1. MassHealth and Massachusetts Tobacco Control Program Examples of Collaboration Donna Warner, Director of Cessation Policy and Program Development, Massachusetts Tobacco Control Program

2. Topics Collaboration to launch a new tobacco cessation benefit Applying the collaboration experience to new ventures Benefits of collaboration on all fronts

3. Collaboration Sharing Data

4. Tobacco Use and Tobacco Cessation Among MA Adults (age adjusted) Source: MA BRFSS, 2000-04

5. Smoking by Race/Ethnicity of MassHealth Members* 2003-2004 Source: Profile of Member Experience with Health Plans and Getting Health Care: Results of the 2003-2004 MassHealth Managed Care Member Survey. * Does not include fee-for-service MassHealth participants who gain eligibility through CommonHealth (disabled), Limited (emergency), Prenatal, those over age 65, and those with other forms of insurance.

6. Collaboration Benefit Design and Implementation

7. Legislative Mandate Smoking Cessation Benefit included in health care reform legislation, April 2005 Legislation mandated: –Two-year smoking cessation pilot –$7 million per year for Medicaid –Report to Legislature each year reviewing benefit utilization, clinical outcomes (quit rates), and cost savings

8. Project Management and Team Led by MassHealth (Medicaid), Office of Clinical Affairs Legal, Medical/Clinical, Pharmacy, Provider Relations, Customer Service, MDPH Project Team: Tobacco Control Staff, JSI/Quitline, UMass Medical School, Mass General Hospital (Rigotti ) More than 20 team meetings in August 2005-September 2006.

9. Designing the Benefit Key Considerations Primary Care or Behavioral Health? Reimburse Brief Provider Interventions? Counseling: How Much? What Formats? Pharmacotherapy: Over-the-Counter (OTC) and prescription medications. How much? Prior Authorization Required? Link Counseling and Pharmacotherapy? Participation of State Quitline? Quitline Reimbursement?

10. Designing the Benefit: Key Considerations Eligible Providers – Who Can Bill MassHealth? Training/Education Requirements – How Much? What Training Will Be Offered? Who Will Pay? Reimbursement Rates – How Much? Medicare Factor? Implications by Provider Type: Community Health Centers, Hospital Outpatient Departments, Primary Care Providers Amend Contracts with MCOs

11. MassHealth Tobacco Cessation Counseling Benefit Two treatment/quit attempts per year 16 sessions per year, any combination of individual or group 45-minute intake/assessment sessions 30-minute individual counseling session 60-minute group session

12. MassHealth Tobacco Cessation Pharmacotherapy Benefit 2 Treatment regimens covered in a 12 month cycle. A treatment regimen includes a 90 day supply of NRT, Bupropion, or Chantix without prior authorization (PA) Nicotine nasal spray and inhaler require PA

13. Rationale for MA Benefit Make benefit accessible to members (no hoops) Encourage quit attempts Reduce barriers for providers Therefore: Did not link Rx and counseling Allowed billing for smoking cessation counseling on same day as medical visit for another purpose Pharmacotherapy benefit straightforward and covered standard of practice medications Rx limits set high to reduce any access challenges for members filling prescriptions And: Needed to fit within existing regulations

14. Collaboration Promoting the Benefit

15. Collaboration Outreach to Providers and Consumers Develop provider materials together and obtained approvals Developed joint dissemination plans and held quarterly meetings Developed and delivered presentations jointly Collaborated on consumer outreach

16. Provider and Consumer One-Page Fact Sheets Provider Detailed FAQ with rates, billing codes Pharmacotherapy dosing pocket guide New Intake and Assessment protocol, sample completed protocol and training guide New on-line CEU program on Intake and Assessment See all on www.quitworks.org with links to MassHealthwww.quitworks.org Provider Tools

18. Consumer Handout in 10 Languages English Spanish Portuguese Khmer Haitian Vietnamese Chinese Albanian Russian Somali Arabic

19. Consumer Promotion MassHealth: Mailing to consumers DPH: Mass Media Campaign Message is smoking cessation with MassHealth “tag” Radio and transit ads

20. Mass Materials Distribution Posters and wallet cards distributed to over 1,000 community organizations

21. Collaboration Monitoring Results, Evaluation & Quality Improvements

22. Tobacco Cessation Benefit Year 1 Utilization Pharmacotherapy Benefit: 7/06-6/07 –Budgeted for 5% utilization and reached roughly 12%*. –Over 30,000 members have utilized the benefit. –Ave. cost per claim $64; ave. cost per member $128 Counseling Benefit: 7/06-6/07 –Budgeted for 2% utilization, reached less than 1%. –Estimated 900 unique member claims.** –Ave. cost per claim $34;ave. cost per member $58. –Tracking is challenging due to lack of universal coverage and some provide services without billing MassHealth. * Excluding prescriptions for wellbutrin ** Estimated for four MCOs based on 6 months data.

23. Medication Utilization Data Prescriptions for Chantix surpasses nicotine patch *MassHealth PCC Plan and Fee-For-Service Claims, no MCO data Meds. July ‘06 Aug ‘06 Sept ’06 Oct ’06 Nov ‘06 Dec’ 06 Jan ‘07 Feb ’07 Mar ‘07 April ’07 Total Chantix118449960375511121277179319798203 Patch125520352125218820111918215217381741162518788 Other NRT 2003693403633603153522732892863147

24. Challenges Estimating utilization and costs of the new benefit Balancing the ideal vs. what is feasible within existing regulations Increasing capacity statewide to offer counseling Provider outreach needed on two fronts: know about the benefit vs. “operationalize” the benefit Limited financial “feasibility” for some CHCs, Hospitals Reimbursement for the state quitline

25. Collaboration Positives

26. Positives of Collaboration with Medicaid Joint cessation benefit design process led to valuable learning and continued MTCP-MassHealth partnership Endorsed shared principles re: addiction/relapse, ease- of-access, treatment intensity, and rate-setting Surfaced important issues and regulatory barriers to federal financial participation (FFP) and Medicaid funding for quitline Joint commitment to evaluation and quality improvement

27. Results of Collaboration Long term sustainable approach to tobacco treatment Increased awareness of the costs of tobacco use and the need for cessation services Ongoing communication and collaboration Relationship modeled positive collaboration for new Wellness Initiative between MDPH and MassHealth

29. Thank You! donna.warner@state.ma.us