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Foreword

The American Association of Health Plans (AAHP) Managed Care Achievements in Tobacco Control Awards Program is an opportunity to recognise member health plans' efforts to increase interest in and capacity for reducing the health problems caused by tobacco. The awards recognise and honour the innovative and practical strategies, practices, programs and policies used by health plans to establish effective tobacco prevention and cessation interventions.

Now in its second year, the Managed Care Achievements in Tobacco Control Awards Program encourages health plans to build upon the Agency for Health Care Policy and Research (AHCPR) guideline on smoking cessation, including evidence based standards and the demonstrated strategies outlined in the guideline.1 By honouring these exceptional efforts, AAHP demonstrates the commitment of health plans to promote widespread adoption of effective tobacco control interventions into routine clinical practice.

Tobacco control intervention opportunities are diverse—from clinical, outpatient, counselling or community settings, to behavioural and pharmacological cessation components, to the involvement of physicians, allied health professionals and employers. Aspiring toward national standards for tobacco control requires creative solutions adaptable and reproducible in a variety of managed care settings, as demonstrated by the Managed Care Achievements in Tobacco Control award winners.

The following award winning examples will assist you in identifying barriers and developing resourceful programs to improve smoking cessation rates and activities within your own organisation. AAHP and the Addressing Tobacco in Managed Care (ATMC) National Technical Assistance Office (NTAO) believe that by sharing these programs and methods we will be one step further in conquering the leading preventable cause of illness and death in Americans—tobacco use.

The awards program is one of many national activities supported by the NTAO of the Robert Wood Johnson Foundation's ATMC program. The ATMC program promotes the study and dissemination of policies and practices, which reduce tobacco use among managed care subscribers. The NTAO is a collaborative effort directed by the American Association of Health Plans (AAHP) with Health Alliance Plan (HAP).

An independent panel of experts in tobacco control and quality improvement practices and programs reviewed award applications. AAHP thanks the panel for their assistance in the review process, and the Health Alliance Plan component of the NTAO for managing the awards process.

GlaxoWellcome joins AAHP in this commitment to tobacco cessation and prevention and is proud to support the Managed Care Achievements in Tobacco Control Awards Program through an unrestricted educational grant.

Award categories

ADULT TOBACCO CONTROL INITIATIVES

This award is presented to a health plan for implementing creative initiatives, strategies, programs or policies that address tobacco prevention and/or cessation in the adult population. Examples include: creative use of resources to overcome barriers to implementation of the intervention; special methods used to engage the population in the intervention; approaches to provider or adult education; worksite programs; outreach to adult populations; and effective methods for tracking, monitoring, data collection, and follow up.

YOUTH/ADOLESCENT TOBACCO CONTROL INITIATIVES

This award is presented to a health plan for implementing initiatives and/or strategies aimed at youth or directly shaping policies focused on reducing youth/adolescent use, exposure or access to tobacco products. Examples include: implementation of public campaigns; school based interventions; provider or youth education; direct involvement in policy development related to youth access; outreach to youth in the community at large; effective methods of tracking, monitoring, data collection, and follow up.

TOBACCO CONTROL IN PREGNANCY CONTINUUM

This award is presented to a health plan for implementing tobacco cessation and/or prevention strategies, before, during and/or after pregnancy. Initiatives that involve prepregnancy or postpartum interventions and/or a paediatric care component are of particular interest. Examples include: system wide integration in maternity initiatives; creative use of resources to engage the target population; methods to increase provider involvement in training and implementation; and effective methods for tracking, monitoring, data collection, and follow up.

TOBACCO CONTROL IN SPECIAL POPULATIONS

This award is presented to a health plan for implementing notable tobacco cessation and/or prevention strategies, interventions directed toward a specific, special population, including but not limited to minorities, at risk patients or patients with comorbid conditions, Medicare enrollees/seniors, and Medicaid or underserved populations. Examples include: needs assessment and rationale which led to the special intervention; creative use of resources to overcome barriers related to reaching the target population; strategies to engage the population in the intervention; special provider or other training methods involved with program implementation; and effective methods of tracking, monitoring, data collection, and follow up.

PRIVATE/PUBLIC PARTNERSHIPS IN TOBACCO PREVENTION

This award is presented to a health plan and their primary public partner who—together—have forged a true working relationship to reduce tobacco use rates within the health plan member population and/or larger community. Applicants were asked to describe the type of relationship and type of organisation(s) with which they are collaborating. Joint collaborations that include state and/or local health departments or agencies, as well as other public or private corporations and community groups, are of special interest.

The award-winning health plans used numerous strategies and processes to design and implement their tobacco control efforts. Many of the interventions are replicable in a variety of managed care models and settings.

Adult tobacco control initiatives

FIRST PLACE AWARD

HealthPartners, Minneapolis, Minnesota

Program overview—HealthPartner's Outcome Recognition Program (ORP) was created by HealthPartners in 1996. It is one of the first programs in the nation to pay medical groups differentially based on the actual quality of care delivered. ORP provides financial recognition to medical groups who achieve superior performance on specific quality and satisfaction targets. One of the medical outcomes goals of ORP is giving advice to smokers to quit—the goal is 80% assessed for smoking and 80% advised to quit. This ongoing program, begun in 1996, has led to improved performance in adult smoking cessation.

Objectives—The program aimed to change physician and medical group behaviour through financial, public and peer recognition; and create a broader role for physicians and medical groups in prevention and education.

Results—The tobacco assessment rate, as determined by chart audit, was 54% in 1996, unchanged in 1997, and significantly improved to 71% in 1998. The tobacco advice rate, as determined by chart audit, was 27% in 1996, significantly improved at 54% in 1997, and unchanged in 1998. The tobacco advice rate, as determined by member survey, increased significantly each year from 66% in 1996, to 72% in 1997, to 76% in 1998. For 1998, four medical groups (Fairview Lakes, North Suburban Family Practice, Camden, and Northwest Family Practice) achieved the stretch goals of > 80% tobacco assessment and > 80% tobacco advice, thus qualifying for the 1998 HealthPartners ORP award.

For more information contact:

Maureen Reed

Medical Director

612-883-5321

maureen.k.reed{at}healthpartners.com

Adult tobacco control initiatives

SECOND PLACE AWARD

Blue Cross Blue Shield of Maine, South Portland, Maine

Program overview—Blue Cross Blue Shield of Maine (BCBSME), a 110 000 member IPA model plan, is currently in the third year of its population based tobacco control initiative. This strategy is based on the AHCPR guideline on smoking cessation.1 Benefit design, education, network reimbursement, and design of all member, employer, and community centred materials and interventions were driven by the guideline. The program is a highly integrated systematic approach to involving members, providers, and BCBSME staff and provides extensive coordination between the science driven recommendations and the plan's operations. Fee for service physician reimbursement has been instituted to promote counselling along with a reimbursement code which allows the plan to track counselling practice patterns. Network contracts for classes are predicated on compliance with the guideline, and the physician recredentialing process is tied to the presence of demonstrated office based systems for assessing patient smoking status. Key disease management initiatives are also closely coordinated with smoking cessation benefits. An external advisory committee has been established to support the initiative. Finally, the tobacco control program is rooted in a model of quality improvement.

Results—A 38% relative improvement in smoking prevalence was demonstrated among the adults (18+ years), and a 44% improvement was found in the 18–34 year old population compared to the same age cohort in the state.

For more information contact:

Meredith L Tipton

Director, Health Improvement

+1 207 822 7537

mtipton{at}bcbsme.com

Youth/adolescent tobacco control initiatives

FIRST PLACE AWARD

Kaiser Permanente Ohio Region, Brooklyn Heights, Ohio

Program overview—For 14 years Kaiser Permanente, through its educational theatre programs, has been a leader in supplementing school based smoking intervention curriculum. The evaluative data demonstrate the effectiveness of the theatre presentations to improve short term cognitive knowledge. The live theatrical presentations, though creative and appealing to children, are labour intensive for the organisation. Because of the resources required to produce programs like “Professor Bodywise's Travelling Menagerie”, the number of exposures to the important non-smoking messages are limited. As educators we know that health behaviour change in children is unlikely without the opportunity for multiple and repetitive interventions. With the advent of interactive technology, children's health promotion programs like “Professor Bodywise's Travelling Menagerie” can receive wider exposures, and audiences can receive multiple interventions. By adapting the theatrical smoking messages into an experimental multimedia format, there is the potential of reaching every child with access to a computer.

Objectives—The objectives were to: gain wider exposure for the “Professor Bodywise's Travelling Menagerie” health education outreach program; reinforce the smoking messages in the program; adapt the theatrical smoking intervention into an attractive multimedia version; and identify “Nikki Teen” with Kaiser Permanente's smoking intervention programs.

Results—In 1997, Kaiser Permanente's educational theatre programs teamed with their counterparts in information technology and health education to develop the multimedia prototype. With the initial prototype completed, the process of evaluating the added multimedia interventions with the live presentations begins.

For more information contact:

Cassandra Wolfe

Educational Theater Programs

+1 216 749 8462

cassie.wolfe{at}kp.org

www.kaiserpermanente\ohio.org

Youth/adolescent tobacco control initiatives

SECOND PLACE AWARD

Health Plan of Nevada, Las Vegas, Nevada

Program overview—Recent research estimates that in Nevada nearly 100 000 people are projected to begin smoking before the age of 18 years. This leads to a projected 31 000 premature deaths resulting in $372 million in health care expenses for the state ($12 000 per death related to smoking). Health Plan of Nevada (HPN) considers this a tragedy and has proactively taken steps by forming the Smoking Stinks partnership in 1996. During the partnership's conception, HPN asked other community minded entities, including the local chapter of the American Cancer Society, a television station, two radio stations, its advertising/public relations agencies, and the Clark County school district, to join the crusade.

Objectives—The partnership's aim is to reduce youth tobacco use in three ways: (1) a multimedia campaign including television and radio public service announcements; (2) a teacher education program designed to give educators the tools and resources needed to teach anti-tobacco messages; (3) middle and high school special events to help students quit or prevent them from using tobacco.

Results—Local youth smoking rates have slightly improved despite tobacco companies' multi-million dollar marketing budgets aimed at youth and the above average transiency rates in local schools. The number of students deemed “regular smokers” dropped by nearly 5% from 1995 to 1997, and the number of students who smoked two or more cigarettes per day, on the days they smoked, dropped nearly 2%. HPN realises the Smoking Stinkspartnership has barely scratched the surface and plans to continue its anti-tobacco crusade by putting more messages on the airwaves, planning more special events in local schools, and helping more teachers to spread the word of the dangers of tobacco use and begin to reach children at an even younger age.

For more information contact:

Jennifer P Martinsen

Director, Health Education & Wellness

+1 702 877 5147

healthed{at}sierrahealth.com

or

Jenny DesVaux Oakes

Assistant Vice President, Public & Community Relations

+1 702 242 7154

jennypr{at}sierrahealth.com

Tobacco control in the pregnancy continuum

FIRST PLACE AWARD

Tufts Health Plan Waltham, Massachusetts

Program overview—The percentage of women who smoke during pregnancy in Massachusetts is 12.2% while the percentage of pregnant Tufts Health Plan members who smoke is approximately 9.0%. Smoking during pregnancy increases the risk of preterm delivery, low birth weight, and long term health risks for both mother and baby. Thus, in 1995, Tufts Health Plan collaborated with the Massachusetts Department of Public Health to learn about “Quitting for You 2”, a smoking cessation program for pregnant women. Initially, the health plan adopted the public health department's program to address member needs. Over the years, as the program has developed, its name has subsequently changed to Tufts Health Plan's smoking cessation program for pregnant women.

Objectives—The program's aim is to reduce the number of cigarettes smoked during pregnancy and/or assist the member to permanently stop smoking. The current program is based on the transtheoretical model of change and the National Cancer Institute's 4A's model of smoking cessation (ask, advise, assist, arrange). Potential program participants are identified through risk assessment by ob/gyns as well as primary care physicians and/or member self referral. Program interventions consist of provider education, outreach, and chart stickers, written member educational materials, three counselling program options, as well as support of self quit efforts.

Results—Data for 1998 has begun to demonstrate program outcomes consistent with its objectives: pairedt test analysis demonstrates a significant difference between the average number of cigarettes smoked at the initial counselling call (8.4 cigarettes) and the average number smoked at the time of call five (5.2 cigarettes) (p < 0.05). In addition, 30.3% (n = 152) of program participants who gave birth quit smoking at least two weeks before they delivered while 35.5% (n = 411) of all women in the program met their self defined quit date.

For more information contact:

Anne Flaherty

Project Manager

+1 781 466 9425

Anne_Flaherty{at}tufts-health.com

or

David Tringali, Massachusetts

Health Care Analyst

David_Tringali{at}tufts-health.com

Tobacco control in the pregnancy continuum

SECOND PLACE AWARD

Southern California Kaiser Permanente, Pasadena, California

Program overview—The Kaiser Permanente Southern California prenatal smoking cessation program is a comprehensive intervention to address the significant harm to maternal, fetal, and infant health from smoking during pregnancy. The intervention includes the systematic identification of prenatal smokers and the delivery of a state-of-the art self help cessation booklet mailed at the start of prenatal care. The booklet,Living Smoke-Free, is delivered in addition to smoking related advice from prenatal providers. Prenatal smokers are also referred to a smokers' helpline for more intensive cessation services. Thus, the program is both proactive and reactive. It was designed and tested as a cost effective intervention for prenatal smoking. The program is appropriate for diverse prenatal populations. The booklet is easy to obtain and its low cost enhances its dissemination to other health care settings.

Objectives—The program has a number of objectives: the systematic identification of smokers through the use of a multi-response category screening question; the provision of a 32 page smoking cessation booklet; referral of prenatal smokers to a smokers' helpline for additional services; and usual care advice from prenatal care providers about the dangers of smoking and the benefits of abstinence during pregnancy.

For more information contact:

Virginia P Quinn

Senior Investigator

+1 626 564 3467

virginia.p.quinn{at}kp.org

Tobacco control in special populations

FIRST PLACE AWARD

Network Health Plan, Menasha, Wisconsin

Program overview—Network Health Plan is committed to improving the health of its members and the community it serves by providing a comprehensive smoking cessation program through an integrated approach. Through its 24 hour health advice line, NurseDirect, Network Health Plan offers the “Call It Quits” smoking cessation program. This program provides a multi-component approach to smoking cessation that uses telephone counselling to assess the individual's smoking habit and readiness to quit, and develops a successful personalised cessation plan to help the individual successfully stop smoking.

Objectives—The program has the following objectives: develop a smoking cessation program that could be accessible to our growing membership in our large service area of 13 counties; focus on member and community populations needs that target smoking cessation interventions; obtain broad organisational support through a program that would be easy for the more than 600 health care providers to understand and to refer patients; integrate smoking cessation with other existing CQI programs and guidelines—for example, HEDIS and NCQA; eliminate any barriers for individuals wanting to quit smoking; and maintain a satisfactory quit rate above or at the national average.

For more information contact:

Patsy Romback

Manager, Health Promotion

+1 920 720 1273

promback{at}networkhealth.com

Private/public partnerships in tobacco control

FIRST PLACE AWARD

Group Health Cooperative of Puget Sound, Seattle, Washington

Program overview—Group Health Cooperative partnered with seven other community based organisations, the governor's office, the office of the attorney general, and Washington State Department of Health to ensure Washington state legislators appropriated tobacco settlement dollars to fund health care priorities, including tobacco prevention and cessation. The principal organisational partner was Washington DOC (Doctors Ought to Care).

Objectives—The main aims of the program were to: secure tobacco settlement funds received by Washington State for public health purposes, particularly tobacco prevention and control; develop a strong coalition of organisations to advocate for public policy in the arena of tobacco use reduction; and build a strong network of tobacco prevention advocates at the grassroots level.

Primary strategies—Primary strateges were: direct lobbying of members of the legislature; a highly visible paid media campaign; and heavy emphasis on grassroots organising and advocacy.

Results—Washington became the only state in the nation to commit all funding from the master tobacco settlement to tobacco control and other public health priorities. Over one third of Group Health physicians signed tailored letters encouraging their legislators to support using tobacco settlement funds for tobacco control and other public health priorities. Group Health Cooperative received letters from the state attorney general and individual legislators in appreciation of our efforts to secure tobacco settlement dollars to fund public health priorities. Almost every newspaper in the state ran editorial positions favourable to the use of tobacco settlement funds to support public health priorities. When the governor and the director of the Washington State Department of Health released a new report on state tobacco use statistics, the director of Group Health's Center for Health Promotion was the only non-governmental representative invited to speak.

For more information contact:

Tim McAfee

Director, Center for Health Promotion

+1 206 287 4329

mcafee.t{at}ghc.org

or

Rachel Grossman

Tobacco Control Roadmap Coordinator

+1 206 442 5242

grossman.r{at}ghc.org

Youth/adolescent tobacco control initiatives

SPECIAL RECOGNITION AWARD

UnitedHealthcare Corporation, Eden Prairie, Minnesota

Program overview—“2 Smart 2 Smoke” is a live theatre production created by the National Theater for Children as a tobacco prevention program for elementary school students. The goal of the program is to reduce the risk of smoking among this age group by changing their intentions to smoke in the future. Using well known stories together with classroom activities and take home materials for parents, the intervention consists of two 30 minute plays aimed at students in kindergarten through grade 3 (ages 5–9) and grades 4–6 (ages 9–12), respectively, that reinforce the drawbacks of tobacco and debunk the psychosocial myth that smoking is image enhancing. Proven as an effective tool to discourage smoking in early trials conducted by the University of Minnesota, “2 Smart 2 Smoke” has since been replicated in 791 schools in 20 states through financial assistance provided by UnitedHealthcare, its 1998 exclusive, national sponsor.

For more information contact:

Margaret Flanagan

Manager, Communications

+1 612 833 8413

pflanag{at}uhc.com

Programs of merit

Providence Health Plan, Portland, Oregon

The goal of Providence Health Plan's multifaceted tobacco cessation program was to design and implement an approach to tobacco that impacts patients at every contact point in the Providence Health System. The efforts of this multidisciplinary task force have led to substantial reductions in smoking rates in Providence Health Plan members, decreasing the rate from 21% in 1994 to 17% in 1998. The principal actions included: member, practitioner, system, and prevention focused actions. The “Systematic approach to smoking cessation in hospitalised patients” has focused attention on hospitalised patients by developing an approach to the inpatient smoker. This includes systematic identification of smoking status upon admission, giving a brief respiratory therapist based intervention to identified smokers, providing pharmacologic intervention as appropriate, and notification of the primary care provider upon discharge.

For more information contact:

Charles J Bentz

Medical Director

+1 503 216 7496

cbentzmd{at}providence.org

First Priority Health Plan, Wilkes-Barre, Pennsylvania

First Priority Health presented the Youth Against Tobacco Conference '98 for 450 fourth grade students (age 9–10) at Wyoming Valley West school district in Kingston, Pennsylvania. The program focused on choosing not to use tobacco through responsible decision making; the program's presenters were high visibility sports figures and high school student leaders. This intervention combined education components of smoking with positive self esteem. The Youth Against Tobacco Conference '98 was a kick off event for curriculum follow up by the school, which included peer education in the younger grades.

For more information contact:

Susan Babicz

+1 570 831 3775

Sue.Babicz{at}bcnepa.com

Humana Inc, Louisville, Kentucky

Humana Inc and the Humana Foundation forged a unique partnership with the American Lung Association in 1998. The partnership's goal: to implement the “Teens Against Tobacco Use” (TATU) program in nine of the major cities Humana serves. Developed by the American Lung Association, TATU uses specially trained teens to spread the no smoking message to younger children. As a coordinated health care organisation, Humana's key objective is to prevent kids from smoking, keeping with the vision to improve the health of the communities in which Humana serves, thus lowering the country's spiralling health care costs. With the aid of a $2 million Humana Foundation grant and a substantial Humana Inc commitment of employee–volunteer hours to support program implementation, Humana and the Lung Association expect to reach some 125 000 elementary school students with the TATU partnership program, working through an army of 10 000 teen mentors.

For more information contact:

Kristy Trenaman

Manager, Corporate Communications

+1 502 580 3676

ktrenaman{at}humana.com

Health Care Plan, Buffalo, New York

“2 Smart 2 Start” is a smoking prevention initiative designed to reduce tobacco use among children. To achieve this objective, Health Care Plan has implemented a high profile public awareness campaign about the “2 Smart 2 Start” pledge. Kids who sign the pledge receive a discount card for their favourite stores and entertainment outlets. The pledge initiative is heavily advertised, and has enthusiastic endorsement of local school districts. Over 12 000 students have taken the pledge. A high visibility sports figure and educational outreach have been used to target third, fourth and fifth grade (ages 8–11) students. Professional theatre performances convey messages about self esteem and peer pressure. Peer education is conducted by middle and high school students who have been trained to deliver effective messages about the dangers of tobacco use. “Tar Wars”, a national project sponsored by the American Academy of Family Physicians, has been implemented with the commitment of local physicians who are interested in taking an active role in delivering the tobacco control message.

For more information contact:

Pamela Pawenski

Director, The Center for Better Health

+1 716 857 6317

pawenski-p{at}healthcareplan.org

1998 Managed Care Achievements in Tobacco Control Award Winners

ADULT TOBACCO CONTROL INITIATIVES

First place—Group Health Cooperative of Puget Sound, Seattle, Washington: Rachel Grossman (+1 206 442 5242,grossman.r{at}ghc.org)

Second place—Kaiser Permanente Northwest, Portland, Oregon: Jack Hollis (+1 503 335 6754,hollisja{at}chr.mts.kpnw.org)

YOUTH/ADOLESCENT TOBACCO CONTROL INITIATIVES

First place—Kaiser Permanente-Northeast, Williston, Vermont: Paul J Reiss (+1 802 878 2334,paul.j.reiss{at}kp.org)

Second place—Allina Health System, Minneapolis, Minnesota: Robert J Jeddeloh (+1 612 992 3907,jeddeloh{at}allina.com)

TOBACCO CONTROL IN SPECIAL POPULATIONS

First place—Healthsource Maine, Inc, Freeport, Maine: Dean Paterson (+1 207 865 5126,patersd{at}hlthsrc.com)

PRIVATE/PUBLIC PARTNERSHIPS IN TOBACCO CONTROL

First place—Blue Cross and Blue Shield of Minnesota, St Paul, Minnesota: Daniel Johnson (+1 651 456 1580,djohnson{at}bcbsmn.com)

References

View Abstract

Footnotes

  • Sponsored by the National Technical Assistance Office of the Robert Wood Johnson Foundation Addressing Tobacco in Managed Care Program.

  • For more information on the Addressing Tobacco in Managed Care Program and the activities of the National Technical Assistance Office (NTAO) contact any of the NTAO program managers: Anne Cahill +1 202 778 3239 acahill{at}aahp.org Abby Rosenthal +1 313 874 6813 arosent1{at}hfhs.org

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