1. Tobacco Use among our Members, 1999 and 2003 Marc Manley, M.D., M.P.H. 1 ; Steven S. Foldes, Ph.D. 1 ; Nina L. Alesci, M.P.H. 1 ; Michael Davern, Ph.D. 2 ; Jeanette Ziegenfuss 2 ; Xiaohong Chen, M.S. 1 ; Patricia Bland, M.S. 2 ; Sanne J. Magnan, M.D., Ph.D. 1 May 5, 2005 1. Blue Cross and Blue Shield of Minnesota, an independent licensee of the Blue Cross and Blue Shield Association 2. University of Minnesota

2. Center for Tobacco Reduction & Health Improvement What I’ll Talk About  Who we are  What we do to reduce tobacco use  Smoking rates in 1999 and 2003 among our members

3. Center for Tobacco Reduction & Health Improvement Blue Cross and Blue Shield of Minnesota  2.6 million members  Not-for-profit  Statewide network of clinicians  Full portfolio of commercial and government health insurance products u Individuals, groups, national employers

4. Center for Tobacco Reduction & Health Improvement Reducing tobacco use what works?  Comprehensive approach  Policy and environmental change  Options for quitting

5. Center for Tobacco Reduction & Health Improvement 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

6. Center for Tobacco Reduction & Health Improvement Blue Cross of Minnesota Physician Counseling Policy  Covers appointments for specific purpose of getting help to quit smoking  No caps on number of visits  Applies to fully-insured and self- insured

7. Center for Tobacco Reduction & Health Improvement Blue Cross of Minnesota Pharmacy Benefit  Applies to fully insured  Covers all FDA-approved meds  Covers OTC and prescription drugs  Self-insured are encouraged to purchase similar benefit

8. Center for Tobacco Reduction & Health Improvement Providing telephone counseling services  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.

9. Center for Tobacco Reduction & Health Improvement Community initiatives  Physician advocacy network  Support increase in state excise tax on tobacco  Support communities creating smoke- free workplaces  Outreach to communities of color - Diverse Racial and Ethnic Groups and Nations Project (DREGAN)  Media campaign for college students

10. Center for Tobacco Reduction & Health Improvement The Minnesota Adult Tobacco Survey (MATS):  Designed to estimate: u Smoking prevalence rates u Tobacco-related attitudes and behaviors  Designed to represent: u Blue Cross and Blue Shield of Minnesota adult members living in Minnesota u Minnesota Adults (not part of this analysis) u Minnesota Young Adults (18-24)  Comparable to 1999 survey

11. Center for Tobacco Reduction & Health Improvement Blue Cross Blue Shield of Minnesota Sample  Telephone survey of 5,047 adult Blue Cross members living in Minnesota  62% response rate  Interviews conducted Nov. 02-June 03

12. Center for Tobacco Reduction & Health Improvement Cigarette Smoking Prevalence: All members 19992003p-value current14.7%12.4%p<.01 former25.7%30.3%p<.001 never59.5%57.4% n.s.

13. Center for Tobacco Reduction & Health Improvement Cigarette Smoking Prevalence by Insured Group 1999 2003 p-value Commercial 15.5% 12.5% p<.01 Medicaid 48.2% 37.4% p<.001 MinnesotaCare 31.1% 27.7% ns Medicare 5.0% 5.1%ns

14. Center for Tobacco Reduction & Health Improvement Quit attempts increase.  The percent of current adult smokers with at least one quit attempt in the past 12 months increased from 46% in 1999 to 54% in 2003.  58,770 members made quit attempts in 2003

15. Center for Tobacco Reduction & Health Improvement More smokers are getting ready to quit.

16. Center for Tobacco Reduction & Health Improvement Interest in using available assistance grows. 19992003

17. Center for Tobacco Reduction & Health Improvement Interest in telephone quitline grows dramatically

18. Center for Tobacco Reduction & Health Improvement More Blue Cross members could use assistance.  42% of current smokers with a quit attempt reported that they had used at least some form of quitting assistance.  That means 58% did not use any assistance.

19. Center for Tobacco Reduction & Health Improvement Summary  The prevalence of smoking among Blue Cross members declined significantly.  Quit attempts and readiness to quit increased significantly.  There’s strong interest in using quit aids, but far from optimal use.

20. Center for Tobacco Reduction & Health Improvement References The Role of Health Plans in Tobacco Control. Annual Review of Public Health, 2003. 24:247-66 Leading the Way Against the Leading Preventable Cause of Death. American Journal of Managed Care, 2004. 10:187-90 http://www.bluecrossmn.com/public/healthand wellness/tobacco.html u Quitting Smoking, 1999-2003: Nicotine Addiction in Minnesota