National Working Group for ACTTION

February 23, 2010

On November 19, 2009, ACTTION presented a webinar on The Impact of Massachusetts MassHealth (Medicaid) Benefit on Smoking Prevalence and Health Outcomes.  This month ACTTION spoke with Lois Keithly, Director of the Massachusetts Tobacco Cessation and Prevention Program, to follow up on the webinar and discuss next steps both for Massachusetts and others who might want to duplicate the Massachusetts cessation benefit.

ACTTION:
Can you briefly summarize the MassHealth* tobacco cessation benefit?  As I understand it,  the benefit provides prescription and over-the-counter quit-smoking medication to members who want to quit. The program also includes optional face-to-face counseling.  Is there anything else involved?
 
LK:
That is the benefit.   It came from a $7 million line item that the legislature put in the health reform legislation.  The benefit had to be implemented quickly so it was worked into the existing benefit structure.  Basically, the pharmacy was the key—people went to the pharmacy to get their prescription filled or to get the over the counter medication.  There could be no contingencies on the prescription.  For example, it could not be limited to pregnant women.

The Tobacco Cessation and Prevention Program worked with MassHealth to design the benefit.  Originally, the tobacco program wanted to have reimbursement for tobacco screening, but MassHealth did not want to implement separate billing codes for screening.  Also, there is no additional funding for the state quitline.

ACTTION:
Can you summarize the findings since the program started in July 2006?

LK:
Through the end of 2008, the last data we have analyzed, about 40% of MassHealth smokers used the benefit, which is a very high rate.  With so many using the benefit, the result was a large percentage drop—26%—in smoking prevalence among MassHealth clients.

ACTTION:
What do you think were the keys to getting such a high participation rate?

LK:
We don’t really know, but we can speculate.  Before the implementation of this benefit, there was no cessation coverage, not even a partial benefit.

This benefit was originally temporary.  Supporters of the benefit put a lot of energy into getting people to use the benefit and show the need to make it a permanent part of the program.  People at MassHealth, the tobacco program, and their partners like the health voluntaries, hospitals, and so on worked to promote the benefit.  Informational material was sent to both providers and consumers.  When the benefit was first available, the program used transit ads and radio ads in markets with high smoking rates.  Another media campaign was run later on. At the same time, pharmaceutical companies were doing their own promotions of their products, including those just being introduced.

Talk of cessation was in the air and awareness of the benefit greatly increased its usage.  The message got out.

ACTTION:
What do you think were the keys to such a high success rate?

LK:
This was a population-based approach.  With a lot of people trying to quit, a certain percentage are going to stay quit.

ACTTION:
Other research has found many smokers relapse and then have to attempt to quit again.  Do you plan to measure how long participants stay tobacco free?

LK:
We are not following individuals.  We are using population statistics.

This benefit was written to be used.  MassHealth did away with many barriers that prevent use.  The co-pay is low, no prior approval is needed, and the benefit is not tied to counseling.

Clients can get two rounds of benefits in each calendar year.  If they try to quit and relapse they can get a second round of benefits that year. We probably could track this usage but have not done so yet.

ACTTION:
What advice do you have for other states that want to replicate your success?

LK:
We were very lucky.  MassHealth staff designed the benefit to be user-friendly.  There was good cooperation between MassHealth and the Tobacco Cessation and Prevention Program.

We were able to look at utilization and prevalence data and use it to make the case for making the benefit permanent.  We had a good story to tell stakeholders and policymakers.  Very few other states collect this kind of data.

It is important to make the benefit easy to use.  We grafted the benefit on to the existing program.  Clients just had to fill prescriptions.  The counseling was separate and optional.

ACTTION:
What’s next for the Massachusetts tobacco cessation benefit program?

LK:
We are focusing on documenting cost savings by showing the decreased incidence of certain diseases.  Working with claims data is formidable, but we have assistance from an economist and others at Mass General to demonstrate the results. 

In the future we hope to be able to expand this benefit into other insurance entities.

ACTTION:
Will the program be able to keep going during tough economic times?

LK:
As long as the news from use of the benefit stays good, we should be able to retain the benefit.  It has not proved to be as expensive as some thought it would be.  In fact, it stayed within the budgeted amount.

ACTTION:
Do you think this can be replicated in the private sector and how?

LK:
Everyone is looking at cost containment.  If we can show health benefits in heart, asthma, and pregnancy and lower costs as a result, then other insurers should be interested in adding this benefit.

* MassHealth is a public health insurance program for eligible low and medium-income residents of Massachusetts. MassHealth is the name used in Massachusetts for Medicaid and the Children’s Health Insurance Program (CHIP), combined in one program.