National Working Group for ACTTION

July 1, 2010

The Multi-State Collaborative for Health Systems Change is a network of 20 state-level tobacco control programs and national partner organizations whose mission is to facilitate sustainable changes in health care policy at the state and national level in order to increase cessation rates and reduce tobacco use prevalence. ActionToQuit recently asked Donna Warner and Caroline Cranos to tell us more about this exciting undertaking.

ActionToQuit:
For the record, please give me your names and titles and describe your role with the Collaborative? How much time do you give to the Collaborative?

Donna:
Donna Warner, Director of Cessation Policy and Program Development, Tobacco Cessation and Prevention Program (MTCP), Massachusetts Department of Public Health. As with all our members, my work for the Collaborative has been as a volunteer. However, starting in July, I will serve as the Collaborative’s Managing Partner one a day a week and will work for MTCP part-time. 

Caroline:
Caroline Cranos, Collaborative Coordinator and Consultant for UMass Medical School. I have the only paid position with the Collaborative and my work is part-time.

ActionToQuit:
What was the inspiration for the Collaborative?

Donna:
Tobacco control program investments in cessation policy and healthcare systems change advanced rapidly in some states in the past five to seven years.  Yet there had been few formal opportunities available to state-level change agents for sharing emerging models and best practices. To fill this gap, Massachusetts, Wisconsin and New York co-founded the Collaborative in 2007 as a community of practice and invited other states and national organizations to join us. We have grown rapidly from seven to 20 states and five national partners. 

The Collaborative priorities are cessation benefit policies (e.g. state medicaid benefits) and system-level strategies for integrating evidence-based tobacco use interventions into health care delivery as a standard of care.  These strategies—such as brief provider interventions and fax or electronic referrals to quitlines—often necessitate significant changes in clinic workflow and health information technology. 

State-level efforts  have  gained momentum from important reports, such as the 2007 Institute of Medicine’s Ending the Tobacco Problem: A Blueprint for the Nation and the Public Health Service tobacco use clinical practice guideline Treating Tobacco Use and Dependence—2008 Update. Both of these reports focus on the need for health systems change and the gaps in our knowledge in this area. 

ActionToQuit:
What is the focus of the Collaborative?

Donna:
The Collaborative has three main objectives:
• to provide a structure and forum to help states to grapple with the practical concerns of how to implement expert recommendations for policy and systems-level changes in healthcare;
• to raise the visibility of cessation policy and health systems change as powerful strategies to reduce prevalence and improve individual and population health, and to demonstrate this empirically with data from member states; and
• to partner with national organizations to promote policy change that is needed beyond state boundaries for the benefit of all states.

ActionToQuit:
Who are members and how do they join?

Caroline:
Members are the lead agencies with responsibility for statewide cessation policy or programs, and national organizations.  Prospective members are asked to complete an application and submit a case study of work completed or progress in one of our priority areas. Members must also be willing to participate actively in our task groups and swap materials and technical assistance with other members.

Collaborative’s expansion to new members is also contingent upon our financial resources.
While the Collaborative has no membership dues, some members do support the Collaborative through voluntary contributions.

State level or national organizations interested in learning more about the Collaborative and how to join can email me at caroline.cranos@umassmed.edu

ActionToQuit:
I know that you have task groups.  What are the issues being addressed by the task groups? Can you give us some examples of activities or progress made?

Donna:
We have time limited task groups based on interests and needs of members or to respond to specific issues. Currently we have active task groups on insurance and benefits, integrating tobacco use in electronic health records, and conference planning. In prior years, we had a Healthy People 2020 task group to formulate systems-level recommendations, and task groups on marketing to clinicians, clinician education, and working with healthcare facilities.

Our goal is to connect our members on issues, topics or needs that each is addressing independently and that we can benefit from addressing collectively in rapid learning cycles.

ActionToQuit:
Can you tell us about any other projects you have underway?

Caroline:
We have a significant project underway to collect and analyze large data sets from state Medicaid agencies and health care delivery systems to assess the impact of benefit policy and tobacco interventions on prevalence, health outcomes and costs, building upon work done in Massachusetts.

We hope to estimate health outcomes for various benefit designs and levels of utilization.  We will also complete evaluations of several large health systems to understand better what specific components in their intervention systems contribute most to positive outcomes.

We are presently identifying state tobacco control programs (and their Medicaid agencies) and health care delivery systems with tobacco intervention data that would like to participate in and benefit from these evaluations. Thus far, we have six candidate states.

Those interested should email me at caroline.cranos@umassmed.edu. We will be convening a conference call with interested states in a month or two.

ActionToQuit:
The reports published by the collaborative—Improving Health Care Systems to Reduce Tobacco Use: Lessons Learned from States http://www.multistatecessationcollaborative.org/HSC_Lessons_Learned_from_States.pdf  and the companion Improving Health Care Systems to Reduce Tobacco Use: Promising Practices Case Studies http://www.multistatecessationcollaborative.org/HSC_Case_Studies.pdf are rich sources of information.  You identify six strategies that emerged repeatedly in the 23 projects covered by your report. Can you give us a few concrete examples of these successful strategies in action?

Donna:
Several case studies focus on successful partnerships between the lead tobacco agency in the state and private health plans that resulted in expanded access to cessation services.

Oklahoma provided a case study of their successful initiative to improve cessation benefits for state employees.

Case studies from Massachusetts and Colorado illustrate how funding allocated for systems changes in health care to address tobacco use, including documentation and reporting, resulted in increased provider interventions and referral to treatment.  These two especially demonstrate the importance of performance measurement to sustain and improve individual clinician interventions.

New York State’s Don’t Be Silent Campaign is also featured in one case study, along with evaluation results.

ActionToQuit:
It is useful for people to know what does not work as well as what does work so they do not replicate weak approaches.  Can you share some examples of hopeful approaches that did not succeed?

Donna:
The case studies were selected to focus on promising and best practices.  However, each author was asked to include what didn’t work.  Whether the focus is health plans or healthcare facilities, projects most often stall when buy-in does not occur at all levels of the organization.  It is vital that key decision-makers at the highest level sponsor this work, make a commitment, and assign staff.  Our experience with integrating tobacco interventions in hospitals and health care clinic systems is that it takes time. There needs to be a long term commitment from both the healthcare facility and the tobacco control program—possibly years.

ActionToQuit:
I was wondering if you wanted someone to read just one case study, which you would recommend. 

Donna:
I would point someone to the matrix we provide that compares all 23 projects on a number of dimensions. It is a reference guide so that readers can review all projects quickly and identify those of special interest to them. Each case study includes the name of an individual to contact for more information. (http://www.multistatecessationcollaborative.org/HSC_Comparison_Charts.pdf)

ActionToQuit:
You have conducted webinars on topics such as defining health systems change, supporting changes in healthcare facilities, benefit/reimbursement strategies, and action planning.  Are these webinars archived somewhere that people can access?  Are there any more planned for the near future?

Caroline:
We are planning a webinar that features new members in the near future.  We have an archive of all of our webinars that anyone can download from our website.

ActionToQuit:
You have your 4th conference coming up in October in Atlanta   Can you share names of some of your speakers? 

Caroline:
We are very excited about the speakers that we have lined up.  The CDC Director , Dr. Tom Frieden, will be addressing the conference, as well as Dr. Michael Fiore, Professor of Medicine, Director, Center for Tobacco Research and Intervention, University of Wisconsin Medical School; Ursula Bauer, Director of the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP); David Abrams, Executive Director, Schroeder National Institute for Tobacco Research and Policy Studies at the American Legacy Foundation; and Rosie Henson, senior advisor to the HHS Assistant Secretary for Health. 

In addition, a number of national organizations, health care delivery systems, insurers, and researchers have agreed to serve on panels.  We also have excellent workshops planned, some focused on new results and some on the theme of “What drives change?”  It should be a very interesting and strategy-focused conference that we hope will galvanize action among the 30 states and national partners that already plan to attend.