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Best Practices and Emerging Interventions to Reduce Tobacco Use Amongst High Prevalence Populations: Case Studies

July 28, 2011: Cessation: Emerging Interventions and Innovations


The Mass Health Cessation Story: Reducing Tobacco Use and Improving Health Among Massachusetts Medicaid Members






Moderator: Michael Fiore, M.D, M.P.H., M.B.A.

Donna Warner, M.B.A., Multi-State Cessation Collaborative and Thomas Land, Ph.D., Massachusetts Department of Public Health

Donna Warner provided background on the Mass Health (Medicaid) benefit design. The smoking cessation benefit was included in Massachusetts Health Reform legislation in April 2006. This legislation mandated a two-year smoking cessation pilot, which was then made a permanent benefit after one year. The design includes the following components:

  • Two treatments per quit attempt per year;
  • Sixteen counseling sessions per year which can be any combination of individual or group;
  • All FDA-approved medications and any combination of these;
  • A 90-day supply per treatment attempt with two treatments per 12-month cycle of medication;
  • With a physician's authorization, patients can receive additional medication;
  • Prior authorization for Zyban (because it is a brand name) and for the nasal spray inhaler are required.

The benefit utilization was much higher than expected—five to ten percent utilization was anticipated, and instead it utilization reached roughly 40 percent within two and a half years. Over the course of the first two years, over 75,000 smokers participated. One major reason for the success of the benefit was the widespread dissemination of information about its availability to both consumers and providers through all Mass Health plans, the Massachusetts Department of Public Health, coalitions and community groups and medical and professional societies. Mailings were sent to all Mass Health members, and a radio and transit cessation ad campaign was developed and launched by the Massachusetts Tobacco Cessation and Prevention Program and featured a message about the new MassHealth Benefit. Promotion was regular and sustained, and also included provider tool kits, fact sheets and availability of a UMass Medical School CEU training program on the intake and assessment component of the benefit.

Thomas Land continued by describing the sharp and immediate declines in smoking prevalence among the Mass Health population of smokers enrolled in the program. Over the course of two and one-half years, smoking prevalence declined from 38 to 28 percent. There was a 46 percent decrease in the probability of hospitalization from acute myocardial infarction and a 49 percent decrease in the probability of hospitalization for acute coronary heart disease. Cost savings included an estimated 81 fewer hospitalizations for heart attacks and 118 fewer hospitalizations for atherosclerosis. The total return on investment was two dollars for every one dollar spent.

Dr. Land concluded his remarks with lessons learned:

  • The close collaboration between Mass Health and the Massachusetts Tobacco Cessation and Prevention Program was a key element to the success of the program;
  • The benefit was straightforward, easy to use, and patients didn’t have to jump through hoops to gain access;
  • Cessation experts were engaged in key benefit design decisions;
  • Promotion of the benefit was critical, and it was sustained and frequently repeated;
  • Evaluation was mandated in the legislation and utilization was tracked monthly from the start;
  • Medicaid tobacco use questions were included in BRFSS before the program launched; and
  • There was a very quick and immediate return on the investment.

Dr. Fiore introduced the next panelist.

 
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