1. Clinical Initiatives Supporting the Treatment of Tobacco Use Dependence Jim Bluhm, MPH Project Manager Blue Cross and Blue Shield of Minnesota Center for Tobacco Reduction & Health Improvement National Conference on Tobacco OR Health November 2002

2. Center for Tobacco Reduction & Health Improvement Blue Cross and Blue Shield of Minnesota  Over 2 million members  Not-for-profit  Statewide network of clinicians  Full portfolio of commercial and government health insurance products u Individuals national employers

3. Center for Tobacco Reduction & Health Improvement Nearly 5 years post - settlement…  MN Supreme Court reverses lower court ruling  Blue Cross and Minnesota Department of Commerce reach agreement on use of settlement proceeds  Current lawsuit delaying use of settlement proceeds  Blue Cross commitment to tobacco reduction remains firm

4. Center for Tobacco Reduction & Health Improvement Investment in Prevention  Cornerstone of A Healthier Minnesota  Science-based  Multi-faceted  Four essential elements: u clinical interventions u local initiatives u high-risk populations outreach u public awareness campaigns

5. Center for Tobacco Reduction & Health Improvement Blue Cross Approach  Combines traditional health plan and clinical efforts with aggressive member, employer and community initiatives.  Both treatment and prevention, youth and adult, individual and population-based programs.  Builds on existing relationships with members, clinicians, employers, and communities.

6. Center for Tobacco Reduction & Health Improvement Clinical Initiatives  Counseling Supported - office visits and tobacco counseling phone line  Cessation Pharmacy Benefit  Incentives and Recognition  Provider Training  Clinical Resources  Research

7. Center for Tobacco Reduction & Health Improvement Clinical Guideline Recommendations for Insurers  All insurance plans [should] include as a reimbursed benefit u counseling u pharmacotherapy treatments.  Clinicians [should be] reimbursed for providing tobacco dependence treatment just as they are reimbursed for treating other chronic conditions. Treating Tobacco Use and Dependence Public Health Service, 2000

8. Center for Tobacco Reduction & Health Improvement Blue Cross Office Visit Medical Policy v New payment policy for ICD 9 code 301.5 (tobacco use) v Outpatient treatment of tobacco dependence is treated just like visits for other medical illnesses (e.g., diabetes or hypertension). 3 According to the benefit package the patient (or employer) has purchased.

9. Center for Tobacco Reduction & Health Improvement Practical Application of Policy for our Members: “Just as you would seek a doctor’s advice and treatment for diseases such as diabetes or heart disease, you can now do the same to treat tobacco addiction.”

10. Center for Tobacco Reduction & Health Improvement Medical Claims Utilization Number of Office Visit Claims by Quarter Medical Claims

11. Center for Tobacco Reduction & Health Improvement BluePrint for Health stop-smoking program  Phone-based individualized counseling based on expert system  Available for ALL Blue Cross and Blue Shield of Minnesota members  No additional cost, co-pay or deductible  Part of a statewide quit line

12. Center for Tobacco Reduction & Health Improvement Patient Education: Minnesota’s Tobacco Phone Counseling Lines  Patient education information card  Jointly developed by ALL MN health plans & statewide quit line  To date, +300,000 distributed to clinics and communities

13. Center for Tobacco Reduction & Health Improvement Clinical Initiatives  Counseling Supported - office visits and tobacco counseling phone line  Cessation Pharmacy Benefit  Incentives and Recognition  Provider Training  Clinical Resources  Research

14. Center for Tobacco Reduction & Health Improvement Cessation Medication Benefit Coverage  Nicotine patch, gum, inhaler, spray, Zyban  All fully-insured members  Self-insured groups make own coverage choices  Member pays regular co-pay

15. Center for Tobacco Reduction & Health Improvement Pharmacy Claims Utilization Number of Pharmacy Claims by Quarter Pharmacy Claims

16. Center for Tobacco Reduction & Health Improvement Clinical Initiatives  Counseling Supported - office visits and tobacco counseling phone line  Cessation Pharmacy Benefit  Incentives and Recognition  Provider Training  Clinical Resources  Research

17. Center for Tobacco Reduction & Health Improvement Tobacco Use Dependence Guideline Incentive Program  Primary care clinic incentive program u Based on managed care membership  Promotes implementation of tobacco use prevention and cessation clinical practice guidelines, ICSI or USPHS.  Requires health care delivery systems to follow the Plan, Do, Check, and Act (PDCA) continuous quality improvement process.

18. Center for Tobacco Reduction & Health Improvement Making a Healthy Difference Awards  Non-monetary award presented to clinics, medical groups and systems  Recognizes achievement in quality improvement and demonstrate innovative approaches in meeting patient needs  Clinics/systems receive a plaque commemorating their efforts, publicity in both Blue Cross publications and their local media, and a celebratory luncheon

19. Center for Tobacco Reduction & Health Improvement Clinical Initiatives  Counseling Supported - office visits and tobacco counseling phone line  Cessation Pharmacy Benefit  Incentives and Recognition  Provider Training  Clinical Resources  Research

20. Center for Tobacco Reduction & Health Improvement Annual Clinical Systems Forum Interactive forum for primary health care providers to discuss innovative, successful and systems-based approaches to implement USPHS and ICSI tobacco use dependence guidelines. Keynotes u 2001 - Michael Fiore, MD, MPH u 2002 - Ed Wagner, MD, MPH, FACP

21. Center for Tobacco Reduction & Health Improvement Blue Cross Sponsored Training and Seminars  Mayo Clinic Nicotine Dependence Seminar u Since 1999, over 245 clinician scholarships awarded  University of Minnesota -- Tobacco Use Research Center, Department of Psychiatry and School of Public Health u Since 2000, over 200 clinicians trained

22. Center for Tobacco Reduction & Health Improvement Pharmacy Benefit Manager Clinical Education Sessions  Education and information on the treatment of tobacco use incorporated into 3 clinical education sessions  To date, over 200 clinicians educated  CME’s and lunch offered as incentive  Specific training devoted specifically to tobacco use dependence nearing completion

23. Center for Tobacco Reduction & Health Improvement Clinical Initiatives  Counseling Supported - office visits and tobacco counseling phone line  Cessation Pharmacy Benefit  Incentives and Recognition  Provider Training  Clinical Resources  Research

24. Center for Tobacco Reduction & Health Improvement Clinical Resources

25. Center for Tobacco Reduction & Health Improvement Clinician Resource Packet

26. Center for Tobacco Reduction & Health Improvement Personalized Quit Plan Tear Sheet

27. Center for Tobacco Reduction & Health Improvement Clinical Initiatives  Counseling Supported - office visits and tobacco counseling phone line  Cessation Pharmacy Benefit  Incentives and Recognition  Provider Training  Clinical Resources  Research

28. Center for Tobacco Reduction & Health Improvement Research  Quality Improvement in Clinical Systems (QUICS) study -- PI: Larry An, MD u Questions Being Addressed: 4 What systems are in place in Minnesota primary care clinics to support tobacco use treatment? 4 How are existing systems related to treatment of tobacco use? 4 What are the opportunities for increasing support for tobacco treatment in Minnesota?

29. Center for Tobacco Reduction & Health Improvement Our purpose W E MAKE A H EALTHY D IFFERENCE IN PEOPLE’S LIVES.