1. 1 Building a sustainable tobacco control program within a health plan Marc Manley, MD, MPH Blue Cross and Blue Shield of Minnesota National Conference on Tobacco or Health December 11, 2003

2. 2 Overview  Blue Cross and Blue Shield of Minnesota and tobacco  Tobacco control in a health plan  Project sampler

3. 3 Blue Cross and Blue Shield of Minnesota  2.5 million members  Not-for-profit  Statewide network of clinicians  Full portfolio of commercial and government health insurance products u Individuals national employers

4. 4 Blue Cross’ litigation v. tobacco industry  Co-plaintiff with State of Minnesota  First private sector health plan to sue and settle  Settlement outcomes (May 1998) u Financial u Public health gains

5. 5 Five years post-settlement….  Blue Cross’ use of settlement funds is delayed now by a subscriber lawsuit  Timeline for lawsuit resolution unknown

6. 6 In the meantime...  Created Center for Tobacco Reduction and Health Improvement  Began implementation of a comprehensive program  Will expand with settlement dollars

7. 7 Evolving role of health plans Pay claims for tobacco- caused disease Benefits and services for the treatment of tobacco use Comprehensive population- based tobacco control

8. 8 Tobacco control in a health plan Challenges  Customers: employers, individuals, governments  Time horizon: month to month  Return on investment: desire for immediate return  Population: continual turnover  Expertise: payment for acute care

9. 9 Tobacco control in a health plan Benefits  Fresh thinking  New capacity: market research, communications  New relationships: businesses, business organizations  Legislative savvy  Action oriented

10. 10 Tobacco control in a health plan Strategies  Prove that it works  Pay attention to the core business  Communicate in understandable terms  Bring “value” to the organization  Innovate  Diversify beyond tobacco

11. 11 What should health plans do?  Cover: Cover effective treatments  Counsel: Provide counseling services  Collaborate: Lobby for effective public policies  Capitalize: Invest people and money  Count: Measure progress

12. 12 Blue Cross of Minnesota Physician counseling policy  Covers appointments for specific purpose of getting help to quit smoking  Physicians reimbursed for cessation counseling office visit as part of member’s coverage for clinic visits  No limit on number or length of visits

13. 13 Providing telephone counseling services in Minnesota  Health plans provide the services for their members.  State-funded program pays for uninsured and underinsured.  Callers are transferred (live) to their health plan’s service.  Blue Cross aggressively advertises its own line to increase participation.

14. 14 Lobby for effective public policies

15. 15 Promoting cessation

16. 16 Resources:  The Role of Health Plans in Tobacco Control. Annual Review of Public Health, 2003, 24:247-66.  Addressing Tobacco in Managed Care: A Resource Guide for Health Plans. http://www.aahp.org/atmc/ATMC_Tool kit.pdf