies for integrated, population-based recruitment into telephone-based smoking cessation counseling Linda C. Lockard Senior Project Coordinator Center for Tobacco Reduction and Health Improvement National Conference on Tobacco or Health May 4, 2005

2. Objectives Describe unique recruitment strategies for a telephone-based cessation counseling program Identify ways a health plan can maximize its contacts with insured smokers Identify effective ways to reach the entire population of health plan smokers, even those not ready to quit

3. Blue Cross and Blue Shield of Minnesota > 2.6 million members Not-for-profit Statewide network of clinicians Full portfolio of health insurance products –Commercial and Government –Individuals to National Employers

4. Blue Cross’ litigation v. Tobacco Industry 1994 - 1998 Co-plaintiff with State of Minnesota First private sector health plan to sue and settle Center for Tobacco Reduction and Health Improvement founded in 1998

5. Cigarette Smoking Prevalence: All members 12.4% among adult (18+) members in Minnesota Higher rates among Prepaid Medical Assistance Program (Medicaid <65) and Minnesota Care Lowest among Medicare supplement An estimated 110,000 smokers in Minnesota Data Source: 2003 Minnesota Adult Tobacco Study, Blue Cross and Blue Shield of Minnesota sample

6. Overview BluePrint for Health® stop-smoking program Phone-based tobacco cessation counseling over twelve months –Counseling: 5 sessions Intake (20-30 minutes) Two months (10-15 minutes) Four months Six months Twelve month (Outcome Survey) –Quit call-done within 4 days of participant’s planned quit date

7. Overview (continued) Free program Unlimited call-in Self help manual and ally guide Tobacco Treatment Specialists focus on behaviors, emotions and physical cravings Vendor is Free & Clear Inc. of Seattle, Washington

8. Recruiting a Broad Cross-Section of Smokers

9. Recruitment Strategies Paid television advertising placement SCRIPS (Smoking Cessation Referrals in Pharmacies) Integration with telephone-based health improvement programs –Healthy Start® prenatal program –24 hour nurse phone line –BluePrint for Health® care support disease management Direct-mail campaign

10. Television Advertising Reaches all MN residents, but program is only available to Blue Cross and Blue Shield of MN members –Blue Cross has 25% market share in the state Key message: “Quit in your own way, at your own pace” Buy remnant time 50-75% of calls attributed to television advertising depending on volume and the success of the advertisement “Ready, Set and Action!”

11. SCRIPS Incentive program supports pharmacies to connect patients filling cessation medication prescriptions to the stop-smoking program Collaboration with PRIME, pharmacy benefit manager, to automate adjudication using existing electronic claims systems From October 2003 through December 2004, 966 members referred and 492 enrolled = 51% recruited

12. Healthy Start® A telephonic care management program focused on reducing pre-term births OB Case Manager offers the expectant smoking mom an outbound call from the stop-smoking program versus calling the number on her own Enrollment increased from 7% to 15% when offered the outbound call option

13. 24 Hour Nurse Phone Line Vendor services for Blue Cross members Based on members’ conditions, the nurse tells them about the stop-smoking program and encourages them to call Since year 2000, 347 referred and 128 enrolled = 37% recruited

14. BluePrint for Health® care support Disease management program to enhance the quality of care received by members with a chronic disease Nurses encourage members to contact the program if they smoke or use tobacco Since 2002, enrollment has been under 5% among those referred

15. Direct-mail Campaign Tailored postcard to low-income populations (PMAP and MNCare members) 3 year campaign Strategy: –2 bulk mailings per year (across 3 years) with clear messages to address cost concerns to all eligible members timed in January & September –Mailing in new member packet –F/U mailing after packet sent

18. Did the mailings work? Over 3 years… Fully insured (control group): 88% growth Minnesota Care: 138% growth PMAP < age 65: 128% growth PMAP age 65+: 341% growth

19. Challenges Not all health plans are like Blue Cross HIPAA Constant communication with health plan program owners Discovering the ‘teachable moment” New ideas

20. Lessons Learned Television advertising can provide motivating message and can be very affective, but can be costly Some advertising works, some does not Referral programs work, but are labor intensive Direct-mail works if it’s consistent

21. Health plans cover large populations Marketing Departments have people interested in developing television advertisement Teachable moments Collaboration with State Agencies on regulatory requirements Summary

22. Question and Answers Our purpose: “We make a healthy difference in people’s lives.” Blue Cross and Blue Shield of Minnesota is an independent licensee of the Blue Cross and Blue Shield Association