Lower Smoking Rates in MediSource Members

Provider can help lower smoking rates in local MediSource members

As a health care professional, you know that tobacco use is the leading preventable cause of death and disease. Tobacco continues to affect New York residents with loss of lives, increased health care costs, lost productivity, and personal and emotional burdens.

More than 25,000 New Yorkers die prematurely every year due to tobacco use, and more than a half a million New Yorkers have serious diseases caused by smoking. Tobacco use costs New Yorkers more than $8 billion in health care costs, including $2.7 billion in Medicaid costs.

The adult smoking rate in New York has fallen faster than the rest of the U.S., dropping from 21.6 percent in 2003 to 15.5 percent in 2010. Although there have been substantial reductions in adult smoking in New York, some tobacco use disparities have become more pronounced during the past decade.

A disturbing trend has been noted: Tobacco use rates did not decline among low-socioeconomic status adults, especially in Western New York, which has some of the highest tobacco use rates in the state. The tobacco use rate is 26 percent in Erie County and 27 percent in Niagara County. The Buffalo-Niagara region has lower household incomes and higher rates of poverty than the rest of the state, which supports the notable trend that individuals with a low income and who are less educated are more likely to use tobacco, and continue to use tobacco.

The 2014 Independent Health tobacco use prevalence rates for MediSource (as shown below by line of business) demonstrates this trend:

  • Commercial – 6.8%
  • Medicare – 6.8%
  • MediSource (Medicaid) – 13.9%

We are encouraging all practitioners to help address the crucial need for prevention and cessation of tobacco use, especially in the Medicaid population – those who are least able to afford the cost of smoking and the consequences of the addiction. We are finding practitioners are assessing most but not all of their patients for tobacco use, and missing opportunities to provide discussion of smoking cessation strategies or medications. It is important to evaluate your office systems and records to ensure that tobacco use is systematically assessed and treated at every clinical encounter.

The NYS Quitline has the following tools/programs available to assist you to provide the support that your patients may need to quit the use of tobacco:

  • Opt-to-Quit Program – policy-driven, system-wide solution for ensuring that support is offered and accessible to patients once they leave your office. This program triggers a referral process and links tobacco using patients to the evidenced based services of the NYS Smokers Quitline. Once the referral is received, the patient is contacted within 72 hours or as specified by the practitioner, who also receives communication regarding the members quit status.
  • eFer-To-Quit Online – An online referral program that encourages a practice to use its secure portal for the referral of tobacco-using patients. Once the referral is received, the patient will be contacted with tailored coaching and screened for NRT eligibility.

Please contact the NYS Quitline at 1-866-697-8487 for more details regarding the programs or assistance with implementing the Opt-To-Quit or the eFer-To Quit programs in your office.

For a registry of Independent Health’s tobacco-using members, contact Elaine Michlin, clinical quality review nurse, at (716) 635-3719.

The evidenced-based tobacco cessation guideline, Clinical Practice Guideline: Treating Tobacco Use and Dependence, is posted on our provider website for reference.

MediSource (Medicaid) members, including pregnant women, are eligible for two quit attempts per 12 months. That includes up to four face-to-face counseling sessions per quit attempt. The counseling sessions may be individual or group counseling sessions by a physician, physician assistant or midwife. Pregnant members are also eligible to participate in the Independent Health Baby and Me Tobacco Free program, and can contact Independent Health at (716) 635-4959 to sign up.

Additionally, nicotine replacement therapy (NRT), including gum, lozenges and patches, nasal spray, inhaler, Chantix and Bupropion are covered by Independent Health. A prescription is required for coverage including over-the-counter smoking cessation agents. Medicaid members are limited to two courses of NRT each year. A course of treatment is considered up to a 90-day supply, so a member may have up to 180 days of NRT treatment covered. Chantix is covered with a limit of 168 days per year of coverage (at a maximum of two tablets per day), and Bupropion is covered with a limit to 180 days per year. Nasal spray and inhalers require prior authorization.

Commercial and Medicare members are also eligible for a very comprehensive tobacco cessation program in conjunction with the NYS Quitline.

After discussing tobacco cessation with your patients, encourage them to contact the NYS Quitline for additional coaching and NRT for a comprehensive cessation program.