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The New Smoking Cessation
                                                                                    Imperative

                                                                           A review of current trends in
                                                                programming, incentives and plan design


                                                                                   November 16, 2012




© 2012 beBetter Health, Inc. Confidential. Do Not Distribute.
Introduction
                                                                            Speakers

Learning objectives :

 To understand the facts of tobacco use                             Gary B. Sams MS
                                                                     Chief Wellness
 To review current trends in tobacco cessation                      Officer

 To review and discuss benefit plan and
  incentive program design issues
 To understand resources available to support    Cameron Smith
  the development and delivery of effective         Regional Sales
  tobacco cessation programs                             Director
Company Background



          WE FOCUS ON
       WELLNESS ESSENTIALS

           eatBetter maintain a healthy diet
         moveBetter get enough exercise
       breatheBetter don’t smoke


The presence of just one healthy behavior compared
with none cuts chronic disease risk in half. (CDC)
beBetter products and services
have helped millions address
their challenges with tobacco use
and nicotine addiction since 1977


The Tobacco Cessation Products and Services of beBetter Health

   Program
 Consultation                    Web Based      Marketing
                  NRT Sales                                      Coaching
 & Evaluation                   Programming      Support
Tobacco Use Facts:
 According to the 2010 U.S. Surgeon General's report, 443,000 U.S. adults die from smoking-
related illnesses each year. Smoking costs the United States $96 billion in direct medical
expenses and $97 billion in lost productivity annually.

                   Among daily smokers, the proportion who smoked ≥30 cigarettes per day (CPD)
                    declined significantly, from 12.6% in 2005 to 9.1% in 2011, whereas the
                    proportion of those who smoked 1–9 CPD increased significantly, from 16.4% to
                    22.0%.

                   Overall, among current smokers and those who had quit during the preceding
                    year, 51.8% had made a quit attempt for >1 day during the preceding year.

                   Current smoking prevalence declined most markedly from 2005 to 2011 among
                    adults aged 18–24 years (from 24.4% to 18.9%), and this age group, which had
                    the highest prevalence in 2005, now has the lowest of any group aged <65
                    years.


                        Source - Morbidity and Mortality Weekly Report (MMWR)
                        Current Cigarette Smoking Among Adults — United States, 2011
                        November 9, 2012 / 61(44);889-894
Employer Response:




Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2012.
Employer Response:


                       Workplace tobacco use policies
                       Hiring and Personnel Policies
                       Health Benefit plan design modification
                       Employee Health and Wellness Programs



Recommended Reading
   www.no-smoke.org
Tobacco Cessation
     Programming Trends

 Goals
 Programs
 Success
 Incentives and Premium Differentials
 Program Planning
 Communication
Tobacco Cessation
           Programming Trends


 Tobacco Cessation Program Goals

 Reduce health care & lost productivity costs
 Support tobacco-free campus policies
 Implement Tobacco Premium Differentials,
  Surcharges and Incentives
 Improve employee health!
Tobacco Cessation
      Programming Trends

Types of Programs
   On-site face-to-face coaching
   Web-based programs
   Texting & Mobile
   Telephonic coaching
Tobacco Cessation
                                                          Programming Trends


                                                    Successful Programs
                                                    1.   Participation
                                                    2.   Quit Rate

                                                    • Communication
                                                    • Incentives
                                                    • Vendor Selection
         Recommended Reading
TowersWatson 2011/2012 Staying@Work Survey report
Tobacco Cessation
              Programming Trends

Types of Incentives
      True premium surcharge or discount
      HSA or FSA Contribution
      Wellness Credits


Premium Differentials
      Identifying tobacco users
i.     Affidavit
ii.    HRA
iii.   Biometric testing or Cotinine testing
Tobacco Cessation
                                                                             Programming Trends

                                                                     Programming Plan for Incentives
                                                                      •   Timeline: offer tobacco cessation program
                                                                          6 months to 1 year in advance
                                                                      •   Tie premium differential/incentive to
                                                                          participation
                                                                      •   Allow year-round opportunity for incentive
                                                                      •   Clear communication strategy



              Recommended Reading
Centers for Disease Control and Prevention. Quitting Smoking Among
Adults—United States, 2001–2010. Morbidity and Mortality Weekly
Report [serial online] 2011;60(44):1513–19 [accessed 2012 Jun 7].
Tobacco Cessation
      Programming Trends

Communication
  • Carrot vs. Stick (reward vs. penalty)
  • Offer spouses support
  • Clearly communicate what needs to
    be done
  • Identify outbound calls to tobacco
    users
  • Support executive management
Legal Considerations

                                                                     Individual state laws vary around
                                                                      smokers’ rights laws and lifestyle
                                                                      statutes
                                                                     Just because it is legal to test for
                                                                      tobacco use doesn't mean it’s the right
                                                                      thing to do
                                                                     There are many complicating issues to
                                                                      consider, such as 2nd-hand exposure
                                                                      through family member use
                                                                     The rising use of e-cigarettes
                                                                     Consider alternatives and company
                                                                      culture
       Recommended Reading
The Trouble with Tobacco Testing
Human Resource Executive Magazine Online
Jill Cueni-Cohen- Tuesday, October 9, 2012
Link: http://www.hreonline.com /HRE/view/story.jhtml?id=534354450
Legal Considerations (Wellness)

                                                                                   The Five Criteria
                                                                                   1. Limited to 20% Differential
                                                                                   2. Must Be Tied to Wellness
                                                                                      Programs
                                                                                   3. Annual Qualification
                                                                                   4. Provide Alternative Standards for
                                                                                      Medical Exceptions
                                                                                   5. Disclose Alternative


    Recommended Reading
Results-Based Wellness Incentives
How to Strategically Tie Your Wellness Program to A Benefit Plan Design with Premium Differentials
An Industry Brief by beBetter Health, Oct. 2012 – available upon request
www.beBetterhealth.com
For additional information, see the DOL FIELD ASSISTANCE BULLETIN 2008-02.10 -Taken from
the Department of Labor website
What’s the ROI?

                                                                                Workplace Costs of Tobacco Use
                                                            Employer Direct Costs Examples

                                                               Greater health insurance costs and claims
                                                               Greater life insurance premium costs and increased claims
                                                               Greater disability costs
                                                               Greater worker's compensation payments and occupational health awards

                                                            Employer Indirect Costs Examples
                                                             Recruitment and retraining costs resulting from loss of employees to
                                                              tobacco-related death and disability
                                                             Lost productivity
                                                             Greater amount of work time used on tobacco-use habits and routines


                Recommended Reading
Smoke-free work sites top ten financial benefits to employers. Western CAPT/CASAT. University of Nevada, Reno.
Center for Health Promotion Publications. The Dollar (and sense) Benefits of Having a Smoke-Free Workplace. Lansing,
Michigan Tobacco Control Program; 2000.
Centers for Disease Control and Prevention. Making your Workplace Smoke-Free: A Decision Makers Guide. Available at:
http://www.cdc.gov/tobacco/secondhand_smoke/00_pdfs/fullguide.pdf. Accessed: September 10, 2007.
NBGH – Tobacco: The Business of Quitting- An Employers Website for Tobacco Cessation. Accessed: November 1, 2012
What’s the ROI?

                                                                      Investments in smoking cessation save health plans and
                                                                      employers money in the short and long term.

                                                                       Research has shown that health plans investing $35-$410 to help a person
                                                                      quit over the course of a year generate positive return on investment (ROI)
                                                                      within 3 years. Simulation models using health plan data to estimate ROI for
                                                                      smoking cessation indicate that spending $0.18-$0.79 PMPM generates
                                                                      positive net ROI of over $1.70-$2.20 after five years. This model also
                                                                      demonstrates positive ROI for employers beginning in the first year that the
                                                                      investment was made and continuing over the five-year period. 1

                                                                      Smoking cessation increases productivity.

                                                                      The American Productivity Audit, a national survey of over 29,000 workers,
                                                                      found that tobacco use was a leading cause of worker lost production time—
                                                                      greater than alcohol abuse or family emergencies. Quitting smoking
                                                                      improves a worker’s productivity.2


               Recommended Reading

1-“Making the Business Case for Smoking Cessation Programs” A report by America’s Health Insurance Plans.
http://www.businesscaseroi.org/roi/apps/execsum.aspx
2-Stewart, WF, Ricci, JA, Chee, E, Morganstein, D. Lost productivity work time costs from health conditions in the United States: Results from the American
Productivity Audit. Journal of Occupational and Environmental Medicine 2003;45(12):1234-1246. ClearWay MinnesotaSM and Minnesota Department of
Health. Minnesota Adult Tobacco Survey: Tobacco Use in Minnesota: 2010 Update. 2011
What’s the ROI?




http://www.businesscaseroi.org/roi/default.aspx
Employer Resources
There are a tremendous number of resources available for
employers who want to develop or improve tobacco cessation
programs for their employees. Below are links to some of the most
prominent organizations offering assistance.

Centers for Disease Control and Prevention – Smoking & Tobacco Use
www.cdc.gov/tobacco/quit_smoking/cessation/index

American Cancer Society Quit for Life Program
www.acsworkplacesolutions.com/quitforlife.asp

Fundamentals of Smokefree Workplace Laws
www.no-smoke.org/pdf/CIA_Fundamentals.pdf

Employers’ Smoking Cessation Guide:
Practical Approaches to a Costly Workplace Problem
www.endsmoking.org

Tobacco: The Business of Quitting
An Employer’s Website for Tobacco Cessation.
www.businessgrouphealth.org/tobacco

1-800-Quit-Now
www.smokefree.gov/quitlines-faq.aspx - http://betobaccofree.hhs.gov/
Employer Resources




          www.breathebetter.me

This program is free for consumers and employers within
basic set up parameters.

Some fee for service features are available such as private
labeling, telephonic coaching and special NRT options.
Thank You


For a copy of today’s presentation slides
and additional resources, please visit:

www.bebetter.com/hplive



For follow up information please contact:

Cameron Smith
Regional Sales Manager
 beBetter Health, Inc.
325 W. Huron Street
Chicago, IL 60654
512.213.7910
cameron.smith@bebetter.net

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The New Smoking Cessation Imperative

  • 1. The New Smoking Cessation Imperative A review of current trends in programming, incentives and plan design November 16, 2012 © 2012 beBetter Health, Inc. Confidential. Do Not Distribute.
  • 2. Introduction Speakers Learning objectives :  To understand the facts of tobacco use Gary B. Sams MS Chief Wellness  To review current trends in tobacco cessation Officer  To review and discuss benefit plan and incentive program design issues  To understand resources available to support Cameron Smith the development and delivery of effective Regional Sales tobacco cessation programs Director
  • 3. Company Background WE FOCUS ON WELLNESS ESSENTIALS eatBetter maintain a healthy diet moveBetter get enough exercise breatheBetter don’t smoke The presence of just one healthy behavior compared with none cuts chronic disease risk in half. (CDC)
  • 4. beBetter products and services have helped millions address their challenges with tobacco use and nicotine addiction since 1977 The Tobacco Cessation Products and Services of beBetter Health Program Consultation Web Based Marketing NRT Sales Coaching & Evaluation Programming Support
  • 5. Tobacco Use Facts: According to the 2010 U.S. Surgeon General's report, 443,000 U.S. adults die from smoking- related illnesses each year. Smoking costs the United States $96 billion in direct medical expenses and $97 billion in lost productivity annually.  Among daily smokers, the proportion who smoked ≥30 cigarettes per day (CPD) declined significantly, from 12.6% in 2005 to 9.1% in 2011, whereas the proportion of those who smoked 1–9 CPD increased significantly, from 16.4% to 22.0%.  Overall, among current smokers and those who had quit during the preceding year, 51.8% had made a quit attempt for >1 day during the preceding year.  Current smoking prevalence declined most markedly from 2005 to 2011 among adults aged 18–24 years (from 24.4% to 18.9%), and this age group, which had the highest prevalence in 2005, now has the lowest of any group aged <65 years. Source - Morbidity and Mortality Weekly Report (MMWR) Current Cigarette Smoking Among Adults — United States, 2011 November 9, 2012 / 61(44);889-894
  • 6. Employer Response: Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2012.
  • 7. Employer Response:  Workplace tobacco use policies  Hiring and Personnel Policies  Health Benefit plan design modification  Employee Health and Wellness Programs Recommended Reading www.no-smoke.org
  • 8. Tobacco Cessation Programming Trends  Goals  Programs  Success  Incentives and Premium Differentials  Program Planning  Communication
  • 9. Tobacco Cessation Programming Trends Tobacco Cessation Program Goals  Reduce health care & lost productivity costs  Support tobacco-free campus policies  Implement Tobacco Premium Differentials, Surcharges and Incentives  Improve employee health!
  • 10. Tobacco Cessation Programming Trends Types of Programs  On-site face-to-face coaching  Web-based programs  Texting & Mobile  Telephonic coaching
  • 11. Tobacco Cessation Programming Trends Successful Programs 1. Participation 2. Quit Rate • Communication • Incentives • Vendor Selection Recommended Reading TowersWatson 2011/2012 Staying@Work Survey report
  • 12. Tobacco Cessation Programming Trends Types of Incentives  True premium surcharge or discount  HSA or FSA Contribution  Wellness Credits Premium Differentials  Identifying tobacco users i. Affidavit ii. HRA iii. Biometric testing or Cotinine testing
  • 13. Tobacco Cessation Programming Trends Programming Plan for Incentives • Timeline: offer tobacco cessation program 6 months to 1 year in advance • Tie premium differential/incentive to participation • Allow year-round opportunity for incentive • Clear communication strategy Recommended Reading Centers for Disease Control and Prevention. Quitting Smoking Among Adults—United States, 2001–2010. Morbidity and Mortality Weekly Report [serial online] 2011;60(44):1513–19 [accessed 2012 Jun 7].
  • 14. Tobacco Cessation Programming Trends Communication • Carrot vs. Stick (reward vs. penalty) • Offer spouses support • Clearly communicate what needs to be done • Identify outbound calls to tobacco users • Support executive management
  • 15. Legal Considerations  Individual state laws vary around smokers’ rights laws and lifestyle statutes  Just because it is legal to test for tobacco use doesn't mean it’s the right thing to do  There are many complicating issues to consider, such as 2nd-hand exposure through family member use  The rising use of e-cigarettes  Consider alternatives and company culture Recommended Reading The Trouble with Tobacco Testing Human Resource Executive Magazine Online Jill Cueni-Cohen- Tuesday, October 9, 2012 Link: http://www.hreonline.com /HRE/view/story.jhtml?id=534354450
  • 16. Legal Considerations (Wellness) The Five Criteria 1. Limited to 20% Differential 2. Must Be Tied to Wellness Programs 3. Annual Qualification 4. Provide Alternative Standards for Medical Exceptions 5. Disclose Alternative Recommended Reading Results-Based Wellness Incentives How to Strategically Tie Your Wellness Program to A Benefit Plan Design with Premium Differentials An Industry Brief by beBetter Health, Oct. 2012 – available upon request www.beBetterhealth.com For additional information, see the DOL FIELD ASSISTANCE BULLETIN 2008-02.10 -Taken from the Department of Labor website
  • 17. What’s the ROI? Workplace Costs of Tobacco Use Employer Direct Costs Examples  Greater health insurance costs and claims  Greater life insurance premium costs and increased claims  Greater disability costs  Greater worker's compensation payments and occupational health awards Employer Indirect Costs Examples  Recruitment and retraining costs resulting from loss of employees to tobacco-related death and disability  Lost productivity  Greater amount of work time used on tobacco-use habits and routines Recommended Reading Smoke-free work sites top ten financial benefits to employers. Western CAPT/CASAT. University of Nevada, Reno. Center for Health Promotion Publications. The Dollar (and sense) Benefits of Having a Smoke-Free Workplace. Lansing, Michigan Tobacco Control Program; 2000. Centers for Disease Control and Prevention. Making your Workplace Smoke-Free: A Decision Makers Guide. Available at: http://www.cdc.gov/tobacco/secondhand_smoke/00_pdfs/fullguide.pdf. Accessed: September 10, 2007. NBGH – Tobacco: The Business of Quitting- An Employers Website for Tobacco Cessation. Accessed: November 1, 2012
  • 18. What’s the ROI? Investments in smoking cessation save health plans and employers money in the short and long term. Research has shown that health plans investing $35-$410 to help a person quit over the course of a year generate positive return on investment (ROI) within 3 years. Simulation models using health plan data to estimate ROI for smoking cessation indicate that spending $0.18-$0.79 PMPM generates positive net ROI of over $1.70-$2.20 after five years. This model also demonstrates positive ROI for employers beginning in the first year that the investment was made and continuing over the five-year period. 1 Smoking cessation increases productivity. The American Productivity Audit, a national survey of over 29,000 workers, found that tobacco use was a leading cause of worker lost production time— greater than alcohol abuse or family emergencies. Quitting smoking improves a worker’s productivity.2 Recommended Reading 1-“Making the Business Case for Smoking Cessation Programs” A report by America’s Health Insurance Plans. http://www.businesscaseroi.org/roi/apps/execsum.aspx 2-Stewart, WF, Ricci, JA, Chee, E, Morganstein, D. Lost productivity work time costs from health conditions in the United States: Results from the American Productivity Audit. Journal of Occupational and Environmental Medicine 2003;45(12):1234-1246. ClearWay MinnesotaSM and Minnesota Department of Health. Minnesota Adult Tobacco Survey: Tobacco Use in Minnesota: 2010 Update. 2011
  • 20. Employer Resources There are a tremendous number of resources available for employers who want to develop or improve tobacco cessation programs for their employees. Below are links to some of the most prominent organizations offering assistance. Centers for Disease Control and Prevention – Smoking & Tobacco Use www.cdc.gov/tobacco/quit_smoking/cessation/index American Cancer Society Quit for Life Program www.acsworkplacesolutions.com/quitforlife.asp Fundamentals of Smokefree Workplace Laws www.no-smoke.org/pdf/CIA_Fundamentals.pdf Employers’ Smoking Cessation Guide: Practical Approaches to a Costly Workplace Problem www.endsmoking.org Tobacco: The Business of Quitting An Employer’s Website for Tobacco Cessation. www.businessgrouphealth.org/tobacco 1-800-Quit-Now www.smokefree.gov/quitlines-faq.aspx - http://betobaccofree.hhs.gov/
  • 21. Employer Resources www.breathebetter.me This program is free for consumers and employers within basic set up parameters. Some fee for service features are available such as private labeling, telephonic coaching and special NRT options.
  • 22. Thank You For a copy of today’s presentation slides and additional resources, please visit: www.bebetter.com/hplive For follow up information please contact: Cameron Smith Regional Sales Manager beBetter Health, Inc. 325 W. Huron Street Chicago, IL 60654 512.213.7910 cameron.smith@bebetter.net