February 26, 2013 -- The coordinated care organizations have been tasked with a daunting challenge – reducing the growth in Medicaid expenditures while also improving healthcare quality and access. Smoking ranks near the top of that list, absorbing $287 million a year in Medicaid costs, according to a recent report compiled by the Oregon Health Authority: Burden of Tobacco Among Medicaid Clients in Oregon.
As these CCOs move forward, the Oregon Health Authority intends to monitor the tobacco use among their members, and the Centers for Medicare and Medicaid intend to make sure the CCOs are providing medical assistance with smoking and tobacco use cessation.
To learn what CCOs are doing to help people quit smoking, The Lund Report conducted several interviews.
Cynthia Ackerman, the director of medical management and government programs officer for AllCare Health Plan, is proud of its tobacco prevention program. “Our efforts at prevention are all encompassing.” AllCare has members in Curry, Douglas, Jackson and Josephine counties.
For example, individual and group counseling is offered at no cost and with no limits, while AllCare targets its efforts at the chronically mentally ill, pregnant members and people with chronic illnesses. AllCare also reaches out to patients who’ve been prescribed nicotine replacement products to make sure they’re receiving the support they need to break the habit.
And, the CCO tracks recidivism rates by calling members who’ve successfully quit at 6 months and 1 year intervals to offer encouragement and continued support.
“With the Medicaid population, we see a higher rate of relapse,” Ackerman noted. “Generally, we can attribute this to other socio-economic factors.” With each quit attempt, she said, the likelihood of success grows.
AllCare, along with other community partners, organized and sponsored the first Great American Smoke Out in Josephine County. Due to its success, it will be an annual event. AllCare is helping organize similar efforts in Jackson and Curry counties.
Meanwhile, Trillium Community Health Plan offers tobacco cessation counseling to its members at no cost and with no limits. People are given nicotine replacement tools as well as prescription drug therapies including Chantix (Varenicline) and Wellbutrin (Bupropion SR), said Dr. John Sattenpiel, chief medical officer.
“We don’t limit cessation counseling,” Sattenspiel said, “But we do limit the duration of prescription use.”
When a member has quit smoking, or is having success with their prescription usage, Trillium may extend the duration, he said.
Trillium has also formed a partnership with the Lane County Public Health Department, to support its tobacco prevention and cessation efforts.
Inspired by Trillium’s partnership with Lane County, Health Share of Oregon – the largest CCO in the state – is interested in doing something similar, said Rosa Klein, chief health and strategy officer.
Health Share is looking at evidence-based best practices to help its members quit smoking. “We (the CCO) are different parts working together in a way we never have before,” Klein noted. “We’re looking at the best models that currently exist and looking at doing new things as well.”
At CareOregon, members have access to Alere (a telephonic counseling program) for tobacco cessation services, and Nicotene replacement therapy (NRT) when prescribed by their doctor, according to Jeanie Lunsford, senior manager of communications. CareOregon works with Columbia Pacific CCO, Jackson Care Connect, Yamhill County Care Organization, and some of Health Share’s members.
“When a doctor prescribes NRT, we mail support and health education materials to the member,” Lunsford said. “Alere reaches out to offer counseling services.”
She also said, “The CCOs are in the planning mode regarding a variety of health issues and will be publishing their transformation plan later in the year.”
InterCommunity Health Network is in the initial planning stages to standardize and expand the care management continuum — awareness, prevention, screening, diagnosis, treatment, management — for tobacco cessation throughout its delivery system, and then beyond to local community organizations and county agencies.
Yet, Cristie Lynch, its communications manager, admits the CCO needs to do more to help its member quit smoking. That could mean, she said, providing hospital discharge planners with training and tools to help assess a patient’s readiness to quit and helping them decide on a cessation plan.
InterCommunity Health also provides smoke-free environments for its staff and patients and is working to develop county-wide policies to reduce exposure to secondhand smoke and counter influences of the tobacco industry.
“We are working toward a consistent, unified approach to tobacco prevention and cessation in Benton, Lincoln and Linn counties that will benefit our Oregon Health Plan members and our communities,” she said.
FOR MORE INFORMATION
http://public.health.oregon.gov/PreventionWellness/TobaccoPrevention/Documents/medicaidburden.pdf
http://www.oregon.gov/oha/OHPB/Documents/special-terms-conditions-accountability-plan-summary.pdf
http://www.thelundreport.org/resource/tobacco_prevention_bolstered_by_partnership
http://www.oregon.gov/oha/healthplan/data_pubs/reports/mco-cessation2011.pdf
