Increasing Institutional Consumer Demand: - PowerPoint PPT Presentation


Title: Increasing Institutional Consumer Demand:


1
Increasing Institutional Consumer Demand
Healthplans, Employers ( Government)
  • Tim McAfee, MD, MPH
  • 206-876-2551
  • Tim.mcafee_at_
  • freeclear.com

2
Why bother with institutions?
  • Strong evidence that
  • removal of access barriers
  • aggressive institutional promotion
  • markedly increases individual consumer use of
    evidence-based services
  • BUT
  • There is only fair to middling institutional
    demand for tobacco treatment services

3
Populations
  • 80 of population has health insurance
  • 70 of smoking population works
  • 100 live in a state
  • Special institutional populations
  • Those who hold the risk long-term
  • Union Trusts
  • VA
  • Medicare

4
Financing as a social justice issue
  • 99 of MSA and tax dollars are being spent on
    things other than helping smokers quit
  • Tobacco taxes are an involuntary tax on an
    addiction
  • Smokers are disproportionately represented in the
    poor
  • Treating tobacco dependence should be a core,
    evidence-based component of healthcare

5
Tobacco Treatment
6
On Wisconsin
  • Medical Assistants invited 4,174 adult smokers
  • Free patches with or without CQ or counseling
  • In urban Milwaukee clinics
  • 68 of those invited accepted
  • 1/2 re-contacted, screened agreed
  • Half self-selected Rx
  • 25 patch-only
  • 33 patch CQ
  • 42 patch CQ Counseling
  • We made it incredibly easy to use with barrier
    and hassle-free access at time of contact
  • Michael Fiore
  • Fiore MC et al. Integrating smoking cessation
    treatment into primary care an effectiveness
    study. Preventive Medicine 38 (2004) 412-420.

7
Union Trust Fund Western WA Carpenters Fund
  • Population 23K 7,400 smokers
  • Intervention
  • Coverage for nicotine patches, gum bupropion
  • Coverage for proactive phone counseling
  • Publicity via mailing and union meeting
    announcements

Ringen et al. Am J Ind Med 42367-377 (2002)
8
Results Western WA Carpenters Fund
  • 944 smokers enrolled (13)
  • 2/3 smoked gt20 years
  • 2/3 smoked gt a pack a day
  • Program usage
  • 60 chose 5-call program
  • 75 used a medication
  • Outcomes
  • 22-27 quit rate at 12 or more months

Ringen et al. Am J Ind Med 42367-377 (2002)
9
Understanding their lawn
  • Healthplans
  • Purchaser user (providers enrollees) pressure
  • Regulatory requirements
  • Evidence of rapid ROI or cost-effectiveness
  • Complex and variable other factors (KISS)
  • Employers
  • ROI
  • Healthcare costs productivity
  • KISS
  • Why not just fire them?
  • State Govt (is a healthcare purchaser)
  • Cost-effectiveness, not ROI
  • Potential impact
  • How it plays in Albany, Sacramento, Olympia, etc

10
Product/services
  • Healthplans
  • Interested in disease mgmt models
  • Stratification
  • Manage population
  • Recruitment effectiveness competency
  • Interested in integrated offerings
  • Employers
  • Show me the productivity savings!
  • Carve out or insist healthplans provide

11
Healthplan Coverage Estimates
  • ATMC 2002 survey - Coverage
  • for patches 8.6
  • For Bupropion 40-80
  • For phone counseling 52
  • For individual counseling 41
  • Limitations
  • Only best-selling commercial HMO product included
  • No ASO vs fully-insured distinction
  • Based on survey response 2/3 from 3 national
    plans
  • Some answers do not jibe with experience
  • s improved from previous surveys
  • McPhillips-Tangum C, et at. Addressing tobacco in
    managed care results of the 2002 survey. Prev
    Chronic Dis (serial online) 2004 Oct URL
    http//www.cdc.gov/pcd/issues/2004/oct/04_0021.htm

12
Employer Coverage Estimates
  • Mercer national survey of employer-sponsored
    health plans 2001
  • Limits
  • 21response rate
  • Results
  • 90 note increased productivity decreased
    healthcare costs as reasons to cover preventive
    services
  • Biggest discrepancy between calculated
    impact/value and provision is tobacco treatment
  • Any type of treatment 20 (29 in HMO)
  • Prescriptions 15 (24 in HMO)
  • Counseling 10 (17 in HMO)
  • Bondi MA et al. Employer Coverage of Clinical
    Preventive Services in the United States.
    American Journal of Health Promotion January 2006

13
Barriers
  • Lack of perceived need benefit
  • Risk is buried
  • Opportunity is uncertain
  • Inertia
  • Complexity
  • Institutional biases
  • The Frog Phenomenon

14
HIGH PARTICIPATION RATES
  • Full coverage of counseling and medication
  • Integration
  • Ongoing promotions
  • Incentives to enroll engage

15
STRONG SUPPORT FOR INCENTIVES
  • 2005 Wall Street Journal online poll reveals
  • 71 of adults think employers should provide
    financial incentives to employees who join a stop
    smoking program
  • 63 of adults favor different levels of insurance
    premiums for smokers

Based on sample of 2,007 U.S adults. Survey
conducted by Harris Interactive Health-Care in
December 2005.
16
What drives institutional demand?
  • 1) Guaranteed and predictable impact
    (participation outcomes) from known strategies
  • 2) Comparison against other programs that are
    embraced with much lower proof of
    ROI/effectiveness (statins, mammograms, holiday
    parties)
  • 3) Comparison against what happens if you do
    nothing  Spiraling cost and sickness

17
THE COST OF TOBACCO
TOBACCO COST EXPOSURE PER YEAR 350,000,000
18
NET SAVINGS OPPORTUNITY
NET SAVINGS OVER 3 YEARS 13,212,787
LINK TO ROI ANALYSIS TOOL
19
Public-private partnerships
  • Minnesota/Oregon examples
  • Healthplans/employers cover meds phone
  • State Healthplan mass media
  • Quitline or phone center triage functions
  • Integration of pharmacotherapy into treatment AND
    promotion
  • Help with advocacy

20
Impact health system state
  • WA state QL
  • popn 5,800,000
  • adult smoking 23
  • 9,500/year use WA QL (0.9 of smokers)
  • 3000 receive proactive follow-up
  • 6,500 receive single intervention
  • 685 quits (12 5)
  • Group Health
  • popn 580,000
  • adult smoking 15
  • 4,500/year use GH QL (7.5 of smokers)
  • All receive proactive follow-up
  • 70 with pharmacotherapy
  • 540 quits (12 AIQR)

21
Its a complex world
  • ABC campaign increased demand, right?
  • Maybe/Maybe not
  • Multiple states cut back on state promotional
    campaigns

22
Novel Healthplan approaches
  • HIP NY
  • DM vendors provided known smokers
  • FC called
  • 50 of those contacted signed up
  • Lumenos
  • Consumer-directed Healthplan
  • Provided counseling/meds as first-dollar coverage
    HSA incentive
  • Strong education
  • Above-average participation rate

23
Program Participation Group Health Enrollees
One-year quit rate 25-30 (30-day abstinence
Intent-to-Treat)
24
WHAT WORKS
  • National retail employer 21 participation
  • 10 monthly premium differential
  • Continuous communication
  • Southwest employer 18 participation
  • Pre-launch web-cast to all managers
  • CEO launch and follow up letters
  • Large western health plan 8 participation
  • Brochures in all clinics
  • Frequent member communications
  • MDs trained and tracked on referrals

25
What we need
  • Better ROI data packaging
  • Chronic condition REAL ROI examination
  • Productivity data
  • Better institutional trend data
  • Bully pulpit pressure from public health
  • Products that speak more directly to
    institutional needs
View by Category
About This Presentation
Title:

Increasing Institutional Consumer Demand:

Description:

There is only fair to middling institutional demand for tobacco ... Mercer national survey of employer-sponsored health plans 2001. Limits: 21%response rate ... – PowerPoint PPT presentation

Number of Views:56
Avg rating:3.0/5.0
Slides: 26
Provided by: consume6
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Increasing Institutional Consumer Demand:


1
Increasing Institutional Consumer Demand
Healthplans, Employers ( Government)
  • Tim McAfee, MD, MPH
  • 206-876-2551
  • Tim.mcafee_at_
  • freeclear.com

2
Why bother with institutions?
  • Strong evidence that
  • removal of access barriers
  • aggressive institutional promotion
  • markedly increases individual consumer use of
    evidence-based services
  • BUT
  • There is only fair to middling institutional
    demand for tobacco treatment services

3
Populations
  • 80 of population has health insurance
  • 70 of smoking population works
  • 100 live in a state
  • Special institutional populations
  • Those who hold the risk long-term
  • Union Trusts
  • VA
  • Medicare

4
Financing as a social justice issue
  • 99 of MSA and tax dollars are being spent on
    things other than helping smokers quit
  • Tobacco taxes are an involuntary tax on an
    addiction
  • Smokers are disproportionately represented in the
    poor
  • Treating tobacco dependence should be a core,
    evidence-based component of healthcare

5
Tobacco Treatment
6
On Wisconsin
  • Medical Assistants invited 4,174 adult smokers
  • Free patches with or without CQ or counseling
  • In urban Milwaukee clinics
  • 68 of those invited accepted
  • 1/2 re-contacted, screened agreed
  • Half self-selected Rx
  • 25 patch-only
  • 33 patch CQ
  • 42 patch CQ Counseling
  • We made it incredibly easy to use with barrier
    and hassle-free access at time of contact
  • Michael Fiore
  • Fiore MC et al. Integrating smoking cessation
    treatment into primary care an effectiveness
    study. Preventive Medicine 38 (2004) 412-420.

7
Union Trust Fund Western WA Carpenters Fund
  • Population 23K 7,400 smokers
  • Intervention
  • Coverage for nicotine patches, gum bupropion
  • Coverage for proactive phone counseling
  • Publicity via mailing and union meeting
    announcements

Ringen et al. Am J Ind Med 42367-377 (2002)
8
Results Western WA Carpenters Fund
  • 944 smokers enrolled (13)
  • 2/3 smoked gt20 years
  • 2/3 smoked gt a pack a day
  • Program usage
  • 60 chose 5-call program
  • 75 used a medication
  • Outcomes
  • 22-27 quit rate at 12 or more months

Ringen et al. Am J Ind Med 42367-377 (2002)
9
Understanding their lawn
  • Healthplans
  • Purchaser user (providers enrollees) pressure
  • Regulatory requirements
  • Evidence of rapid ROI or cost-effectiveness
  • Complex and variable other factors (KISS)
  • Employers
  • ROI
  • Healthcare costs productivity
  • KISS
  • Why not just fire them?
  • State Govt (is a healthcare purchaser)
  • Cost-effectiveness, not ROI
  • Potential impact
  • How it plays in Albany, Sacramento, Olympia, etc

10
Product/services
  • Healthplans
  • Interested in disease mgmt models
  • Stratification
  • Manage population
  • Recruitment effectiveness competency
  • Interested in integrated offerings
  • Employers
  • Show me the productivity savings!
  • Carve out or insist healthplans provide

11
Healthplan Coverage Estimates
  • ATMC 2002 survey - Coverage
  • for patches 8.6
  • For Bupropion 40-80
  • For phone counseling 52
  • For individual counseling 41
  • Limitations
  • Only best-selling commercial HMO product included
  • No ASO vs fully-insured distinction
  • Based on survey response 2/3 from 3 national
    plans
  • Some answers do not jibe with experience
  • s improved from previous surveys
  • McPhillips-Tangum C, et at. Addressing tobacco in
    managed care results of the 2002 survey. Prev
    Chronic Dis (serial online) 2004 Oct URL
    http//www.cdc.gov/pcd/issues/2004/oct/04_0021.htm

12
Employer Coverage Estimates
  • Mercer national survey of employer-sponsored
    health plans 2001
  • Limits
  • 21response rate
  • Results
  • 90 note increased productivity decreased
    healthcare costs as reasons to cover preventive
    services
  • Biggest discrepancy between calculated
    impact/value and provision is tobacco treatment
  • Any type of treatment 20 (29 in HMO)
  • Prescriptions 15 (24 in HMO)
  • Counseling 10 (17 in HMO)
  • Bondi MA et al. Employer Coverage of Clinical
    Preventive Services in the United States.
    American Journal of Health Promotion January 2006

13
Barriers
  • Lack of perceived need benefit
  • Risk is buried
  • Opportunity is uncertain
  • Inertia
  • Complexity
  • Institutional biases
  • The Frog Phenomenon

14
HIGH PARTICIPATION RATES
  • Full coverage of counseling and medication
  • Integration
  • Ongoing promotions
  • Incentives to enroll engage

15
STRONG SUPPORT FOR INCENTIVES
  • 2005 Wall Street Journal online poll reveals
  • 71 of adults think employers should provide
    financial incentives to employees who join a stop
    smoking program
  • 63 of adults favor different levels of insurance
    premiums for smokers

Based on sample of 2,007 U.S adults. Survey
conducted by Harris Interactive Health-Care in
December 2005.
16
What drives institutional demand?
  • 1) Guaranteed and predictable impact
    (participation outcomes) from known strategies
  • 2) Comparison against other programs that are
    embraced with much lower proof of
    ROI/effectiveness (statins, mammograms, holiday
    parties)
  • 3) Comparison against what happens if you do
    nothing  Spiraling cost and sickness

17
THE COST OF TOBACCO
TOBACCO COST EXPOSURE PER YEAR 350,000,000
18
NET SAVINGS OPPORTUNITY
NET SAVINGS OVER 3 YEARS 13,212,787
LINK TO ROI ANALYSIS TOOL
19
Public-private partnerships
  • Minnesota/Oregon examples
  • Healthplans/employers cover meds phone
  • State Healthplan mass media
  • Quitline or phone center triage functions
  • Integration of pharmacotherapy into treatment AND
    promotion
  • Help with advocacy

20
Impact health system state
  • WA state QL
  • popn 5,800,000
  • adult smoking 23
  • 9,500/year use WA QL (0.9 of smokers)
  • 3000 receive proactive follow-up
  • 6,500 receive single intervention
  • 685 quits (12 5)
  • Group Health
  • popn 580,000
  • adult smoking 15
  • 4,500/year use GH QL (7.5 of smokers)
  • All receive proactive follow-up
  • 70 with pharmacotherapy
  • 540 quits (12 AIQR)

21
Its a complex world
  • ABC campaign increased demand, right?
  • Maybe/Maybe not
  • Multiple states cut back on state promotional
    campaigns

22
Novel Healthplan approaches
  • HIP NY
  • DM vendors provided known smokers
  • FC called
  • 50 of those contacted signed up
  • Lumenos
  • Consumer-directed Healthplan
  • Provided counseling/meds as first-dollar coverage
    HSA incentive
  • Strong education
  • Above-average participation rate

23
Program Participation Group Health Enrollees
One-year quit rate 25-30 (30-day abstinence
Intent-to-Treat)
24
WHAT WORKS
  • National retail employer 21 participation
  • 10 monthly premium differential
  • Continuous communication
  • Southwest employer 18 participation
  • Pre-launch web-cast to all managers
  • CEO launch and follow up letters
  • Large western health plan 8 participation
  • Brochures in all clinics
  • Frequent member communications
  • MDs trained and tracked on referrals

25
What we need
  • Better ROI data packaging
  • Chronic condition REAL ROI examination
  • Productivity data
  • Better institutional trend data
  • Bully pulpit pressure from public health
  • Products that speak more directly to
    institutional needs
About PowerShow.com