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

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: HawaiiTriage 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

dosborne@naquitline.org

1-800-398-5489 x 706