Building Demand for Businesses & Health Plans Dawn Robbins February 1, 2005

What are consumers saying? “If everyone wants people to stop smoking, they should give the patches away for free. The money seems to be the barrier for everyone here.” Employee focus group, 2004

Overview 28 million smokers (60%) have private insurance 70% want to quit Effective help can double or triple their chances of successfully quitting Millions have no access to this help, don’t know about it, or can’t afford it Consumers can urge businesses and insurers to remove financial barriers to cessation, but we need to fuel demand.

One insurance agent says (2003): “We don’t think about tobacco as part of the checklist we use with employers. If they’re thinking about prevention, if they’re thinking about controlling costs, yeah, we mention it. I’ve only had a couple of businesses ask in the past two years.”

Another agent (2003) “(Help for smokers) has to come, to a great extent, through the insurers. If insured programs include tobacco cessation benefits, then you start seeing them more often in the self-insured market. I think getting insurance companies to include tobacco cessation would probably reduce the cost overall.”

Survey of Oregon employers, 2002 Cost is equal to health & productivity issues as a primary factor steering benefit choices Those who didn’t offer cessation said they would make the investment if it reduced use of medical services 8 out of 10 who didn’t offer assistance said they would if it were part of a standard benefit

Three ways to fuel demand Blur the silos Frame the issues Build the drumbeat

Blur the silos “Give feedback across the group. I always learn more when I’m hearing from a health care professional and a CEO’s viewpoint vs. just ours. At some point, if you want to bring representatives, there’s a lot to learn.” Agent, 2003

Transform silos into partnerships Tobacco control – Cessation, advocacy, public health, health care providers Insurers – Medical directors, marketing, finance, claims Business – Human resources, finance, management, labor, communications

Oregon’s effort to blur silos

Frame the issue “Businesses are asking, ‘What can I do for next year?’ They’re not interested in a 10-year return.” Insurance Agent, 2003 “Dawn, insurers don’t give a rip (not the real word) what you think. Bring Edna (not her real name). She sells product to the big guys.” Oregon health plan CEO, 2004

“Show the real pain. Add up the dollars associated with the asthmatic child with this number of visits to an ER, which means they’re staying home from work. Add up the break periods … Look at the family. Look at the time loss associated with the process of smoking—the actual smoking event, and then the other things—the bronchitis … All those things, add them up, and then you can start to articulate return on investment.” Edna speaks (2003):

Oregon Public Employees’ Benefit Board Oregon’s largest health care purchaser: 110,000 lives, including retirees Members work in health-related areas, including tobacco program and Medicaid Low turnover Labor-management board 2005 premiums: $435 million New Strategic Plan, New Executive Director

PEBB Partnership Board Decision: Barrier-Free Benefit Cost-Benefit Analysis: Cost $200,000 for 5% participation Broadcast Success: ACS Great American Smokeout

PEBB’s RFP 2007: Dominoes! Systems of care that produce comprehensive integrated services Plan design, provider selection, and member incentives showing significant improvements in quality and health outcomes Movement in the Oregon insurance market!

Jean Thorne, Executive Director, Oregon Public Employees’ Benefit Board

Build the drumbeat Are you covered? Weave messages with partners Target media Seek and develop likely and unlikely champions

Breakthrough opportunities New FDA approvals QUIT NOW New Medicare coverage Consumer-driven health plans Electronic medical records Cross-silo message development

Dawn Robbins