1) This report summarizes a study on tobacco cessation treatment in Maine as directed by Resolve 2007, c. 34.
2) A workgroup found that a model tobacco treatment program includes screening, evidence-based pharmacotherapy, unlinked counseling and medication coverage, and minimal cost sharing.
3) The report discusses tobacco treatment programs in Maine's private sector, Medicaid program, and through the Partnership for a Tobacco-Free Maine, finding some areas of alignment with best practices and clinical guidelines, and some areas limited by fiscal constraints.
Quitting tobacco use provides significant health and financial benefits to both individuals and state governments. For individuals, quitting reduces the risk of various chronic diseases and can add over 10 years to one's life. For state governments, quitting can save Medicaid programs hundreds of millions each year in tobacco-related healthcare costs. Providing comprehensive tobacco cessation benefits through Medicaid and state employee health plans can help more people quit and achieve these savings. Effective cessation treatments include both medications and counseling.
The document discusses the effectiveness of the "truth" tobacco prevention media campaign for youth. It finds that the campaign successfully increased awareness of the dangers of tobacco use among 12-17 year olds. Surveys showed that 77-82% of youth found the ads convincing, attention-grabbing, and providing good reasons not to smoke. The campaign was also found to be cost-effective, at an estimated $1.38-$3.65 per youth reached. Expanding such campaigns, along with other prevention programs, was recommended to further reduce youth smoking rates.
This document describes a multipayer initiative in Pennsylvania to implement the patient-centered medical home model guided by the chronic care model for diabetes patients. 25 primary care practices with over 10,000 diabetes patients participated in the initiative. Practices received payments for transforming their practices and achieved improved clinical outcomes for diabetes patients in the first year, including better screening and treatment rates. This initiative represents one of the largest implementations of the chronic care model with payment reform across diverse practice types.
Chronic diseases are the leading cause of death in the US. Managed care organizations implement disease management programs like smoking cessation programs to help prevent chronic diseases and lower costs. These programs aim to eliminate risk factors for disease such as smoking and provide incentives, care management, and access to services to help patients quit smoking. Quality of care is evaluated through structure, process and outcomes to ensure these programs are effective.
This document summarizes the findings of the Special Commission on Provider Price Reform in Massachusetts. It discusses how provider prices vary widely in Massachusetts and this variation is a major contributor to rising healthcare costs. The Commission examined price variation across different providers and hospitals to understand the factors driving it. The Commission developed principles to guide its work and recommendations. It engaged stakeholders for feedback and ultimately proposed six recommendations, including increasing transparency, ensuring competitive markets, evaluating approaches to engage consumers, researching acceptable versus unacceptable factors for variation, and establishing a process to reduce higher prices not correlated to quality.
The document discusses a report from the NGA that acknowledges pharmacists' scope of practice is restricted by state laws and encourages classifying pharmacists as health care providers to maximize pharmacy services. It summarizes that the report encourages states and private entities to expand what pharmacist services are covered by insurance, state employee health plans, health information exchanges, and Medicaid to allow pharmacists to practice at the full extent of their training.
Medicaid Reimbursement Rates for Dental CareBrian Zard
Increasing Medicaid reimbursement rates for dental care in Minnesota is necessary to improve access to care. Currently, reimbursement rates are based on fees from 1989 and have not kept up with inflation. As a result, many dentists no longer accept Medicaid patients. The document proposes increasing reimbursement rates to 50% of commercial insurance rates to incentivize more dentists to participate. This would improve access to preventive dental care and reduce costly emergency room visits for dental issues.
Meaningful use - Will the end result be meaningful?Jodi Sperber
Defining - and implementing - meaningful use has the potential to dramatically impact the use of electronic health records in the US. At this early stage, it is critical ask if the end goals are being served by the approach. This paper introduces the concept and considers how to implement such significant change in the context of the American health care system.
Written for a course on Quality and Performance Measurement for Brandeis University.
Quitting tobacco use provides significant health and financial benefits to both individuals and state governments. For individuals, quitting reduces the risk of various chronic diseases and can add over 10 years to one's life. For state governments, quitting can save Medicaid programs hundreds of millions each year in tobacco-related healthcare costs. Providing comprehensive tobacco cessation benefits through Medicaid and state employee health plans can help more people quit and achieve these savings. Effective cessation treatments include both medications and counseling.
The document discusses the effectiveness of the "truth" tobacco prevention media campaign for youth. It finds that the campaign successfully increased awareness of the dangers of tobacco use among 12-17 year olds. Surveys showed that 77-82% of youth found the ads convincing, attention-grabbing, and providing good reasons not to smoke. The campaign was also found to be cost-effective, at an estimated $1.38-$3.65 per youth reached. Expanding such campaigns, along with other prevention programs, was recommended to further reduce youth smoking rates.
This document describes a multipayer initiative in Pennsylvania to implement the patient-centered medical home model guided by the chronic care model for diabetes patients. 25 primary care practices with over 10,000 diabetes patients participated in the initiative. Practices received payments for transforming their practices and achieved improved clinical outcomes for diabetes patients in the first year, including better screening and treatment rates. This initiative represents one of the largest implementations of the chronic care model with payment reform across diverse practice types.
Chronic diseases are the leading cause of death in the US. Managed care organizations implement disease management programs like smoking cessation programs to help prevent chronic diseases and lower costs. These programs aim to eliminate risk factors for disease such as smoking and provide incentives, care management, and access to services to help patients quit smoking. Quality of care is evaluated through structure, process and outcomes to ensure these programs are effective.
This document summarizes the findings of the Special Commission on Provider Price Reform in Massachusetts. It discusses how provider prices vary widely in Massachusetts and this variation is a major contributor to rising healthcare costs. The Commission examined price variation across different providers and hospitals to understand the factors driving it. The Commission developed principles to guide its work and recommendations. It engaged stakeholders for feedback and ultimately proposed six recommendations, including increasing transparency, ensuring competitive markets, evaluating approaches to engage consumers, researching acceptable versus unacceptable factors for variation, and establishing a process to reduce higher prices not correlated to quality.
The document discusses a report from the NGA that acknowledges pharmacists' scope of practice is restricted by state laws and encourages classifying pharmacists as health care providers to maximize pharmacy services. It summarizes that the report encourages states and private entities to expand what pharmacist services are covered by insurance, state employee health plans, health information exchanges, and Medicaid to allow pharmacists to practice at the full extent of their training.
Medicaid Reimbursement Rates for Dental CareBrian Zard
Increasing Medicaid reimbursement rates for dental care in Minnesota is necessary to improve access to care. Currently, reimbursement rates are based on fees from 1989 and have not kept up with inflation. As a result, many dentists no longer accept Medicaid patients. The document proposes increasing reimbursement rates to 50% of commercial insurance rates to incentivize more dentists to participate. This would improve access to preventive dental care and reduce costly emergency room visits for dental issues.
Meaningful use - Will the end result be meaningful?Jodi Sperber
Defining - and implementing - meaningful use has the potential to dramatically impact the use of electronic health records in the US. At this early stage, it is critical ask if the end goals are being served by the approach. This paper introduces the concept and considers how to implement such significant change in the context of the American health care system.
Written for a course on Quality and Performance Measurement for Brandeis University.
Benefits of implementing_the_primary_care_pcmhVicki Harter
This document provides a review of cost and quality results from implementing the patient-centered medical home (PCMH) model of primary care. It summarizes newly reported and updated results from PCMH initiatives nationwide over the past two years. The results show that the PCMH improves health outcomes, enhances the patient and provider experience of care, and reduces unnecessary hospital and emergency department utilization, meeting the goals of better health, better care, and lower costs. The document defines key features of the PCMH model and provides data demonstrating how each feature contributes to these outcomes. It outlines growing private and public sector support for the PCMH in the United States.
This document provides a summary of cost and quality results from patient-centered medical home (PCMH) initiatives in 2012. It finds that the PCMH improves health outcomes, enhances the patient and provider experience of care, and reduces unnecessary hospital and emergency department utilization. Major health plans like Aetna, Humana and UnitedHealthcare are expanding PCMH programs based on evidence that it meets the goals of better health, better care and lower costs. The momentum for PCMH is growing across the healthcare system, including 90 commercial insurance plans, 42 state Medicaid programs, and thousands of clinical practices nationwide.
The document discusses Thailand's development of a universal health coverage benefit package. It outlines the key steps Thailand took:
1) Establishing systematic processes for developing the package, involving stakeholders and using evidence-based criteria and health technology assessments.
2) Starting with a basic package focusing on primary care and high-impact services, then expanding over time as resources increased.
3) Introducing rigorous health technology assessment processes to evaluate new interventions, ensuring only cost-effective options were included.
The document discusses how changes in physician-hospital alignment are inevitable due to a confluence of events in the healthcare industry. Reimbursement trends are driving the need for alignment as Medicare costs are projected to grow substantially and physician reimbursement increases have been minimal. Clinical integration can help generate efficiencies and is viewed favorably by regulators. The document outlines three models for physician-hospital alignment and notes they each implicate legal issues around reimbursement, antitrust, and fraud/abuse.
The document summarizes data from MaineCare (Maine's Medicaid program) on the use and costs of tobacco cessation benefits in fiscal year 2010, including pharmacotherapy (medications), counseling services, and copay costs paid by Medicaid recipients. It finds that in 2010, MaineCare paid over $1.26 million for pharmacotherapy provided to 13,533 members, with Chantix accounting for over $300,000 of costs. Counseling services cost $33,234 and were provided to 2,066 members. Eliminating copays for medications could cost Maine less than $100,000 annually based on 2010 data of $91,956 in copays paid.
The document provides information about health care costs and insurance plans in the United States, Minnesota, and the Foley School District. It shows that on average, 87 cents of every health insurance dollar in the US goes toward medical costs, while 13 cents goes toward administrative costs and profits. Minnesota and Foley School District plans have lower administrative costs than national averages. The Resource Training & Solutions school pool offers advantages like lower costs and premium increases compared to other plans like SEGIP and PEIP.
1) The document summarizes recent reforms to the English National Health Service (NHS) proposed by the UK coalition government.
2) Key aspects of the reforms include transferring around 70% of the NHS budget to groups of general practitioners (GPs), increasing hospital autonomy and competition, and expanding patient choice.
3) The reforms aim to reduce central control over the NHS and introduce more market-based incentives, but also face significant implementation challenges and risks of disruption.
Presentation Objectives:
1) Define SBIRT and identify components of this evidence-based intervention for identifying, reducing, & preventing problematic use, abuse & dependence on alcohol & illicit drugs
2) Learn how to use the all the components of the SBIRT app, including, but not limited to the screening, brief interventions & referral to treatment features included in this app
3) Recognize the critical need for more research related to occupational therapy intervention and SBIRT, as well as potential obstacles to implementation of SBIRT in treatment settings & resources for continuing education on this topic.
Painsolver is a clinical decision support tool designed to improve healthcare outcomes for low back pain. It addresses limitations in how patient care is currently managed by providing evidence-based guidance, integrating recommendations into workflows, and promoting shared decision making between providers and patients. The tool aims to help organizations and providers succeed under emerging pay-for-performance models by enhancing outcomes and reducing costs over a patient's lifetime. Vertelogics believes Painsolver can help providers and organizations not just survive but thrive as the healthcare system shifts its focus to outcomes-based reimbursement.
This article analyzes annual cost profiles and consumption patterns of Medicare beneficiaries with diabetes from 2000 to 2006. It finds that while the percentages of beneficiaries and expenditures in different consumption clusters (ranging from "crisis consumers" to "low consumers") remained generally constant year to year, there was significant movement of individuals between clusters over time. Notably, a large proportion of those in the lowest clusters in one year transitioned to the highest clusters in subsequent years, representing a significant portion of inpatient costs. This dynamic migration between clusters, with individuals moving from low to high usage, was a previously unrecognized trend with important implications for targeting of disease management programs.
NCQA_Future Vision for Medicare Value-Based Payments FinalTony Fanelli
This document discusses principles for achieving an optimal future state of quality measurement to support performance-based clinician payment under MACRA. It outlines five principles: 1) Every Medicare enrollee needs a dedicated and well-organized primary care team; 2) Measurement must be specified appropriately for each different unit of accountability; 3) Measurement should support rapid improvement and clinical decision making; 4) A core set of measures will let all stakeholders make comparisons across programs; 5) Quality measure results should be easy for consumers and payers to get and use. The document emphasizes the importance of coordinated, team-based primary care and having measures tailored to different payment and delivery models.
Review the shortage of medical professionals and the increasing need for advanced practitioners to serve in primary care roles
Identify the current barriers that prevent CNP from practicing to the full extent of their education, scope and training
Outline concrete ways in which these barriers can be effectively removed so as to improve autonomy for CNP’s and quality of care for patients.
MAFP Quality Reporting for Cash-CMS Incentives and Your Bottom Linelearfieldinteraction
This document discusses quality reporting incentives from CMS and their impact on physician practices. It outlines the requirements and incentives for three separate CMS programs - Meaningful Use, PQRS, and e-Prescribing. Participation in these programs can provide incentives, but failure to participate may result in payment penalties beginning in 2015. The document provides an overview of each program's objectives, measures, and reporting options to help physicians incorporate quality reporting into their practices.
This document discusses pay for performance (P4P) and its implications for healthcare organizations. It explains that P4P aims to improve quality by directly incentivizing superior care delivery. The document outlines drivers of P4P like rising healthcare costs and quality issues. It also reviews current P4P programs and discusses strategies organizations can take to prepare, like integrating performance data and contracting approaches that reward quality and efficiency.
The document summarizes a vision session on prescription opioid overdose that included presentations from the Oklahoma Commissioner of Health and the president of ASTHO. Key points discussed include:
- The growing epidemic of prescription opioid overdose deaths and costs to the healthcare system.
- ASTHO's Prescription Drug Overdose Prevention Challenge which aims to reduce overdose rates and engages state health officials and partners across sectors.
- Strategies discussed to address the epidemic through prevention, monitoring, enforcement, treatment and recovery efforts.
This study evaluated the impact of integrating a substance abuse treatment program into population-based behavioral health care. The program identified individuals at risk for medical issues from substance use disorders and engaged them in treatment. Participants had 16% fewer ER visits and 67% fewer hospitalizations after treatment compared to before. Healthcare costs for participants dropped 46% on average after treatment. The findings suggest integrating substance abuse treatment programs into population health strategies can increase enrollment in treatment and reduce costs.
Medicine expenditure in South Africa decreased slightly by 0.6% in 2012, continuing a downward trend from 2011. This is due to a 0.8% decrease in medicine utilization and a 0.2% increase in medicine item costs. The increased use of generic medicines, which have significantly lower costs, contributed to the decreased expenditure. Top therapeutic groups with the highest expenditure were treatments for hypertension, diabetes, and high cholesterol.
This document provides an update to a 2014 paper on integrating tobacco cessation medications into state and provincial quitlines. It summarizes trends showing an increase in quitlines offering medications from 70% in 2008 to 87% in 2012. The update reviews evidence that providing medications through quitlines increases their reach and effectiveness by improving quit rates. It describes current models for medication integration including information only, limited distribution, full distribution, and partnership distribution. Finally, it summarizes literature finding that medication use improves quit outcomes and increased call volumes when promoted.
Patient-centered medical home initiatives in several states have shown promising results in improving access to care, quality, and cost control for Medicaid patients. Oklahoma saw a $29 per patient annual reduction in Medicaid costs from 2008-2010 alongside increased use of preventive care. Colorado expanded Medicaid access from 20% to 96% of pediatricians at lower costs. Vermont saw 21-22% decreases in inpatient care use and costs from 2008-2010 alongside 31-36% drops in ER use and related costs. Washington state's acute care spending was 18% below average with 35% fewer inpatient stays per beneficiary. Overall, these initiatives demonstrate that the patient-centered medical home model can positively impact Medicaid programs.
This document discusses several topics related to healthcare finance and quality reporting systems:
1) It summarizes the goals of the Physician Quality Reporting System (PQRS) and Value-Based Purchasing System (VBPS), including improving quality of care and tying reimbursement to quality metrics.
2) It outlines the roles of Health Information Management professionals in supporting these programs through data analytics and quality reporting.
3) It describes the roles of Quality Improvement Organizations in ensuring accurate medical coding and documentation for reimbursement.
4) It provides an overview of several laws and acts aimed at reducing healthcare fraud, including the Anti-Kickback statute and their effects on providers.
The Exxon Valdez oil spill of 1989 spilled approximately 10.9 million gallons of crude oil into Prince William Sound, Alaska after the ship ran aground. Over 1,100 miles of coastline were impacted, making it the largest oil spill in U.S. waters at the time. Cleanup efforts continued for years. In 2010, the Deepwater Horizon drilling rig exploded in the Gulf of Mexico, releasing up to 5,000 barrels of oil per day. Experts estimated this Gulf spill could surpass the spillage of the Exxon Valdez four times over in just a few weeks if not contained. Multiple containment options were attempted but proved difficult given the depth and scale of the leak. The Gulf spill had
This document summarizes research showing that increased investments in tobacco prevention programs in Maine could save millions in health care costs by reducing smoking rates. Studies from other states found their tobacco prevention programs saved far more than they cost by lowering smoking-related health problems. With increased funding of $8.6 million per year, Maine could reduce smoking rates by 1% annually for 5 years. This would save over $733 million in long-term health costs and provide substantial public health benefits.
Benefits of implementing_the_primary_care_pcmhVicki Harter
This document provides a review of cost and quality results from implementing the patient-centered medical home (PCMH) model of primary care. It summarizes newly reported and updated results from PCMH initiatives nationwide over the past two years. The results show that the PCMH improves health outcomes, enhances the patient and provider experience of care, and reduces unnecessary hospital and emergency department utilization, meeting the goals of better health, better care, and lower costs. The document defines key features of the PCMH model and provides data demonstrating how each feature contributes to these outcomes. It outlines growing private and public sector support for the PCMH in the United States.
This document provides a summary of cost and quality results from patient-centered medical home (PCMH) initiatives in 2012. It finds that the PCMH improves health outcomes, enhances the patient and provider experience of care, and reduces unnecessary hospital and emergency department utilization. Major health plans like Aetna, Humana and UnitedHealthcare are expanding PCMH programs based on evidence that it meets the goals of better health, better care and lower costs. The momentum for PCMH is growing across the healthcare system, including 90 commercial insurance plans, 42 state Medicaid programs, and thousands of clinical practices nationwide.
The document discusses Thailand's development of a universal health coverage benefit package. It outlines the key steps Thailand took:
1) Establishing systematic processes for developing the package, involving stakeholders and using evidence-based criteria and health technology assessments.
2) Starting with a basic package focusing on primary care and high-impact services, then expanding over time as resources increased.
3) Introducing rigorous health technology assessment processes to evaluate new interventions, ensuring only cost-effective options were included.
The document discusses how changes in physician-hospital alignment are inevitable due to a confluence of events in the healthcare industry. Reimbursement trends are driving the need for alignment as Medicare costs are projected to grow substantially and physician reimbursement increases have been minimal. Clinical integration can help generate efficiencies and is viewed favorably by regulators. The document outlines three models for physician-hospital alignment and notes they each implicate legal issues around reimbursement, antitrust, and fraud/abuse.
The document summarizes data from MaineCare (Maine's Medicaid program) on the use and costs of tobacco cessation benefits in fiscal year 2010, including pharmacotherapy (medications), counseling services, and copay costs paid by Medicaid recipients. It finds that in 2010, MaineCare paid over $1.26 million for pharmacotherapy provided to 13,533 members, with Chantix accounting for over $300,000 of costs. Counseling services cost $33,234 and were provided to 2,066 members. Eliminating copays for medications could cost Maine less than $100,000 annually based on 2010 data of $91,956 in copays paid.
The document provides information about health care costs and insurance plans in the United States, Minnesota, and the Foley School District. It shows that on average, 87 cents of every health insurance dollar in the US goes toward medical costs, while 13 cents goes toward administrative costs and profits. Minnesota and Foley School District plans have lower administrative costs than national averages. The Resource Training & Solutions school pool offers advantages like lower costs and premium increases compared to other plans like SEGIP and PEIP.
1) The document summarizes recent reforms to the English National Health Service (NHS) proposed by the UK coalition government.
2) Key aspects of the reforms include transferring around 70% of the NHS budget to groups of general practitioners (GPs), increasing hospital autonomy and competition, and expanding patient choice.
3) The reforms aim to reduce central control over the NHS and introduce more market-based incentives, but also face significant implementation challenges and risks of disruption.
Presentation Objectives:
1) Define SBIRT and identify components of this evidence-based intervention for identifying, reducing, & preventing problematic use, abuse & dependence on alcohol & illicit drugs
2) Learn how to use the all the components of the SBIRT app, including, but not limited to the screening, brief interventions & referral to treatment features included in this app
3) Recognize the critical need for more research related to occupational therapy intervention and SBIRT, as well as potential obstacles to implementation of SBIRT in treatment settings & resources for continuing education on this topic.
Painsolver is a clinical decision support tool designed to improve healthcare outcomes for low back pain. It addresses limitations in how patient care is currently managed by providing evidence-based guidance, integrating recommendations into workflows, and promoting shared decision making between providers and patients. The tool aims to help organizations and providers succeed under emerging pay-for-performance models by enhancing outcomes and reducing costs over a patient's lifetime. Vertelogics believes Painsolver can help providers and organizations not just survive but thrive as the healthcare system shifts its focus to outcomes-based reimbursement.
This article analyzes annual cost profiles and consumption patterns of Medicare beneficiaries with diabetes from 2000 to 2006. It finds that while the percentages of beneficiaries and expenditures in different consumption clusters (ranging from "crisis consumers" to "low consumers") remained generally constant year to year, there was significant movement of individuals between clusters over time. Notably, a large proportion of those in the lowest clusters in one year transitioned to the highest clusters in subsequent years, representing a significant portion of inpatient costs. This dynamic migration between clusters, with individuals moving from low to high usage, was a previously unrecognized trend with important implications for targeting of disease management programs.
NCQA_Future Vision for Medicare Value-Based Payments FinalTony Fanelli
This document discusses principles for achieving an optimal future state of quality measurement to support performance-based clinician payment under MACRA. It outlines five principles: 1) Every Medicare enrollee needs a dedicated and well-organized primary care team; 2) Measurement must be specified appropriately for each different unit of accountability; 3) Measurement should support rapid improvement and clinical decision making; 4) A core set of measures will let all stakeholders make comparisons across programs; 5) Quality measure results should be easy for consumers and payers to get and use. The document emphasizes the importance of coordinated, team-based primary care and having measures tailored to different payment and delivery models.
Review the shortage of medical professionals and the increasing need for advanced practitioners to serve in primary care roles
Identify the current barriers that prevent CNP from practicing to the full extent of their education, scope and training
Outline concrete ways in which these barriers can be effectively removed so as to improve autonomy for CNP’s and quality of care for patients.
MAFP Quality Reporting for Cash-CMS Incentives and Your Bottom Linelearfieldinteraction
This document discusses quality reporting incentives from CMS and their impact on physician practices. It outlines the requirements and incentives for three separate CMS programs - Meaningful Use, PQRS, and e-Prescribing. Participation in these programs can provide incentives, but failure to participate may result in payment penalties beginning in 2015. The document provides an overview of each program's objectives, measures, and reporting options to help physicians incorporate quality reporting into their practices.
This document discusses pay for performance (P4P) and its implications for healthcare organizations. It explains that P4P aims to improve quality by directly incentivizing superior care delivery. The document outlines drivers of P4P like rising healthcare costs and quality issues. It also reviews current P4P programs and discusses strategies organizations can take to prepare, like integrating performance data and contracting approaches that reward quality and efficiency.
The document summarizes a vision session on prescription opioid overdose that included presentations from the Oklahoma Commissioner of Health and the president of ASTHO. Key points discussed include:
- The growing epidemic of prescription opioid overdose deaths and costs to the healthcare system.
- ASTHO's Prescription Drug Overdose Prevention Challenge which aims to reduce overdose rates and engages state health officials and partners across sectors.
- Strategies discussed to address the epidemic through prevention, monitoring, enforcement, treatment and recovery efforts.
This study evaluated the impact of integrating a substance abuse treatment program into population-based behavioral health care. The program identified individuals at risk for medical issues from substance use disorders and engaged them in treatment. Participants had 16% fewer ER visits and 67% fewer hospitalizations after treatment compared to before. Healthcare costs for participants dropped 46% on average after treatment. The findings suggest integrating substance abuse treatment programs into population health strategies can increase enrollment in treatment and reduce costs.
Medicine expenditure in South Africa decreased slightly by 0.6% in 2012, continuing a downward trend from 2011. This is due to a 0.8% decrease in medicine utilization and a 0.2% increase in medicine item costs. The increased use of generic medicines, which have significantly lower costs, contributed to the decreased expenditure. Top therapeutic groups with the highest expenditure were treatments for hypertension, diabetes, and high cholesterol.
This document provides an update to a 2014 paper on integrating tobacco cessation medications into state and provincial quitlines. It summarizes trends showing an increase in quitlines offering medications from 70% in 2008 to 87% in 2012. The update reviews evidence that providing medications through quitlines increases their reach and effectiveness by improving quit rates. It describes current models for medication integration including information only, limited distribution, full distribution, and partnership distribution. Finally, it summarizes literature finding that medication use improves quit outcomes and increased call volumes when promoted.
Patient-centered medical home initiatives in several states have shown promising results in improving access to care, quality, and cost control for Medicaid patients. Oklahoma saw a $29 per patient annual reduction in Medicaid costs from 2008-2010 alongside increased use of preventive care. Colorado expanded Medicaid access from 20% to 96% of pediatricians at lower costs. Vermont saw 21-22% decreases in inpatient care use and costs from 2008-2010 alongside 31-36% drops in ER use and related costs. Washington state's acute care spending was 18% below average with 35% fewer inpatient stays per beneficiary. Overall, these initiatives demonstrate that the patient-centered medical home model can positively impact Medicaid programs.
This document discusses several topics related to healthcare finance and quality reporting systems:
1) It summarizes the goals of the Physician Quality Reporting System (PQRS) and Value-Based Purchasing System (VBPS), including improving quality of care and tying reimbursement to quality metrics.
2) It outlines the roles of Health Information Management professionals in supporting these programs through data analytics and quality reporting.
3) It describes the roles of Quality Improvement Organizations in ensuring accurate medical coding and documentation for reimbursement.
4) It provides an overview of several laws and acts aimed at reducing healthcare fraud, including the Anti-Kickback statute and their effects on providers.
The Exxon Valdez oil spill of 1989 spilled approximately 10.9 million gallons of crude oil into Prince William Sound, Alaska after the ship ran aground. Over 1,100 miles of coastline were impacted, making it the largest oil spill in U.S. waters at the time. Cleanup efforts continued for years. In 2010, the Deepwater Horizon drilling rig exploded in the Gulf of Mexico, releasing up to 5,000 barrels of oil per day. Experts estimated this Gulf spill could surpass the spillage of the Exxon Valdez four times over in just a few weeks if not contained. Multiple containment options were attempted but proved difficult given the depth and scale of the leak. The Gulf spill had
This document summarizes research showing that increased investments in tobacco prevention programs in Maine could save millions in health care costs by reducing smoking rates. Studies from other states found their tobacco prevention programs saved far more than they cost by lowering smoking-related health problems. With increased funding of $8.6 million per year, Maine could reduce smoking rates by 1% annually for 5 years. This would save over $733 million in long-term health costs and provide substantial public health benefits.
The document summarizes funding and outcomes for various public health programs funded by Maine's Fund for a Healthy Maine. It describes how funds support Head Start and child care programs, home visitation services, dental education and care initiatives, substance abuse treatment, family planning clinics, tobacco prevention and control efforts, school-based health programs, and efforts to build a public health infrastructure and provide immunizations. Proposed funding cuts would eliminate services for thousands of families and children and negatively impact key public health programs.
Maine's first tobacco law was passed over 100 years ago. Since 1981, many laws have been enacted to reduce tobacco use and exposure to secondhand smoke. This includes laws that restrict smoking in public places, reduce youth access to tobacco, encourage smoking cessation, and prevent youth initiation. The document provides a summary of tobacco-related legislation passed in Maine between November 2008 and June 2009, including laws that further restricted smoking in public places and increased tobacco taxes.
- 17.2% of Maine adults smoke, down from 18.2% in 2008, with higher rates among those with a high school degree or less. 18.1% of high school students smoke.
- Smoking costs Maine $602 million annually in health care costs. Tobacco use results in 2,200 adult deaths and 27,000 premature youth deaths each year.
- Maine spends $11.8 million on tobacco prevention annually, meeting 63.6% of the recommended CDC funding level of $18.5 million. This ranks Maine 6th nationwide for tobacco prevention spending.
The document contains data from 1955-2010 on cigarette excise taxes, retail prices, and per capita sales in Maine. It shows that the tax as a percentage of retail price increased from 52.2% in 1955 to 48.2% in 2010. Over this period, the retail price of cigarettes rose from $0.23 per pack to $6.24 per pack. Meanwhile, annual per capita cigarette sales in Maine declined from 133 packs in 1955 to 53 packs in 2010.
The Choose To Be Healthy Coalition implemented several programs focused on nutrition, physical activity, and substance abuse prevention in the York County region, including:
1) Implementing the Let's Go 5210 program in schools and child cares to address child obesity.
2) Partnering with local food pantries to improve nutrition for clients.
3) Assisting over 20 businesses to implement worksite wellness programs.
4) Engaging nearly 50 local youth in tobacco and substance abuse prevention advocacy programs.
Maine's first law regulating tobacco was passed over 100 years ago in 1897. Since then, laws have been passed to restrict smoking in public places, reduce youth access to tobacco, raise tobacco taxes, and establish tobacco prevention programs. The document provides a detailed history of tobacco legislation in Maine from 1897 to 1995, with the laws becoming increasingly restrictive over time to reduce the harms of tobacco use and exposure to secondhand smoke.
The Family Smoking Prevention and Tobacco Control Act of 2009 grants the FDA authority to regulate tobacco products. Key provisions include banning fruit-flavored cigarettes, graphic health warnings covering 50% of cigarette packs, limits on advertising and marketing appeals to youth. It does not preempt all state/local tobacco control laws. The act aims to reduce youth tobacco use and inform the public of health risks but was partially struck down by a Kentucky court over some marketing restrictions.
This document discusses the negative health impacts and costs of tobacco use and the effectiveness of comprehensive tobacco prevention and cessation programs. It notes that tobacco use is the leading preventable cause of health problems and costs in many states. While evidence-based prevention programs have been shown to significantly reduce youth and adult smoking rates, save lives and money, most states are still not adequately funding these programs compared to revenues from tobacco taxes and settlements. The tobacco industry also continues to heavily market their products and oppose policy changes. [/SUMMARY]
This document proposes quality improvements to MaineCare tobacco cessation coverage, including:
- Increasing screening, access to pharmacotherapy, and counseling services
- Removing barriers like prior authorizations and duration limits on medications
- Expanding reimbursements for physicians, tobacco treatment specialists, and group counseling
- Improving communication to Medicaid recipients about the tobacco treatment benefit
The goal is to help more MaineCare recipients who smoke to successfully quit tobacco use through an evidence-based and comprehensive tobacco dependence treatment program.
The document describes a unique floral boutique design inspired by Daniel Libeskind's methods of folding and unfolding architecture to create an effortless flow of nature. Radiating circular patterns in the floor plan are meant to create a feeling of consecutive waves emanating from the central garden outwards. A simple, unified design is achieved through repetition of patterns and a limited color palette.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
The document discusses different approaches to requirements analysis and documentation. It covers defining requirements at a high level through use case diagrams and descriptions before detailing them in specific steps and rules. Both functional and non-functional requirements are important to define the system's behaviors and attributes. The level of documentation needs to balance the needs of different stakeholders while not exceeding what is necessary. The methodology used can influence how and when requirements and documentation are produced.
- Tobacco use kills over 400,000 Americans annually and costs nearly $100 billion in health care costs, while tobacco companies spend over $12 billion on marketing. Comprehensive tobacco prevention programs are proven to reduce smoking and help smokers quit.
- States collect over $25 billion annually from tobacco taxes and settlements, yet fund tobacco prevention programs at only a fraction of the recommended levels. Increasing funding of these programs to CDC-recommended levels would cost less than 15% of current tobacco revenues and save lives.
- Studies show that increased investment in tobacco prevention programs significantly reduces youth and adult smoking rates, as well as saving states money through lower tobacco-related healthcare costs over time. States should uphold their commitment to use tobacco
This document provides an overview of various tobacco products currently available on the US market, including chewing tobacco, cigars, blunts, cigarillos, little cigars, dipping tobacco, cigarettes, and dissolvable tobacco. It describes the basic composition and use of each product type. The tobacco industry is pursuing these new products to attract new users and offset declining cigarette sales due to health regulations.
The Fund for a Healthy Maine (FHM) allocates funds from Maine's annual tobacco settlement payments to support health programs aimed at disease prevention. It accounts for only 0.7% of Maine's total healthcare spending but funds critical programs in areas like smoking prevention and cessation, childcare, oral health, substance abuse treatment, and school-based health centers. Greater investment in prevention through the FHM has the potential to dramatically reduce chronic disease and healthcare costs over the long term.
This document summarizes Maine's history of tobacco policy initiatives and laws from 1897 to 2011. It discusses the progression of laws that have been passed to reduce exposure to secondhand smoke, restrict youth access to tobacco, increase tobacco taxes, and establish tobacco prevention programs. Key milestones include the first workplace smoking ban in 1985, comprehensive smoke-free laws in the 1990s and 2000s, increased tobacco taxes in 1997 dedicated to prevention programs, and the 1998 tobacco Master Settlement Agreement. The document provides a high-level overview of Maine's extensive efforts to enact tobacco control policies and initiatives over the past century.
An introduction to SAMHSA's SBIRT program, its role in addressing problematic drug and alcohol use and a call for occupational therapy leadership in its implementation.
The document discusses the medical home model as a disruptive innovation for primary care. It proposes paying primary care physicians for coordinating patient care and managing health outcomes and costs through a medical home model. This shifts care from a specialist-focused model to a simpler, rules-based primary care model. The medical home aims to provide integrated, whole-person care through teams led by primary care physicians. It also discusses pilots of medical homes, challenges, and the potential for cost savings through reduced errors, care gaps, and procedures.
The document discusses emerging value-based healthcare payment models in the US and provides recommendations for stakeholders. It outlines recent legislation like MACRA that aims to shift Medicare payments from fee-for-service to value-based models. MACRA establishes the MIPS program which combines existing quality programs and the APM program which incentivizes participation in alternative payment models. It also describes various CMS pay-for-performance programs focused on readmissions, hospital value, and hospital-acquired conditions. The document concludes with recommendations for stakeholders to collaborate across the healthcare system to effectively transition to value-based models.
This document summarizes recent initiatives in tobacco control and prevention in the United States. It discusses major programs from the Centers for Disease Control and Prevention, U.S. Food and Drug Administration, and new national strategies. It outlines opportunities like forthcoming media campaigns and warnings, as well as threats like new tobacco products and funding cuts. It concludes that spending on comprehensive tobacco control programs provides large economic benefits that greatly outweigh costs.
Approaches in Implementing the Mental Health and Addiction Equity Act.Best Pr...Mariel Lifshitz
This document describes best practices used by seven states to implement and monitor compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA). The states identified five key components of effective implementation: 1) open communication with health insurers, 2) standardized materials and terms, 3) templates and tools for assessing compliance, 4) market conduct exams and network adequacy reviews, and 5) collaboration across agencies and stakeholders. The states developed various templates, guides and other resources to promote consistent application of parity rules. They also analyzed complaints, conducted on-site exams of insurers, and collaborated closely with multiple groups to identify and address any compliance issues.
Patient support programmes within medicines optimisation – the pros and consPM Society
Patient support programs have the potential to improve medication adherence and patient outcomes while also providing a return on investment. A personalized text message program for asthma patients improved adherence from 43% in the control group to 58% in the intervention group. The program continued to show benefits in adherence even after the intervention ended. A support program for age-related macular degeneration patients led to an 8-fold decrease in treatment discontinuation and a 941% return on investment. Personalized interventions that address patients' beliefs and perceptions have the most potential to positively impact adherence long-term.
The document provides an overview of the Canadian pharmaceutical market, highlighting several key trends that will affect pharmaceutical manufacturers. The Canadian market, while smaller than some other countries, still ranks among the top 10 globally in drug spending. Launching a drug in Canada can be profitable if manufacturers understand the specific nuances of the market, such as Canada's complex reimbursement system with both public and private insurance. Health technology assessments play an important role in reimbursement decisions. Manufacturers must tailor their reimbursement and launch strategies to the target payer market, whether public or private plans. Health economic evidence is also becoming increasingly important for market access, pricing, and contracting in Canada.
The document discusses medication therapy management (MTM) services provided by pharmacists. It notes that MTM aims to improve patient outcomes, promote safe medication use, and reduce costs. MTM services include comprehensive medication reviews, adherence support, and disease state management. Studies show MTM can identify and resolve medication-related problems, lower healthcare costs, and improve health outcomes for conditions like diabetes and asthma.
FINAL MSmith_ Medn Measures that Matter_ AJPB_Jan-Feb 2015Marie Smith, PharmD
This document discusses the need for new quality measures that assess medication management across care settings and providers. It notes that while current measures address prescribing and adherence, they do not address optimization, coordination of medications prescribed by multiple providers, or medication management during care transitions. The document advocates developing measures that close these gaps, such as those assessing comprehensive medication reviews, reconciliation of medication lists during care transitions, and development of patient medication action plans. It provides examples of how measures could be organized into families and sets that cut across conditions and specialties to promote coordination and alignment of quality measurement.
Navigate 2 Scenario for Health PolicyEpisode 1Policy An.docxmayank272369
Navigate 2 Scenario for Health Policy
Episode 1:
Policy Analysis and Development
Overview
In this episode, you will be in a health care policy internship program in a Senator’s office in Washington, D.C. The Senator wants to develop policy that requires all health care organizations that receive federal funds to implement the recommendations presented in the Institute of Medicine reports on quality care. You will develop a policy, so that it can become proposed legislation. You must collect data, describe the problem, solutions and related ethical issues, examine the cost-benefit analysis, identify stakeholders (such as lobbyists from American Hospital Association, health care providers, health care corporations, pharmaceuticals, insurers, etc.), and impact. Based on this information, you will create a policy description that will be the foundation for a bill. You will describe critical issues that would be in the bill such as requirements of hospitals to:
Monitor and report medical errors to the Department of Health and Human Services
Use root cause analysis on a certain percentage of errors
Track and report patient outcomes focused on the clinical problems identified in the
National Health Care
Quality Report
Integrate the 5 health care profession core competencies into staff education and track outcomes
Establish a no-blame culture
*I suggest for you to do some research on your own, and if you use outside sources to help your compile your policy description, be sure to reference them (following an APA format) at the end of your post.
Assignment
You will post a policy description to this discussion board forum. Make sure to identify a plan that addresses legal and ethical issues in a health care policy. You must also respond to 2 of your peers' posts and make sure to reference any outside sources you may have used in your recommendation.
Below are the characters from this LearnScapes scenario (LearnScapes for
Health Policy
1):
The Student (which is you), Health Care Policy Intern for Congress
The student used to work within the Bright Road Health Care System, and had a special interest in policy. The student is thinking about moving into politics, hoping to make a difference at that level. The student has just been accepted into the internship; this is the student’s first big project.
Peter Shackley, Senior Policy Staff Member
The student’s mentor, Peter, is a young and feisty staff member. In his late 20s, Pete has been interested in politics since he was President of his high school student body. He’s especially passionate about policy-making and how the process works. Pete will help guide the student through the policy-making process.
Gretchen Wilde, Senator Chief of Staff
Gretchen is in her 30s and has been the Senator’s Chief of Staff for about 2 years now. She’s very professional, and holds high expectations for everyone in the Senator’s office, including interns. Gretchen is responsible for reviewing polic.
Diabetes Management Policy Proposal
Miatta Teasley
Capella University
NHS-FPX6004 Health Care Law and Policy
Professor Georgena Wiley
May 19, 2022
Click to edit Master title style
Click to edit Master title style
Hello and welcome to today's presentation on drug error regulatory policy proposals. This presentation is intended to provide you, your stakeholders, with all pertinent information regarding the need for an institutional policy to reduce medication errors in medical centers. We will also go over the scope of the recommendations, strategies for addressing medication errors, and stakeholder involvement in putting these strategies into action.
Policy Proposal
Diabetes Management
2
Click to edit Master title style
Click to edit Master title style
This proposal revolves around creating and implementing strategies that will help Med’s caregivers be able to improve on patient care regarding diabetes.
Presentation Outline
Policy on Managing Medication Errors
Need for a Policy
Scope of Policy
Strategies to Resolve Mediation Errors
Role of the Hospital Staff
Positive impact on Working Conditions
Issues in the Application of Strategies
Alterative Perspectives on Mitigating Medication Errors
Stakeholder Participation
3
Click to edit Master title style
Click to edit Master title style
The presentation highlights key functions in any policy implementation process. The steps this presentation takes appear in the order as indicated here. We will start y looking at
Policy on Managing Medication Errors then
Need for a Policy followed by
Strategies to Resolve Mediation Errors. Then the
Role of the Hospital Staff and the
Positive impact on Working Conditions. Also, we will look at
Issues in the Application of Strategies and the
Alterative Perspectives on Mitigating Medication Errors and finally,
Stakeholder Participation
Policy on Managing Medication Errors
4
Health practitioners should create and advance engaging policies
Many Healthcare departments require modernization
Healthcare policies should be adjusted to meet defined benchmarks
Key stakeholders are vital for successful implementation of proposed policies
Click to edit Master title style
Click to edit Master title style
When advocating for organizational regulation changes about federal, state, or local health care guidelines or rules and regulations, healthcare practitioners should be able to create and advance an engaging and logical policy and guideline parameters that will provide a segment, a group, or an entire institution to correct and shed light on issues of accomplishment and execute developments in the quality and safety of medical management.
Despite being recognized as one of the greatest health insurance carriers for people over 65, several departments need to be modernized. The most pr.
The document discusses plans to implement a medication therapy management (MTM) program across Walgreens clinics. It outlines strategies for recruiting pharmacists, obtaining financing, marketing the program, focusing initial efforts on diabetes and hypertension, and addressing legal and ethical considerations to improve patient health outcomes through comprehensive medication reviews.
Catasys provides an integrated behavioral health program called OnTrak that identifies high-cost individuals with behavioral health issues and engages them in a 52-week treatment program. Catasys uses predictive analytics to identify eligible members from claims data provided by health plans. OnTrak reduces medical costs by about 50% and provides a 3-to-1 return on investment for health plans. Catasys expects $20 million in billings in 2018 based solely on its existing pool of eligible members.
Catasys provides an integrated virtual healthcare program called OnTrak that identifies and treats behavioral health conditions like substance abuse and depression. OnTrak uses predictive analytics to identify high-cost patients with behavioral health issues who rarely seek treatment. Patients enroll in a 52-week virtual treatment program with care coaching support. Studies show OnTrak significantly reduces healthcare costs by improving patient outcomes and lowering emergency room visits and hospitalizations. Catasys contracts with health insurance plans to provide OnTrak and is paid a monthly fee per enrolled patient.
Catasys provides an integrated virtual healthcare program called OnTrak that identifies and treats behavioral health conditions like substance abuse and depression. OnTrak uses predictive analytics to identify high-cost patients with behavioral health issues who rarely seek treatment. Patients enroll in a 52-week virtual treatment program with care coaching support. Studies show OnTrak significantly reduces medical costs and healthcare utilization for enrolled members. Catasys contracts with health plans to provide OnTrak and is paid a monthly fee per enrolled member.
MYnd Analytics, (NASDAQ: MYND) with its wholly owned subsidiary Arcadian Telepsychiatry Services LLC, is a technology-enabled telepsychiatry and teletherapy company that provides enhanced access to behavioral health services, improves patient outcomes and helps lower the costs associated with behavioral health issues. The MYnd Psychiatric EEG Evaluation Registry (PEER) is a predictive analytics decision support tool that helps physicians reduce trial and error treatment for behavioral health conditions. PEER provides the physician a personalized care plan with recommended treatment options based on a patient’s unique brain markers, reducing treatment time and treatment costs. Arcadian Telepsychiatry Services LLC provides a suite of complementary telemedicine services that can be combined with PEER, including telepsychiatry, teletherapy, digital patient screening, curbside consultation, on-demand services, and scheduled encounters for all age groups. MYnd’s customers include major health plans, health systems, and community-based organizations. To read more about the benefits of this patented technology for patients, physicians and payers, please visit: http://www.myndanalyticsinfo.com
Respond by Day 5 to at least two colleagues in one of the follmickietanger
Respond by Day 5
to at least two colleagues in one of the following ways:
Describe two factors that might make minority groups especially vulnerable in the Medicaid policy your colleague cited. Explain why these groups may not have a voice in the policy-making process.
Offer examples of organized self-help and citizens’ groups as both support mechanisms and potentially powerful lobbies. Describe how these lobbying bodies can help in amending the policy your colleague described.
Colleague 1
Chana Smith
RE: Discussion - Week 9
COLLAPSE
How the evolution of health care policy has influenced programs such as Medicaid and Medicare.
America health policy shifted from environmental concerns to individual. Over time we have moved from dispensaries, to marine hospitals, to focusing on check ups. "The federal government entered briefly into health provision during Franklin Roosevelt's New Deal with the Resettlement Administration's medical cooperatives" (Popple & Leighninger, 2019). The Depression led way for prepaid programs such as, Blue Cross and Blue Shield, due to hospitals being left with unpaid hospital bills. The government stepped back in when those who were less healthy, retired, unemployed, underemployed or self employed suffered. This is when both the Democratic and Republican parties worked together to put forth proposals that would protect the senior population that was getting left out of the employer based health plans (Popple & Leighninger 2019). Hospitals were reimbursed by Medicare however, continuously rising hospital costs, resulted in the Reagan administration developing a standardized payment based on diagnosis. Medicare became their cash cow because congress was able to take advantage of the cost reduction by transferring savings in Medicare into the general deficit reduction (Popple & Leighninger, 2019).
Specific Medicaid policy in your state that should be amended, and explain how you would amend it and why.
The Medicaid policy in North Carolina that should be amended is the policy that prohibits payment for diet programs in weight loss centers. Helping recipients with their goal towards weight loss could help reduce Medicaid costs. Medicaid paying for weight loss programs could result in lowered expenses towards weight related health issues such as high blood pressure, and diabeties (dhhs.gov, 2018).
The stakeholders involved in the Medicaid and Medicare health care policy in your state, and explain the role of these stakeholders in policy development for this issue.
The stakeholders involved in the Medicaid and Medicare health care policy include ombudsmen, providers, and consumer health advocacy groups. The provide expertise and knowledge to contribute towards identifying solutions to meet the needs the people. They then work together towards developing the policy (Nguyen, & Miller, 2018).
Colleague 2
Tameka Sutton
RE: Discussion - Week 9
COLLAPSE
In this week’s discussion, we are to communicate the devel ...
Implications for The Medicare Program Discussion.docx4934bk
This document discusses implications for the Medicare program given demographic trends in the aging US population. It outlines 10 issues arising from an increasing senior population and the implications for Medicare delivery and costs. It also discusses potential solutions to issues providing healthcare for seniors, including maintaining the political and fiscal viability of Medicare in the future.
Marketing proposal to Hartford HealthcareArchit Patel
The presentation is a brief description to the proposed marketing strategy for the Hartford healthcare specifically targeting on the New Health Enhancement Program proposed for Connecticut state employees.
This document summarizes a lean transformation initiative at Ruby Hospital in Calcutta, India. Through gemba walks, the team found that only 31% of outpatients with drug prescriptions purchased them from the hospital pharmacy and only 50% purchased all prescribed items. They also found most purchases occurred during rush hours and that patients wanted to complete the purchase within 12 minutes of consultation. Process mapping, data collection, and analysis showed the biggest time wasters were walking to the pharmacy and item retrieval, contributing over 10 minutes. The root causes were identified as poor pharmacy location and unavailable inventory.
This document shows smoking rates among high school students in Maine and the US from 1993 to 2009, with rates generally declining over time but Maine rates consistently higher than US rates. In 1993, 39.2% of Maine high school students smoked compared to 36% nationally, falling to 18.1% of Maine students and 17.2% of US students by 2009.
The document summarizes programs funded by the Fund for a Healthy Maine prior to the 2012-2013 biennium. It lists various departments within the Department of Health and Human Services (DHHS) that received funding, including the Centers for Disease Control, Office of Child and Family Services, Office of Substance Abuse, and Office of MaineCare Services. It also lists other state departments and programs that received funding, such as the Department of Education's School Breakfast Program, the Attorney General's office, the Department of Public Safety, and the Department of Administrative and Financial Affairs. Quality child care and bone marrow screenings programs previously received funding but saw it eliminated in 2012-2013.
The Fund for a Healthy Maine previously funded several State positions in various departments including the Department of Health and Human Services, Department of Education, Department of Public Safety, Judiciary, and Attorney General's Office. However, in fiscal years 2012 and 2013, the General Fund began funding these positions instead of the Fund for a Healthy Maine. The positions included public health educators, social services specialists, education specialists, fire marshals, and assistant attorneys general among others. Departments had to absorb the costs of some positions without additional funding.
Maine collected increasing amounts of excise tax revenue from non-cigarette tobacco products like smokeless tobacco from 1998 to 2011, rising from $2.89 million in 1998 to $11.57 million in 2011. In 2005, Maine changed its smokeless tobacco excise tax from a flat rate per unit to a weight-based system of $2.02 per ounce, with a minimum of $2.02 per canister, which contributed to higher and steadier revenue collection in subsequent years.
This document summarizes funding allocations from the Fund for a Healthy Maine (FHM) program for various public health and social services programs. It shows the original FHM allocations, other sources of funding for each program, any proposed cuts or amendments to funding, and the total funding for each program. Key decisions included restoring full funding for substance abuse treatment, oral health, and home visitation programs by reallocating funds from other programs and sources. Funding was also allocated to increase payments to the MaineCare program.
The document summarizes transfers of funds from the Fund for a Healthy Maine to the General Fund between April 2000 and June 2011. It shows that $15 million was initially transferred in April 2000, with an additional $11 million transferred in June 2001 after the trust fund was abolished. In total, over $126 million, or 69% of the funds, was diverted from the Fund for a Healthy Maine to the General Fund during this period through transfers of reserve funds, unexpended balances, and program cuts.
Youth smoking prevalence in Maine dropped significantly from 1993 to 2009, falling from 39% to 14%. Several increases in Maine's cigarette tax rates during this period, including a $1 increase in 2002, corresponded with drops in teen smoking of 12.5% to 16%. By 2009, Maine saw a 58% reduction in youth smoking over the 16-year period studied.
This document shows cigarette sales in millions of packs in New Hampshire from fiscal year 1990 to 2010. It displays several dips in sales that correspond to tax increases on cigarettes in New Hampshire, Maine, and Massachusetts over that period. Cigarette sales in New Hampshire generally trended downward from 220 million packs in 1990 to slightly over 100 million packs in 2010, with tax increases in surrounding states contributing to the decline.
Higher cigarette pack prices in Maine between 1993-2009 were associated with lower youth smoking rates. As the average retail price of a pack of cigarettes increased from $1.85 in 1993 to $5.61 in 2009, the percentage of high school students who reported smoking decreased from 38% to 14% over the same period.
The high cost of health care and health insurance places a large burden on Maine businesses. The average cost of a family health insurance policy was $8,700 in 2008 but is projected to exceed $15,000 by 2012, a trajectory that is unsustainable for many businesses. Maine's economic recovery depends on reducing health care costs, which the Fund for a Healthy Maine aims to do. Every dollar invested in prevention saves $7.50 in health costs within five years. Without the Fund, Maine's public health investment would fall significantly compared to other states. Dismantling the Fund would send the wrong message and take Maine in an unwise direction for businesses.
The document discusses Maine's Fund for a Healthy Maine (FHM), which was created using money from the tobacco settlement to invest in preventing disease and promoting health. It argues that the FHM helps lower healthcare costs for businesses and families by keeping people healthy. However, the Governor's budget proposes dismantling the FHM and using the funds to fill budget gaps instead of for prevention as originally intended. Supporters believe the FHM should be protected to continue creating opportunities for better health and lower costs through prevention.
The document shows revenue and program allocations for Maine's Fund for a Healthy Maine from fiscal years 2001 to 2013. It displays the beginning balance for the fund, the program cuts of $9 million in the first year, and flat funding for four years after money was diverted from the fund to the general fund. Revenue came from annual Master Settlement Agreement payments while allocations funded public health programs.
The Fund for a Healthy Maine (FHM) was created by the Maine Legislature in 1999 to distribute tobacco settlement funds to support eight categories of health programs. The FHM receives annual payments from the tobacco settlement and allocates funds to supplement existing health programs, not replace taxpayer funding. However, in the past the Maine Legislature has diverted over $126 million from the FHM to the state's general fund. Supporters of the FHM want to ensure funds continue to be used for their intended health-related purposes and view the FHM as a unique opportunity to invest in disease prevention and health promotion programs that save costs.
The document outlines the intended and actual allocations of funds from Maine's Fund for a Healthy Maine since its inception. The vision was to allocate 90% of funds to substance abuse prevention and treatment programs and 10% to a trust fund. However, the reality has seen 17.1% of funds diverted to the state's general fund, rather than the intended health programs, with $126.8 million diverted through 2013. Key health programs like child care, oral health, and home visitation have not received their intended levels of funding.
The document discusses the benefits of comprehensive tobacco treatment coverage through Medicaid/MassHealth programs. It provides the example of Massachusetts, which in 2006 began covering tobacco cessation treatment including counseling and FDA-approved medications. Between 2006-2008, over 70,000 unique MassHealth members used the new benefit, and the smoking rate decreased 26% from 38.3% to 28.3%. The benefit was cost-effective, with $1.11 returned for every $1 spent due to reduced hospitalizations for conditions like heart attacks.
The Fund for a Healthy Maine has supported several public health initiatives in Maine with successes in multiple areas:
1) Tobacco use among youth has declined significantly, with high school smoking down 64% and middle school smoking down 73% between 1997 and 2007. The Tobacco HelpLine and Healthy Maine Partnerships have also helped reduce tobacco use.
2) Underage alcohol use has declined steadily over the past decade in Maine. A higher education partnership increased participating colleges and universities from 4 to 18 around preventing high risk drinking.
3) School based health centers provided over 13,000 patient encounters in 2009-2010 and helped over a third of students who smoked to quit or reduce smoking. Asthma management among users also
The document shows tobacco use rates in Maine in 2009 broken down by level of education completed. The highest rate of tobacco use, at 34.7%, was among those with less than a high school education. The rate decreased with more education, with only 8.5% of college graduates using tobacco. Tobacco use rates were highest among those with the lowest levels of education.
This document shows tobacco use rates in Maine by age group in 2009. The highest rate of tobacco use was among those aged 18-24, at 28%. Rates generally declined with age, with only 7% of those aged 65 and older reporting tobacco use. Tobacco use rates were highest among younger adults and declined steadily with increasing age.
This document presents data from 2009 on tobacco use rates in Maine by income bracket. It shows that tobacco use was highest, at 32.8%, for those earning less than $15,000 annually and declined steadily as income increased, being lowest at 9.9% for those earning $50,000 or more per year.
Youth smoking rates in Maine decreased from 39.2% in 1995 to 14% in 2010 after a series of tobacco tax increases from 1995 to 2008, but began increasing again in 2010 for the first time in over 10 years. A graph shows cigarette smoking rates among Maine youth declining steadily from 1995 to 2009 as tobacco taxes increased by $0.37, $0.26, and $1.00 over that period.
More from Maine Public Health Association Tobacco Policy Subcommittee and Friends of the FHM (20)
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Tests for analysis of different pharmaceutical.pptx
Resolve 34 Final Report
1. State of Maine
Department of Health and Human Services
Partnership for a Tobacco Free Maine,
Maine Center for Disease Control and Prevention
and
Office of MaineCare Services
Final Report
on
Resolve, Regarding Tobacco Cessation and Treatment
December 15, 2008
2. TABLE OF CONTENTS
Page
Summary .......................................................................................................................... …….3
Discussion …………………………………………………………………………………………6
Appendices
A. Resolve, Regarding Tobacco Cessation and Treatment
B. Work group
C. MHMC survey questions
D. 2008 Survey results - summary
E. MHMC 1998 Survey results- excerpts from Executive Summary
F. Efficacy rates from meta- analysis of pharmacotherapy (source: 2008 PHS Guidelines)
G. Projected Cost: removing barriers to accessing tobacco dependence treatment in MaineCare
H. Updated Chart of Current Tobacco Treatment Benefits in Maine
References
2
3. Summary
Resolve 2007, c. 34 (Appendix A) directed the Department of Health and Human Services to ―undertake a study of best
practice treatment and clinical practice guidelines for tobacco cessation treatment‖ and to ―use the most recent available
clinical practice guidelines (―Guidelines‖) of the U.S. Department of Health and Human Services Public Health
Service‖.
The study included development of a model tobacco cessation treatment program in the public and private sectors and
was conducted by the Partnership For A Tobacco-Free Maine (―PTM‖), Maine Center for Disease Control and
Prevention (―ME CDC‖) and the Office of MaineCare Services (―Medicaid‖). PTM and Medicaid reported back in a
preliminary report to the Joint Standing Committee on Health and Human Services (―the Committee‖) on January 15,
2008: http://mainegov-images.informe.org/dhhs/reports/tobacco.pdf The workgroup‘s request to be permitted to provide
a final report by December 15, 2008 was accepted by the Committee.
This final report pursuant to the Resolve is submitted by Medicaid and PTM.
A workgroup consisting of staff from Medicaid, PTM and PTM partner organizations (or sub-groups) met nine times
during the spring, summer and fall of 2008 on April 10, May 2, May 28, June 26 (full group), July 16, August 12,
August 14 (full group), August 26 and September 23 to finalize discussion, planning and recommendations for the final
report. Workgroup members, including those providing information in this report who did not attend meetings, are listed
in Appendix B.
____________________________________
Private Sector
1) Survey of Maine employers1. A survey of a relatively large (50) group of Maine based private employers
representing 19% of Maine employees was conducted by PTM through Maine Health Management Coalition (MHMC)
to better understand the coverage currently available in Maine through self-funded and other insurance plans. The recent
increase in the number of self funded plans, not generally subject to state regulation, made this information more
difficult to obtain. Member organizations were surveyed in December,2008 and the survey and a summary of results are
attached as Appendices C and D, respectively. At the end of the survey, information on the ‗gold standard‘ for tobacco
dependence treatment coverage was provided to member organizations. A ‗baseline‘ survey assessing tobacco
dependence coverage of all 30 MHMC members, was conducted in 1998 by Susan Swartz Woods, MD, MPH. Excerpts
from the earlier survey executive summary are included as Appendix E.
2) Wellness programs. There has been a large increase, nationally as well as in Maine in employer based wellness
programs which include tobacco cessation cost incentives in an effort to reduce health care costs of employees. Dozens
of bills have been introduced across the country to spur introduction of wellness programs in the public and private
sectors. In Maine, in the past year, two bills (not enacted) provided incentives to encourage wellness programs2. Some
large employers in Maine, such as Maine Health, Barber Foods, L.L. Bean and Cianbro, have established worksite
wellness policies that include tobacco free grounds and wellness programs with cash or other incentives to quit such as
free counseling and nicotine patches. Cianbro‘s policy is notable in that it includes disincentives for violating the smoke
free policy in the form of lost wages and eventual dismissal for multiple violations.
An informal survey of worksite wellness programs in June, 2008 of small businesses (50 or fewer employees) randomly
selected in Kennebec County, was conducted by Healthy Communities of the Capitol Area. Of the 27 who responded,
1
A 2007 national survey of 502 employers‘ perceptions about the business impact of smoking was conducted by the National Business Group on
Health. The report, ―Smokers in the Workplace‖, noted that, 85% of small and large employers believed that offering smoking cessation benefits
would improve employees‘ health and decrease health care costs but only 2% of companies surveyed provided comprehensive smoking cessation
benefits (62%/61% covered counseling/prescription medications; only 37% covered over the counter NRT, only 27% eliminated or minimized co-
pays or deductibles). The survey online :http://www.calquits.org/page_attachments/0000/0036/NBGH_Employer_Survey_Summary_Report.PDF
2
LD 1890 (2008) would have required all carriers to offer a discount on premiums for non-smokers and would have required small and large
group carriers to offer a discount on premiums for participants in wellness programs. The Dirigo Health Maine Quality Forum would have been
required to develop certification standards for eligible workplace wellness programs. LD 2059 (2007) would have allowed businesses to take a tax
credit for instituting a wellness program that included a smoking cessation class.
3
4. 67% supported employees who want to quit by offering insurance coverage, counseling, classes, medications or simply
posting Helpline posters in employee areas. 89% said that they had a worksite tobacco policy and the majority reported
that they were moving to incorporate a wellness policy as a part of that. There is no known information as to the
efficacy of these programs in Maine.
______________________________
Public Sector
The following is a summary of the results of the study and final actions by Medicaid and PTM on preliminary
proposals:
1) Guidelines
The final 2008 Guidelines published in May differ little from the draft 2008 Guidelines issued in November, 2007. The
final Guidelines did note that only 25% of Medicaid patients reported any practical assistance with quitting or any
ensuing follow up. The 2008 Guidelines focus much more heavily on the need for systemic delivery of tobacco
dependence treatment (recognizing that physicians and other providers are only one, important part of a larger system),
on emerging evidence of the efficacy of treating special populations and perhaps most importantly, on comparative,
evidence based analyses of the efficacy of new (varenicline) and multiple pharmacotherapies. The last is particularly
useful as a guide for purchasers. See Appendix F for comparative data on the efficacy of pharmacotherapies (source:
2008 Guidelines).
2) Model Program
The workgroup determined (and this finding was not revised for the final report) that a model tobacco dependence
treatment program in either the public or private sector includes:
1. Screening, identification and intervention for tobacco use by every practice with referral as necessary for
further counseling
2. Evidence based pharmacotherapy is readily available to all
3. Pharmacotherapy and counseling are not linked in a payment scheme; one can be reimbursed without the
other
4. Cost sharing and deductibles are minimal; the duration of treatment reimbursed reflects successful quit
patterns
5. Benefits are targeted to those most in need such as pregnant smokers and those with behavioral health
problems such as major depression
6. Providers are given adequate reimbursement for counseling
7. Education is conducted about benefits offered and evaluation of the treatment provided is conducted on a
regular basis
Model program implementation
Model directive (1): Medicaid does not require by contract that each patient be identified, documented, assessed
and addressed by all clinicians in every clinical setting at every visit
(½) Model directive (2): Medicaid covers all FDA approved meds, individual but not group counseling and has
not eliminated modest co-pays (mail order scripts have no co-pays, however, the mail order pharmacies often do
not carry over the counter medications, mail order is not promoted by MaineCare and is not a significant part of
claims processed), step therapy, duration or single medication limits on its coverage for medications, due to fiscal
constraints.
o Utilization. Medicaid data for FY08 illustrates that total payments for pharmacotherapy have increased
by nearly $1 million, likely due to the new preferred status of varenicline and to its heavy promotion
4
5. by Pfizer in early 20083. FY08 data on counseling demonstrates, by contrast, that fewer claims are
being paid ($35,612 in FY08 vs. $62,612 in FY05) for fewer members (2,312 members in FY05 vs.
1,600 in FY08). Projected costs associated with waiving co-pays, opening a new ‗screening‘ code for
reimbursement or covering more intensive counseling are outlined in Appendix G.
NOTE : American Lung Association (ALA), in its annual report on state tobacco control activities, to be
published in January, 2009, analyzes the conformity of states‘ tobacco cessation treatment with the
recommendations of the Guidelines. ALA gives Maine an average grade and its Medicaid program figures
prominently. The program received good marks for providing coverage for all FDA approved medications but
deductions for numerous barriers to access including imposition of co-pays, time limits and no coverage for group
counseling. The absence of a state mandate that requires a standard coverage for tobacco treatment for private
insurers was also noted.
Model directive (3): Medicaid does not require counseling to be offered with medication or vice versa, in
conformity with model plan directive 3 (unlink benefits as best practice)
Model directives (4), (5): Medicaid has not eliminated cost sharing or limits on duration of treatment that reflect
successful quit patterns, due to questions as to relative efficacy and to current fiscal constraints
Model directive (6): Medicaid has not expanded the types of providers, such as tobacco treatment specialists, or
offered reimbursement for screening and counseling, due to fiscal constraints
Medicaid, in compliance with model directive (7) (education and evaluation offered to raise awareness and to
encourage utilization), has instituted a program that will be reporting feedback to all primary care providers
including Federally Qualified Health Centers and hospital based providers on their tobacco counseling and
medication use, by year end. Also, Medicaid will be providing a physician incentive payment to primary care
practices that have the highest percentages of tobacco treatment counseling claims only (there is a cost associated
with collecting other claims data). A December, 2008 newsletter to MaineCare primary care practices will be
announcing the physician incentive payment, using tobacco dependence counseling as a performance measure.
3) Best Practice
(1/2) Best practice for PTM as a tobacco control program, according to the US CDC, requires funding at the
recommended level.
The revised U.S. CDC budget recommendations are based on a funding formula adjusted for changes in state
population and inflation, attainable rates of quitline usage and provision of NRT to callers. Maine‘s recommended
level of funding for cessation intervention in FY07 was $5.1 million with a range of $2.9 to $7.7 million. Actual
spending on helpline cessation treatment and community medication vouchers by Maine‘s Tobacco program was
about $3 million in FY08, below the recommended level but above the minimum recommended.
(3/4) Best practice also requires that the Guidelines system strategy changes be adopted (yes), that quitline
services be sustained and expanded (yes), that treatment for face to face counseling be supported (yes) and that
cost and other barriers to treatment for the uninsured and populations disproportionately affected by tobacco use
be eliminated.
o PTM has met 3 of the 4 above criteria through its consistent level of funding of the Helpline and the
expansion of funding for services for new face to face treatment programs. PTM is focusing strategic
planning on eliminating barrier through more comprehensive coverage for the uninsured, MaineCare
members and other populations disproportionately effected by tobacco use.
4) Preliminary proposals and final action
3
From $1.25 million in FY02 to $2.2 million in FY08; $1.2 million of which was for varenicline (Chantix). In FY07 varenicline claims were only
about 10% of all claims. (The percentage of claims for varenicline has declined in the third quarter of calendar year 2008, however.) Medicaid
will be doing a survey to assess quit success with varenicline for its members. The cost per member has actually declined from $152/member in
FY2005 to $136/ member in FY08; the additional total expense is due to the additional members served: 11,154 in FY05 to 19,570 in FY08
5
6. 1. MaineCare‘s Physician Incentive Payment for clinicians would include tobacco use screening, tracking,
intervention and counseling as a performance measure. Final: Adopted. Enacted by Medicaid, but based
on counseling claims only due to fiscal impact of need to hire staff to obtain data for other measures.
2. A fax referral system to the Tobacco Helpline implemented statewide with feedback to providers on the
patients referred Final: Adopted. Still in process.
3. A demonstration project that emphasizes intensive counseling for youth, pregnant smokers and others
who have co-morbidity or mental health issues would be offered through rural health centers. Final:
Adopted. Enacted.
4. A pilot project would be implemented using a ‗stepped care‘ approach that combines Helpline counseling
with face to face treatment for youth and pregnant smokers and others who have co-morbidity or mental
health issues requiring additional professional support to quit. Final: Adopted. Enacted.
5. MaineCare will explore increasing the reimbursement rate for more intensive counseling and certified
tobacco treatment specialists and reimbursing others for this work Final: Not adopted due to budget
constraints.
6. MaineCare will explore waiving co-pays and other patient cost sharing and step therapies for tobacco
dependence treatment Final: Not adopted due to budget constraints.
Discussion
Resolve 34 was enacted due to concern that tobacco use continues to take a significant and yet largely preventable toll
on the health of Maine residents 4 and continues to drain the economic resources of the state. Maine‘s demographics and
socio-economic status contribute to the ‗hardening‘ of this problem. The state has one of the highest percentages of
civilian veterans in the nation, a higher than average percentage of persons with behavioral health issues, is
overwhelmingly white and has lower than average educational attainment and income levels. All of these factors are
associated with higher than average rates of tobacco use. 5
While Maine‘s population with the highest income and educational attainment have experienced significant drops in
smoking prevalence, the uninsured and MaineCare (Medicaid) members‘ smoking rates remain more than twice that of
the insured population and twice that of the general population 6, as noted in the Preliminary Report. Moreover, despite a
strong tobacco control program which supports a Tobacco Helpline7 for all smokers including the uninsured, Maine‘s
4
Maine was among the states with the highest incidence of lung and bronchial cancer among both sexes, despite significant overall
decreases in lung and bronchial cancers reported nationally, during the period studied. CDC MMWR September 5, 2008
Surveillance for Cancers Associated with Tobacco Use; U.S., 1999-2004 (data from state cancer registries); Annual Report issued
11/26/08 to the Nation on the Status of Cancer, 1975-2005, Featuring Trends in Lung Cancer, Tobacco Use and Tobacco Control,
Journal of the National Cancer Institute, last accessed online on 11/26/ 08 at: http://jnci.oxfordjournals.org/cgi/content/full/djn389v1
―Although the decrease in overall cancer incidence and death rates is encouraging, large state and regional differences in lung cancer
trends among women underscore the need to maintain and strengthen many state tobacco control programs.‖ [Maine is one of only
two states not in the south or midwest where lung cancer rates among women have increased, rather than leveled off, during the
time period examined]
5
See Maine State Health Plan, April, 2008, accessed at:
http://maine.gov/dhhs/boh/phdata/Additional%20Reports%20Pdf%20Doc/2008-2009%20State%20Health%20Plan.pdf
6
Maine Adult Tobacco Survey, 2004 32% or about 69,000 of all adult smokers (210,100) in Maine receive MaineCare benefits at
any given time during a calendar year
7
The Maine Tobacco Helpline reported (report unpublished, available from PTM) that in 2007 33% of callers quit who also used
medication (reported 7 months after assistance from Helpline). The Helpline reached 8,885 Maine residents (3.5% of adult
smokers). The Helpline is an important resource for helping, at no cost, uninsured Mainers who want to quit.
6
7. overall adult smoking rate (20.2%) is above the national average of 19.8% and has not appreciably declined in four
years.8 Its smoking attributable expenditures are significantly higher than the national state average and are summarized
in Table 1.
Table 1
Maine U.S.
$208 $129 Average Medicaid costs per capita (adult)
$6.37 $5.31 Average medical costs per pack of cigarettes
$5.23 $5.16 Average productivity costs per pack of cigarettes
$2.29 $1.63 Average medical costs per pack of cigarettes
$660 $630 Average/ household cost: state/ federal tax burden from smoking-caused gov't expenditures
Source: US CDC: Sustaining State Programs for Tobacco Control: Data Highlights 2006 (2004 dollars)
According to recent reports from national public health organizations 9, including the U.S. Public Health Service Clinical
Practice Guidelines (2008), offering treatment and eliminating barriers to help with quitting has proven very effective at
reducing tobacco use. Barriers encountered by those tobacco users attempting to quit include the absence of a
coordinated, integrated delivery system for assessing and treating tobacco dependence 10 and the lack of consistent,
barrier free coverage for the costs of treatment. The cost of quitting using varenicline, the nicotine patch, gum or
lozenges (excluding any additional private counseling cost) is roughly equal, on a short term basis, to smoking a pack of
Marlboro‘s a day ($155/month). If one smokes roll your own tobacco or little cigars, the cost to quit, due to their lower
price, would be 2-5 times more expensive (short term) than to continue to use tobacco in these forms. From a purely
short term, financial perspective, there is no incentive to quit, without help from insurance.
The limitations of private insurance coverage and Maine‘s Medicaid coverage are particularly vivid if one accepts the
principle, adopted by a growing number of medical practitioners, that tobacco dependence, especially in the case of
older, heavy users, is a chronic condition and shares similarities with diabetes and asthma, both of which are routinely
classified as ‗medical‘ (whereas tobacco use classification remains unclear—is it medical, behavioral health, substance
8
Maine ranks 31st among states (and DC) in adult smoking prevalence. 2007 BRFSS (CDC MMWR October 2008) By contrast,
Maine‘s current youth smoking rate (14%) reflects plummeting use, the state has already exceeded its Healthy Maine 2010 goal of
15% and has one of the lowest youth smoking rates in the country. 2007 YRBS; Maine‘s Healthy Maine target rate for 2010 is 20%
for smoking rates among pregnant women on Medicaid; the current rate is 33%, which has declined only modestly from 36.5% in
2002. PRAMS 2005 Annual Report issued 11/26/08 to the Nation on the Status of Cancer, 1975-2005, Featuring Trends in Lung
Cancer, Tobacco Use and Tobacco Control, Journal of the National Cancer Institute, last accessed online on 11/26/ 08 at:
http://jnci.oxfordjournals.org/cgi/content/full/djn389v1 ―Although the decrease in overall cancer incidence and death rates is
encouraging, large state and regional differences in lung cancer trends among women underscore the need to maintain and
strengthen many state tobacco control programs.‖ [Maine is one of only two states not in the south or midwest where lung cancer
rates among women have increased, rather than leveled off, during the time period examined]
9
CDC MMWR, February 8, 2008, State Medicaid coverage for Tobacco –Dependence Treatments-Us, 2006, noted that only one
state (Oregon) covered all treatments recommended by the Guidelines and barriers in Medicaid coverage were common. American
Lung Association, Tobacco Policy Trend Report, Helping Smokers Quit, State Cessation Coverage, November 13, 2008 notes that
Maine is not in the top ranks in addressing tobacco cessation as a state: although the Maine state employee health plan has good
coverage, Maine has no statutory mandate for minimum standard coverage by private insurance and barriers to full coverage under
Medicaid exist including co-pays, duration limits and prior authorization requirements. See:
http://www.lungusa.org/atf/cf/%7B7A8D42C2-FCCA-4604-8ADE-7F5D5E762256%7D/HELPING%20SMOKERS%20QUIT%20-
%20STATE%20CESSATION%20COVERAGE%2011-13-08.PDF)
10
See Health Coach Program in a Medical Group Improves Self-Care and Decreases Readmissions for High-Risk, Chronically
Ill Patients at http://www.innovations.ahrq.gov/content.aspx?id=1747#a3;
7
8. abuse, preventive care?). Asthma and diabetes have standard coverage with no duration limitations on long term use of
medications in public and private insurance and are increasingly systematically treated using self-care management
models within many health care practices. 11
There is consensus as to the elements necessary in a model system and acknowledgement that, although the Maine
system has its strong points, notably a highly regarded, effective Tobacco Helpline, good coverage through some private
plans and better than average Medicaid coverage, it does not have a model program. But it will require political will and
corporate leadership to fix it, especially in these hard economic times. One approach which has shown promise in
Massachusetts would be to enact legislation that requires barrier free tobacco dependence coverage through the
Medicaid program12, with periodic reporting to the legislature of utilization and efficacy rates. A second provision
would require all private insurers (those subject to state regulation) to offer comparable coverage and would establish
tax credits or a state grant program for small businesses (most likely to have insurance subject to a state mandate) who
implement benefits or wellness programs which include tobacco dependence treatment for their employees.
Available information indicates that in Maine there has been improvement in coverage of tobacco dependence treatment
in recent years but there remain numerous barriers to smokers accessing affordable help with quitting. Since many
tobacco users need much encouragement to make an attempt to quit and to maintain that effort, erecting barriers (time
limits on coverage, etc.) to those users accessing help is highly counter-productive. Tobacco dependence treatment as a
preventive service within an insurance benefit is not over-utilized by the patient, there is strong evidence that, with rare
exception, it is highly under-utilized.
In closing, it is important to acknowledge a central issue: effective tobacco dependence treatment requires, above all, a
systemic approach: removing cost barriers to treatment in Medicaid coverage alone, while beneficial, will not fully solve
the problem if formularies remain highly variable from public/private sector plan to plan, if physicians and other
providers as well as tobacco users aren‘t fully aware of what is available and don‘t consistently assess and follow up
with tobacco using patients and if there are an insufficient number of adequately trained counselors to offer appropriate
more intensive counseling for tobacco users who need more help.
11 Medicare tobacco dependence coverage for older or disabled patients with a chronic illness and the Maine Tobacco Helpline for all enrolled
callers do offer up to 4 months (two 8 week courses) vs. 3 months (MaineCare) of coverage for medications and counseling, in a calendar year.
The case for treating tobacco dependence as a chronic disease, Ann Inten Med. 2008; 148:554-556
http://www.annals.org/cgi/content/full/148/7/554?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=tobacco+2008
&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
12
Massachusetts‘ experienced a 8% drop in its adult smoking prevalence rate (now 16.5%) after the Health Care Reform Act established a two
year pilot program (funding and program were extended in the FY09 budget) with $7 million each year for the Medicaid program tobacco
dependence treatment program, required all residents to be insured (and increased its cigarette tax by $1). The executive office must report
annually on the number of enrollees who participate in smoking cessation services, number of enrollees who quit smoking, and Medicaid
expenditures tied to tobacco use by Medicaid enrollees. See c. 58, section 108 of the Act at:
http://www.mass.gov/legis/laws/seslaw06/sl060058.htm See also:
http://www.wickedlocal.com/lexington/news/lifestyle/health/x1936634263/Smoking-reported-down-8-percent-in-state;
8
9. Appendix A
PLEASE NOTE: The Office of the Revisor of Statutes cannot perform research, provide legal advice, or interpret
Maine law. For legal assistance, please contact a qualified attorney.
Resolve
123rd Legislature
First Regular Session
Chapter 34
S.P. 499 - L.D. 1421
Resolve, Regarding Tobacco Cessation and Treatment
Sec. 1 Best practice and model treatment programs. Resolved: That the Department of Health and Human
Services, through the Partnership for a Tobacco-Free Maine, Maine Center for Disease Control and Prevention and the
Office of MaineCare Services, shall undertake a study of best practice treatment and clinical practice guidelines for
tobacco cessation treatment. The study must use the most recent available clinical practice guidelines available from the
United States Department of Health and Human Services Public Health Service and must include development of a
model tobacco cessation treatment program for use in the public sector and private sector. The department shall report
back to the Joint Standing Committee on Health and Human Services by January 15, 2008. The committee may submit
legislation to the Second Regular Session of the 123rd Legislature related to best practice treatment and clinical practice
guidelines for tobacco cessation treatment.
Effective September 20, 2007
9
10. Appendix B
Resolve 34: Workgroup Members
Department of Health and Human Services
Office of MaineCare Services (MaineCare)
Brenda McCormick Director, Division of Health Care Management
Roderick Prior, MD Medical Director, MaineCare
Nicole Rooney Comprehensive Health Planner II
Jennifer Cook Acting Manager, Pharmacy Unit, Div of Health Care Management
Kristin Cowing Management Analyst 2 Division of Policy and Performance
M. Ouellette Pharmacist, Goold Health Services
Partnership for a Tobacco Free Maine, Maine Center for Disease Control and Prevention
Dorean Maines Tobacco Control Program (Acting) Manager, PTM
MaryBeth Welton Tobacco Control program Manager, PTM
Molly Schwenn, MD Cancer Registry, Director
Andrew Spaulding Worksite Health Specialist, Maine CDC/Cardiovascular Health program
Maine Coalition on Smoking or Health/Health Policy Partners of Maine
Pamela MB Studwell Senior Policy Analyst (American Lung Association of Maine)
Becky Smith Executive Director (Medical Care Development)
Maine Health Management Coalition
Elizabeth Mitchell CEO
Center for Tobacco Independence
Allesandra Kazura, MD Medical Director, Helpline, Center for Tobacco Independence
Ken Lewis Executive Director, Maine Health, Center for Tobacco Independence
Healthy Communities of the Capitol Area
Joanne Joy Director
Amy Wagner Worksite Wellness program manager
10
11. Appendix C
Dear Employer,
Maine Health Management Coalition (MHMC) is helping to facilitate the distribution of a survey on employer tobacco
dependence treatment benefits. The survey has been designed by the Partnership for a Tobacco-Free Maine (PTM),
Maine Center for Disease Control and Prevention and Health Policy Partners who are working in partnership to address
the harm tobacco causes the people of Maine. As part of a statewide effort to gather information about services
available to people to help them quit commercial tobacco use, we are asking you to complete this survey by December
5, 2008.
This survey is 22 questions and should take you less than 10 minutes to complete. All responses will be kept
confidential and results will be made available on an aggregate basis to MHMC by January, 2009.
Thank you in advance for completing this survey. Questions can be directed to Pamela Studwell, Senior Policy Analyst,
Health Policy Partners/American Lung Association of Maine (207-624-0325).
Welcome
Are you a hospital or non-hospital?
Is your plan an HMO or a Point of Service plan?
Is health care coverage provided by your company self-insured?
How many employees does your company have? How many employees are enrolled in your health coverage?
Are employees subject to an annual deductible? What is the deductible amount for office visits?
What is the deductible amount for prescribed medication? What is the deductible amount for counseling?
For the following tobacco cessation treatments, do your health benefits include full coverage (no co-pay), co-pay, or no
coverage?
Does this smoking cessation benefit coverage also apply to covered dependents? Is there an age restriction for
dependents?
Is there an ANNUAL limit to the number of total quit attempts covered per person?
Is there a LIFETIME limit to the number of total quit attempts covered per person?
Is there a requirement that the person participate in counseling to obtain reimbursement for OVER THE COUNTER
(OTC) quit medications?
Is there a requirement that the person participate in counseling to obtain reimbursement for PRESCRIPTION quit
medications?
For OTC Nicotine Replacement Therapy, is there a dollar amount limit?
For OTC Nicotine Replacement Therapy, is there a limit on the number of quit attempts?
For prescription quit medications, is there a dollar amount limit?
For prescription medication, is there a limit on the number of quit attempts?
Do you know how many of your employees and covered dependents have obtained smoking cessation medications in
the last year?
Is there anything else you would like to tell us about your tobacco cessation benefits?
11
12. Appendix D Tobacco Dependence Treatment Survey Results Summary
The survey asked twenty two questions on tobacco dependence treatment coverage under insurance plans in an
internet based survey of the members of the Maine Health Management Coalition (MHMC). The deadline for
response was December 10.
MHMC has 52 members (as of Dec.10, 2008): 13 hospitals, 4 health plans, 16 physician practices and 19 employers,
including LL Bean‘s, Hannaford‘s, Barber Foods, Bowdoin College, and the City of Portland, representing more than
200,000 employees, some of whom may be residents of other states*.
*Maine’s workforce, full and part-time employees was about $1 million in 2007.. Source: Urban Institute and Kaiser Commission on
Medicaid and the Uninsured estimates based on the Census Bureau's March 2007 and 2008 Current Population Survey (CPS: Annual
Social and Economic Supplements).
Employer, Employees, Types of plans
13 of 52 Employers responded to the tobacco dependence coverage survey (25% response rate)
141,817 Employees with possible access to coverage described by survey responses (70%of members‘
employees)
103,526 Employees insured (average of 73% of total employees working for each employer; range was 47%
to 100%)
5-120,000 Number of employees, each employer respondent (85% had more than 200)
77% Respondents who were non-hospital employers
46%/53% Split between health maintenance organization plans (HMO‘s) and ‗point of service‘ (POS)
(more flexible variant of HMO‘s) plan coverage described**
69% Self insured* employers as % of total employers who responded to survey
*Plan generally governed by federal ERISA, not state, law where the employer assumes the risk of liability for costs under the plan, the
insurer is the administrator only; the employer negotiates with the insurer for particular coverage
** MHMC employer members may offer more than one type of plan; only one plan was described in this survey per employer (27% of
employers surveyed in 1998 offered more than one plan)
Plan limits
92% No annual limit to # of quit attempts in reimbursement for counseling
84.6% No lifetime limit on # of quit attempts in reimbursement for counseling
92% Don‘t require counseling to get over the counter medication (patch, gum, lozenges)
85% Don‘t require counseling to get prescription meds (varenicline, buproprion, spray, inhaler)
77% Don‘t have dollar limits on annual or lifetime over the counter medication
91.7% Don‘t have (annual) dollar limits on prescriptions
76% Don‘t have (lifetime) dollar limits on prescriptions
Plan Benefit Coverage
Office visit: 38% $15-25 co-pays
38% no co-pays
23% other
Medications: 30.7% tiered co-pays
30.7% $10-$20 co-pays
23% no-co pays
15% other
Counseling: 46% $15-25 co-pay or other minimal co-pay
30.7% no co-pays
23% other
Comments
12
13. 1 large employer commented that just under 9% of its employees smoked; the company offers free on site tobacco
cessation classes and free nicotine patch and gum. As further incentive, if the employee quits for 6 months, she receives ½
day off with pay; after 1 year, a full day off with pay.1 insurer respondent offers no tobacco dependence coverage in its
standard HMO or POS plans
____________________________________________________
Comparison between 1998 survey and current survey
It was impossible to directly compare the 1998 survey of MHMC members and the current survey for the following
reasons:
(1) current survey did not have access to member identity although 3 members voluntarily self-identified, (2) members
have changed in ten years, (3) the prior survey had 30 respondents, current survey had 13 who self-selected; (3) the prior
survey looked at worksite smoking policies, (4) the prior survey compared managed care plan benefits with other (mostly
indemnity) plan benefits; current survey does not compare plans, asking for HMO or POS plan information only and also
self-insured status, (5) the prior survey included onsite counseling as well as plan counseling and considered ‗full access‘
to a type of benefit to include benefits with a minimal ($10) co-pay but did not look at benefits offered at no cost, (6)this
survey looked at cost free benefits and actual cost of co-pay and considered only insurance derived, not onsite benefits. [It
is now the standard based on PHS Guidelines research to consider even modest co-pays as limiting access.] Having said
this, the 1998 survey does provide an interesting backdrop to the results of the current survey.
General observations
74% members surveyed in 1998 were non-hospitals: a percentage split comparable to the current survey
13% plans in current survey with no coverage for counseling (phone, individual or group) vs. 33% in 1998
16% plans in current survey with no coverage for medications (varenicline, buproprion) vs. 25% (buproprion only) in
1998
41% plans in current survey with no coverage for OTC (patch, gum lozenge) vs. 50% in 1998 (patch only)
76.7% offer counseling (individual, group, telephonic) at minimal/ no cost [33% at no cost] vs. 47% in 1998 at
minimal/no cost
61% offer OTC (nicotine patch, gum, lozenges) (46% at no cost) vs. 50% in 1998 (patch only)
83% offer prescription medication (varenicline, buproprion) (33% at no cost) vs. 50% in 1998 (buproprion)
75% offer spray/inhaler prescriptions – not offered in 1998
7 % offer coverage for OTC, all prescription medication and all forms of counseling in current survey (at no cost to
employee) vs. 0% in 1998
13
14. Appendix E
Excerpts from Executive Summary of 1998 Tobacco Treatment Benefit Survey of MHMC members
The survey was conducted to evaluate worksite smoking policies and health insurance benefits for tobacco cessation
among members of the Maine Health Management Coalition (MHMC). Completed by all 30 MHMC members in 1998,
this report describes worksite smoking policies and variations in cessation benefits.
All MHMC employers have a worksite smoking policy. The majority of employers offer outdoor designated smoking
areas, and only 10% have an entirely smoke-free worksite. Policies that increasingly restrict smoking are generally
viewed as being successful. It is uncommon (10%) for an employer to generate higher insurance premiums for smoking
employees.
Among 30 employers, a total of 44 employers‘ insurance ―products‖ were evaluated; 34 of which were hospital
employers. The over distribution of hospital employers (who would be more likely to offer these benefits) was controlled
for and noted in assessing results. Cessation counseling at the worksite was provided by 33% of employers, and
availability of worksite counseling was inversely related to employer size.
Counseling through health plans was available in 47%, and only 18% had full access to plan-level counseling resources.
When both worksite counseling and health plan-level counseling were taken into consideration, 36% of employers‘
products remained without counseling benefits.
Pharmacotherapy for tobacco cessation was more readily available, with 77% of insurance products providing some
coverage for nicotine patch and bupropion. Coverage for both medications was similar. Full access to medications
occurred in 50% of employers‘ products.
20.5% of all insurance products had coverage for both counseling and pharmacotherapy with full access; 16% had no
coverage for either.
Many MHMC insurance products do not offer comprehensive cessation benefits recommended by the Agency for Health
Care Policy and Research. [The AHCPR Smoking Cessation Clinical Practice Guideline was developed in 1996, the
AHCPR guideline is a comprehensive literature review of effective cessation treatments and the first AHCPR guideline
directed at insurers, purchasers, and administrators as well as clinicians.]
[The first set of questions was about worksite smoking policy. The second series of questions revolved around the
availability of health benefits for tobacco cessation, including cessation resources at the worksite. Any type of cessation
counseling available to employees was determined, including the counseling format, co-payments and deductibles, and
limitations that apply to the benefit. Coverage for tobacco-related pharmacotherapy, including prescription and non-
prescription nicotine patch and buproprion (Zyban) were assessed for each employer‘s insurance product. The survey also
identified whether cessation resources were fully accessible or had reduced access.
Access to benefits were identified as being full = readily available, or reduced = requiring employee payment or linked to
utilization of another resource. The latter, ―reduced access‖ was defined as resources requiring significant out-of-pocket
payment by the employee (NOT small co-payments) or linkage to another resource. Examples include (a) full payment of
nicotine patch reimbursed at a later date, (b) coverage for nicotine patch linked to cessation counseling, and (c) access to
telephonic behavioral counseling linked to treatment with nicotine patch.]
Full unpublished executive summary available from: pstudwell@lungme.org
14
15. Appendix F
Efficacy of medication compared to placebo at 6-months post-quit
Combination therapies #ARM odds ratio efficacy
Patch (long-term; >14
weeks) + ad lib NRT
(gum or Spray) 3 3.6 (2.5, 5.2) 36.5 (28.6, 45.3)
Patch + Bupropion 3 2.5 (1.9, 3.4) 28.9 (23.5, 35.1)
Patch + Nortriptyline 2 2.3 (1.3, 4.2) 27.3 (17.2, 40.4)
Patch + Inhaler 2 2.2 (1.3, 3.6) 25.8 (17.4, 36.5)
Second generation
antidepressants (paroxetine,
venlafaxine) & patch 3 2.0 (1.2, 3.4) 24.3 (16.1, 35.0)
________________________________________________________________________
Efficacy of medication and medication combinations compared to patch at 6-months post-quit
Combination therapies ARM odds ratio
Patch (long-term; >14
weeks) + NRT (gum
or Spray) 3 1.9 (1.3, 2.7)
Patch + Bupropion 3 1.3 (1.0, 1.8)
Patch + Nortriptyline 2 0.9 (0.6,1.4)
Patch + Inhaler 2 1.1 (0.7, 1.9)
Second generation
antidepressants &
patch 3 1.0 (0.6, 1.7)
SSRI 3 0.5 (0.4, 0.7)
Naltrexone 2 0.3 (0.1, 0.6)
________________________________________________________________________
Efficacy of medication, long term meds compared to placebo at 6-months post-quit
Medication
Placebo 1.0 13.8
Monotherapies
Varenicline (2 mg/day) 3.1 (2.5, 3.8) 33.2 (28.9, 37.8)
Nicotine Nasal Spray 2.3(1.7, 3.0) 26.7 (21.5, 32.7)
High dose nicotine patch
>25 mg; standard/long term 2.3 (1.7, 3.0) 26.5 (21.3, 32.5)
Long-Term Nicotine Gum
>14 weeks 2.2 (1.5, 3.2) 26.1 (19.7, 33.6)
Varenicline (1mg/day) 2.1 (1.5, 3.0) 25.3 (19.6, 32.2)
Nicotine Inhaler 2.1 (1.5, 2.9) 24.8 (19.1, 31.6)
Source: Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence.Clinical Practice Guideline. Rockville,
MD: U.S. Department of Health and Human Services. Public Health Service. May 2 0 0 8 . :
http://www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf
15
16. Appendix G – Fiscal Impact
MaineCare Coverage
Estimate of fiscal impact per year: reducing 3 current barriers in coverage for smokers who want help to quit
1. Waiving co-pays for medications
$133,53613
2. Counseling : Opening new screening code for primary care practices only* (99406: 3-10 mins)
$25,70014
3. Counseling : Reimbursement for more intensive counseling code for primary care practices only* (99407: more than
30 mins)
$50,97615
Total: $210,212
*Federally qualified health centers are also paid for tobacco use counseling in addition to their standard per visit rate under a different code at the
same rate as primary care practices but far fewer claims have been filed.
NOTE: Reimbursement (in FY08) under only codes available to primary care practices, 99401, 99402, 99403 (tobacco use prevention counseling,
15-45 mins @$20) was $35,612.
13
11,128 claims x $3/co-pay =$33,384 (1st quarter cal. year 2008) x 4 quarters/year=$133,536; does not include waiver of co-pays for
counseling (total claims for FY2007=2,124); fiscal impact of current waiver of co-pays for mail order claims = $2,208 (based on
waiver of co-pay for 184 mail order claims for 1st quarter calendar year 08 (offset in part by reduction given to MaineCare by mail
order pharmacies on claims, less than 1% of total claims) NOTE: Federal law requires that MaineCare members receive medication
even if they don‘t or can‘t pay co-pay
14
(2,124 x $12.10):average # claims for FY 05, 06, 07 and if Maine adopts 100% of Medicare rate for code 99406, based on southern
tier in physician office rate
15
(2,124 claims x $24) based on 100% o f Medicare rate for code 99407
16
17. Appendix H CURRENT TOBACCO TREATMENT COVERAGE OVERVIEW - MAINE
Insurance Coverage for Nicotine Replacement Therapy, Varenicline, Buproprion & Counseling
Updated: December 5, 2008
Nicotine Patch Nicotine Gum Spray Loz
Source of coverage
w/prior authorization, if
gum and patch tried
and failed due to lack up to 3 mo
of efficacy or w/ provide
up to 3 months/year
up to 3 months/year w/ intolerable side effects (although o
w/ provider script
provider script (although or if presence of a counter me
Medicaid* (MaineCare) over the counter medication)
(although over the
condition that prevents available t
counter medication)
$3 co-pay usage of preferred drug not able to
$3 co-pay
or interaction with patch or gu
another drug and auth; $3 co
preferred drug exists,
$3 co-pay
w/script; no w/script; no w/script; n
w/script; no yearly/lifetime
yearly/lifetime limit; yearly/lifetime limit; yearly/lifet
Dirigo** limit; $10/15/30/50 co-pay
$10/15/30/50 co-pay $10/15/30/50 co-pay $10/15/30/
tiers
tiers tiers tiers
yes, with prescription yes, with prescription yes, with p
yes, with prescription cap of
cap of $200 / year, cap of $200 / year, cap of $20
Anthem $200 / year, $400 / lifetime.
$400 / lifetime. $10 co $400 / lifetime. $10 co $400 / lifet
$10 co pay
pay pay pay
covered w/no co
covered w/no co pays, covered w/no co pays, covered w
pays, annual or
Self-insured Plan *** annual or lifetime limits or
lifetime limits or
annual or lifetime limits annual or l
deductibles or deductibles limits or de
deductibles
free up to
free up to 8 weeks, 2 refills/year
free up to 8 weeks, 2
Maine Tobacco Helpline refills/year for uninsured
refills/year for not covered uninsured;
uninsured of treatme
after last c
17
18. may be covered -
Not covere
Medicare (updated 8/08)***** Not covered b/c OTC Not covered b/c OTC depends on Part D
over the co
drug plan
*Pharmacotherapy coverage based on Prescription Drug List (PDL) last revised 10/31/08
**Harvard Pilgrim insurer for Dirigo health plan as of 1/1/08
***Self insured plan of Maine Health through Anthem
Note: Buproprion hydrochloride is sold in generic form under brands Wellbutrin (for depression) and Zyban (for smo
Although Wellbutrin and Zyban contain same active ingredient only generic bupropion and Zyban are approved by th
Rx.
****Counseling covered if has illness caused/ complicated by smoking or other tobacco use, such as heart disease
Prepared for Partnership for a Tobacco-Free Maine re: PL2007 Resolve 34 by Pam Studwell, last revised 12/08
18
19. References
(1) Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence.Clinical Practice Guideline. Rockville, MD:
U.S. Department of Health andHuman Services. Public Health Service. May 2 0 0 8 .
: http://www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf
(2) Best Practices for Comprehensive Tobacco Control Programs – 2007, October, 2007 US CDC
http://www.cdc.gov/tobacco/tobacco_control_programs/stateandcommunity/best_practices/
(3) Adoption of System Strategies for Tobacco Cessation by State Medicaid Programs, Bellows, Nicole M. et al, Medical
Care, Vol. 45, Number 4, April, 2007
(4) Ending the Tobacco Problem: A Blueprint for the Nation, Institute of Medicine Report, May 24, 2007
http://www.iom.edu/CMS/3793/20076/43179.aspx
(5) Low Use of Preventive Care including Tobacco Cessation Treatment, August, 2007 Partnership for Prevention Report:
http://www.prevent.org/content/view/129/72/
19