Advocating for Better Benefits In Oregon Wendy Bjornson, MPH OHSU Smoking Cessation Center

 Effective January 1, 2010: coverage or reimbursement of at least $500 for a tobacco use cessation program for 15+ years.  Affects Oregon-based commercial health plans.  Does not affect Medicaid, Medicare, self- insured, non-Oregon based plans.  Purpose was to create a common “floor” of benefit coverage sufficient to pay for 1-2 courses of treatment.  Estimated 70% of Oregonians now covered.

Mission:  Quality improvement in benefit among health plans.  Improved benefit = improved outcomes.  Approach: ◦ Collaborative with representatives from Oregon based health plans, health agencies, advocates, employers. ◦ Consensus on a common set of benefit design recommendations; endorsement by health plans. ◦ Strategic communication.

 Target audiences: ◦ Oregon based health plans ◦ Employers ◦ Large benefit purchasers ◦ Brokers  Press release, media outreach targeted to business and health care.  Continued outreach to health plan champions – convert from “endorser” to “advocate.”  HBOS representatives = advocates.  Advocacy message?

Health Care Transformation

 A one percent decrease in prevalence saves Oregon $400,000,000.  Smoking rates are down but still higher than our neighboring states.  Half of Oregon’s smokers try to quit every year but less than half of those smokers get any help.  We can bring our rates down further by improving benefits for smokers already covered and trying to quit: we can do better.

 We all have a role to play in improving outcomes for tobacco users trying to quit. By making Helping Benefit Oregon Smokers Recommendations the Oregon standard of Care for tobacco dependence, we make health possible for more people and help reduce costs for everyone.

 Outcomes improve by: ◦ Making sure tobacco users are helped to find out what treatments are available and how to access them. ◦ Using best practices based in science and delivered in ways that are tailored to individual needs, similar to treatment for chronic diseases. Some people need more, some less. ◦ Reducing barriers to make it easy to access and use benefits. Better access means better utilization means better results. ◦ Monitoring outcomes to make sure goals are being reached.

 Recommendations: ◦ Description and justification for evidence based benefit.  Case Studies: ◦ Making it real: illustrate barriers from patient, provider, health plan, employer perspectives. ◦ Benefit design often from cost containment vs. access perspective. Barriers look different from different perspectives.  Benefit comparison charts: ◦ At a glance ◦ Specifics, details.  Meetings and list serve

Health plan “A” is committed to providing an effective benefit and holding down costs. To do that, their policy is to ask members to demonstrate commitment to quitting by paying a higher co-pay – “skin in the game.”

Mary is recovering from head and neck cancer. She needs to quit to reduce risk of recurrence. Mary sets a quit date and has a prescription for Chantix. She is covered under health plan “A” and finds out that the co-pay is $80 for the initial prescription and $80 for each refill. Mary can’t afford the co-pay and asks her clinic for help. The nurse in the clinic searches for a reduced cost option for Mary to help her get the medication that she needs.

 EHB benchmark plan chosen. Look for opportunities to advocate for better implementation.  CCO’s are established, racing to show short term results. Opportunities to influence tobacco cessation benefit design and system delivery.  Continue collaboration and education; building expertise among advocates.  Continue supporting incremental adjustments in health plan benefits and benefit delivery.

Health Plans Organizations (* Founders)  Aetna®, Seattle, WA.  Kaiser Permanente® Portland, OR..  LifeWise Health Plan of Oregon, Portland, OR.  The ODS Companies, Portland, OR.  Providence Health Plans, Portland, OR.  Regence BlueCross Blue Shield of Oregon, Portland, OR.  CIGNA® HealthCare, Seattle, WA.  PacificSource Health Plans, Springfield, OR.  CareOregon; Portland OR.  Family Care; Portland, OR.  American Cancer Society Action Network; Portland, OR.  American Lung Association® of the Mountain Pacific, Tigard, OR. *  American Heart Association, Portland, OR.  Oregon Coalition of Health Care Purchasers, Portland, OR. *  Oregon Public Health Division Portland, OR. *  Oregon Division of Medical Assistance Programs; Portland, OR  Oregon Health & Science University; Portland, OR * (Program Coordination)  Tobacco-Free Coalition of Oregon, Inc., Portland, OR.  USI Northwest; Portland, OR.

Contact Wendy Bjornson, MPH c/o Oregon Health & Science University Smoking Cessation Center Acknowledgements Funding is provided through the Oregon Health Authority, Public Health Division