Helping Health Plans Develop Strategies to Help Patients Stop Smoking
From 2000 to 2003, the Alliance of Community Health Plans, Washington, a nonprofit membership organization that provides services and products to managed care health plans in 24 states, worked with five health maintenance organizations to expand smoking cessation interventions in clinical settings.
- Five health plans developed and tested interventions to reduce tobacco use, targeting either providers or health plan enrollees. For example, one plan educated physicians about opportunities to enroll patients in a telephone smoking cessation program and another engaged dental providers.
- Three of the five plans showed meaningful improvement in their main outcome measures as a direct result of their interventions. However, the improvement was sustained for the life of the project only in one case.
The Robert Wood Johnson Foundation (RWJF) provided $248,084 from July 2000 through December 2003 for the project.
The Alliance of Community Health Plans has been a leader in efforts to make tobacco prevention a primary care priority for the managed care industry and has raised awareness among health plans of their ability to influence patients' behavior regarding tobacco use.
According to the project director, member health plans have successfully educated their staff-model providers (who are employees of the HMO) and group-model providers (in which an HMO contracts with a single multispecialty medical group to provide services) about the importance of tobacco screening and have increased the rate at which these providers routinely assess smoking behavior and provide appropriate counseling to patients.
Some of this work was accomplished with matching funds provided by RWJF to the Alliance of Community Health Plans (then called the HMO Group) (see Grant Results on ID# 027459). The current project builds on this work, focusing on network-model HMOs, which are the fastest growing segment of managed care. In the network model, an HMO contracts with multiple physician groups.
This grant addresses two of RWJF's goals: to promote health and prevent disease by reducing the harm caused by substance abuse and to improve the way services are provided to people with chronic health conditions by increasing communities' capacity to deliver supportive services.
To address the first goal, RWJF has made many grants to improve screening and treatment for tobacco use, such as the Collaborative HMO Effort to Reduce Tobacco Use Among Youth (see Grant Results on ID# 027459).
Its national program Addressing Tobacco in Managed Care seeks to integrate effective tobacco treatment as part of the basic health care provided by managed care organizations through identifying effective supportive systems change. (See Grant Results on the program.)
The Alliance of Community Health Plans guided five health plans in developing strategies for improving tobacco control in clinical settings, creating a methodology called the Shared Improvement Project to allow the plans to learn from one another about their respective efforts. A sixth plan was originally participating in the project but did not have the financial resources to continue.
Improvement experts and tobacco cessation clinicians provided three learning sessions to help the health plan teams develop their tobacco cessation strategies. The faculty used two tools at these learning sessions: the Model for Improvement, a framework developed by the Institute for Healthcare Improvement to accelerate improvement and organizational change, and the Chronic Care Model, developed by the MacColl Institute for Healthcare Innovation to identify the essential elements of high-quality chronic disease management.
The project director reported the following results:
- Five health plans developed and tested interventions to reduce tobacco use, targeting either providers or health plan enrollees. For example, one plan educated physicians about opportunities to enroll patients in a telephone smoking cessation program and another engaged dental providers. Two teams used mailing, faxes and telephone calls to encourage members with specific chronic illnesses (asthma, diabetes and coronary artery disease) to participate in various tobacco cessation programs. The fifth used physician "champions" to enroll pregnant women in a behavior change counseling program.
- Three of the five plans showed meaningful improvement in their main outcome measures as a direct result of their interventions, however, the improvement was sustained for the life of the project only in one case. A March 2003 survey showed that despite this failure of sustainability, participating HMOs felt that this grant had planted seeds to improve tobacco cessation efforts in the future.
The project director is writing a paper on improving tobacco cessation in provider networks targeted at health plan managers and quality improvement professionals interested in tobacco cessation elsewhere in the health delivery system. The report will be posted on the Alliance of Community Health Plans' Web site.
- Health plans can develop interventions to encourage members to pursue smoking cessation activities, but the gains are not necessarily sustainable. (Project Director)
- Generic smoking cessation efforts for health plan members are difficult to develop because data are not generally available to identify those who smoke. To intervene effectively, it is essential to have member-specific data about diagnoses and the use of clinical services. (Project Director)
- Systems changes are needed to support routine health interventions. Few of the sites tested systems changes as part of the interventions they tested. Accordingly, the Chronic Care Model had fairly limited direct relevance to this project. (Program Officer)
GRANT DETAILS & CONTACT INFORMATION
Advancing Tobacco Control in Physician Networks
Alliance of Community Health Plans (Washington, DC)
Dates: July 2000 to December 2003
Daniel J. Styf, M.S.
Participating Health Plans
Group Health Cooperative
Health Alliance Plan
Report prepared by: Scott Edwards
Reviewed by: Karyn Feiden
Reviewed by: Molly McKaughan
Program Officer: C. Tracy Orleans