Unless action is taken, the high costs associated with smoking could cripple the transformation process
June 15, 2011— The latest statistics show that 37 percent of adults on the Oregon Health Plan are lighting up, which is of grave concern because of the high healthcare costs associated with smokers who may develop lung cancer, emphysema, asthma and other illnesses.
These statistics come from a 2007 Consumer Assessment of Healthcare Providers and Systems (CAPHS) survey of health plan members and is based on self-reported smoking status among clients on fee for service and managed care. It compares with a 13 percent smoking rate among adults who have other insurance, according to Alissa Robbins, communications officer with the Oregon Health Authority.
In 2007, there were 151,000 adult Medicaid participants. Of those, 51,000 reported that they smoked.
A more recent CAPHS survey was conducted in 2010, which includes smoking prevalence, and that data will be available soon, Robbins told The Lund Report.
High tobacco use “drives costs that are not sustainable over the long term,” Jon Pelkey, quality improvement and medical section manager of the Oregon Health Authority, told the medical directors in early May. “This is such a critical issue to get right.”
The state’s transformation
efforts to create coordinated care organizations, bringing together physical, mental and dental healthcare, won’t succeed unless tobacco prevalence decreases, Cathryn Cushing, who leads the Oregon Public Health Division’s tobacco control integration project
, told the medical directors.
“We’re sunk” if no action is taken, she said. “We’re going to have to manage the population a lot better than we are right now. We need to throw as much as we can behind this effort. It reduces suffering in families, and it will eventually reduce costs to have a healthier population to deal with.”
With the economy waning, more people have come into the Oregon Health Plan, many of them smokers, said Dr. Lyle Jackson, president of Mid Rogue Valley Independent Physician Association
. “We’re getting people all the time who’ve never been in managed care. They’re the working poor. They’re more likely to be smoking than a disabled child.”
Cushing suggested that physicians ask their patients whether they smoke, and, if so, whether they’d be interested in quitting. Such data, she said, could help tailor prevention and treatment programs.
But Dr. John Sattenspiel, senior medical director of Eugene-based Agate Healthcare
, said “it would be a huge amount of work” to document each conversation a physician has with their patients.
“We establish contracts,” he said. “Ultimately, those services are delivered in their offices. We don’t look over their shoulders and tell them how to practice, and what the content of each their encounters should be with patients.”
“We try to ask,” said Dr. Ariel Smits, a family physician at Oregon Health & Science University
. “If it’s a complicated patient, and they need their depression medication, I may not be able to talk to them about tobacco. We need some flexibility.”
Kaiser Permanente has had a return on investment with its tobacco cessation programs, according to Jeffrey Fellows, PhD, health economist at Kaiser Permanente Northwest’s Center for Health Research
“Tobacco control interventions have been demonstrated to be cost effective,” he said.
The majority of people who quit smoking are those who’ve had a “come to Jesus moment” when they’re diagnosed with a health condition directly correlated with their smoking. “Being a quitter is a signal that you’ve got health problems,” he said.
The goal of a tobacco cessation program, he said, is “to turn these expensive quitters who are quitting under duress into healthy quitters.”
Kaiser conducted a study of various intervention strategies to determine the cost benefits of a tobacco cessation program, using the records of 200,000 patients of whom 34,000 represented current smokers.
Overall, people who chose to continue smoking left the health plan, while those who quit, stayed, which resulted in savings. What the study shows, Fellows said, is that “helping patients quit is good business.”
There is, he added, “more to fear from sicker quitters staying, than healthy quitters who leave.”
Increasing the tobacco tax is one of the most effective ways of pursuing tobacco cessation, said Cushing, because prevalence decreases rapidly and detectably. Fellows referred to such a tax as a “sledgehammer” approach.
However, four bills introduced this session that would have increased the state’s tobacco tax between $1 and $2.42 have died.
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