quitline reimbursement and cost-sharing partnerships: massachusetts experience donna warner

Massachusetts Department of Public Health, Tobacco Control Program

Quitline Reimbursement and Cost-Sharing Partnerships: Massachusetts Experience

Donna WarnerMA Tobacco Control Program

NAQC Conference Call: ReimbursementJanuary 7 and 9, 2009

Four (Brief) Topics

• Background on Massachusetts cessation strategies

• Massachusetts Medicaid coverage and quitline experience

• Strategies to improve benefit coverage and reimbursement in MA

• Cost-sharing quitline partnerships

Background• Declining smoking

prevalence (16.4%)

• Cessation strategic focus– Tax policy, benefit coverage,

healthcare systems change, quitline/QuitWorks, patch giveaways

• NAQC “option” categories– For self-referred callers: single state-

funded quitline operating alongside others, generally uncoordinated

– For fax-referred QuitWorks patients: single state fax-referral program, coordinated with major health plans.

Medicaid Benefit and Quitline Experience

• MA Medicaid Coverage

– New comprehensive benefit in 2007

– Strong utilization in first two years

• Experience seeking Medicaid quitline

reimbursement

Massachusetts Climate to Promote Improvements

• Medicaid benefit serves as model in MA

• Seeking Group insurance Commission cessation coverage for state employees and retirees

• Smoke-free campuses in all EOHHS facilities as of July 1, 2009

• Longstanding QuitWorks fax-referral partnership offers opportunity and market insights

Partnership with Health Plans

• Annual contracts with three commercial plans for quitline/QuitWorks data reports.

• Pilot project with Harvard Pilgrim Healthcare (2nd largest commercial plan in MA) to provide quitline/NRT services for their employees.

• March meeting with health plans to discuss quitline options and to explore service, legal, database solutions together.

Cost-Sharing Partnership with Carpenters Union (30,000

Members)• Opportunity to work with up

to 8 Taft-Hartley funds

• Key steps in offer and agreement to provide quitline and NRT services

• Work required to customize quitline services: customize protocol database, verify members, produce billing and service reports.

Asbestos WorkersBricklayersCarpentersIron WorkersPipe FittersTeamsters Painters and Allied TradesPlasterers and Cement MasonsRoofers Other Trades

Some Lessons Learned from Health Plans and Unions in

Massachusetts• Commercial health plans report increased employer

demand for cessation services.

• In response, health plans, employers, unions consider various service models, costs/ROI and issue RFPs for quitline services or integrated DM solutions. (They use MDPH as resource).

• To serve health plans or unions, quitline must meet needs re: client tracking, member verification, consent, data reports, and turn-around times.

• MA health plans increasingly report concerns with uncoordinated cessation services (e.g. multiple vendors, contracts)

Key Take-Away Points

• Need and use leader-examples (e.g. exemplary health plan, union, Medicaid)

• Partnerships are invaluable and necessary

• Develop strong personal relationships with folks within Medicaid, health plans, unions

• With cost-sharing partners, state quitline must offer quality, customer service, and rapid turnaround

• Bring in the experts, as needed (e.g. ROI, researchers, communications)

Massachusetts Department of Public Health, Tobacco Control Program

Thank Youdonna.warner@state.ma.us