Systems Change & Behavioral Health Initiatives
Health Systems Change
The transformation of healthcare throughout our country has created new opportunities to implement systematic changes to reduce tobacco use, improve overall health, and enhance services, all while reducing healthcare costs. As promoted by the CDC’s Best Practices for Comprehensive Tobacco Control Programs, GNAHEC works closely with local healthcare organizations to assist with the institutionalization of tobacco cessation interventions into routine clinical care. This process helps to ensure that every patient is screened for tobacco use, are advised to quit, and provided with the support and resources needed to stop using tobacco.
GNAHEC can provide support to organizations with their delivery system design, referral process, clinical information on tobacco cessation, as well as standardizing and delivering regular tobacco cessation education and training to the organization’s staff.
Quit Smoking & Tobacco Resources for Healthcare Providers
Hospitals and/or clinics in Florida can request their own automated referral form to electronically submit referrals for patients who are ready to quit within the next 30 days. Please click the link below for more details on the automated AHEC referral form.
Link to visit for more in-office resources for healthcare providers:
Behavioral Health Initiatives
According to new findings from researchers at the CDC, Americans with mental health conditions have a 70% greater likelihood of smoking than the general population. Participation in tobacco cessation efforts, while engaged in other substance abuse treatment, has been associated with a 25% greater likelihood of long-term abstinence from alcohol and other drugs. GNAHEC works with behavioral health sites in Citrus, Hernando, Hillsborough, Pasco, and Pinellas Counties to provide cessation services to help clients quit using tobacco and support their recovery efforts.
Offering Continuing Education to Practicing Healthcare Providers & Training Health Professional Students
As part of the Tobacco Free Florida AHEC Cessation Program, GNAHEC offers educational programs based on the Centers for Disease Control and Prevention (CDC) Best Practices for Comprehensive Tobacco Control Programs and on the Clinical Guidelines for the Treatment of Tobacco Use and Dependence from the Department of Health and Human Services.
The primary goal of these continuing education programs is to strengthen the capacity of the healthcare system throughout our counties to deliver effective evidence-based tobacco use treatment and cessation services. GNAHEC offers a variety of educational options for healthcare providers to obtain FREE continuing education credits and to become proficient in delivering effective tobacco cessation care to their patients.
GNAHEC offers the following programs:
- Best Practices for Tobacco Treatment (BPFTT)
- BPFTT in Behavioral Health
- BPFTT for Nicotine & ENDS Treatment
- BPFTT Smoking During Pregnancy & Postpartum
Free Tobacco Online Modules
The Tobacco Free Florida AHEC Cessation Program also offers healthcare providers and health professions students access to a suite of online tobacco cessation education modules. These are readily available providing various CE/CME credits at no cost. Over 18+ educational modules are offered to receive the latest information about tobacco cessation and treatment. Most courses listed are in audio/visual format and approximately 60 minutes in length, making it time-efficient for our busy healthcare providers.
Importance to Healthcare Insurers
Recommendations for Insurance Health Plan Providers
Insurance providers are in a unique position to reduce the burden of disease associated with tobacco use in their subscriber populations by adhering to the following recommendations:
Recommendation: Health insurance providers should include effective tobacco cessation treatments as paid or covered services for all subscribers.5
- Seven medications and three types of counseling are recommended to treat tobacco dependency. Nicotine replacement therapies (NRTs) are available over-the-counter (patch, gum, lozenge) and by prescription (nasal spray, inhaler), while bupropion (Zyban) and varenicline (Chantix) are two non-nicotine, prescription-only options.5
- The types of counseling include individual (either face-to-face or telephone) and group counseling.5
- Coverage should be provided for at least two cessation attempts per year.6
- Having access to all these treatments increases the likelihood of successful cessation among tobacco users.5
- Quit rates are higher when health insurance covers tobacco cessation treatments.5
Recommendation: Health insurance providers should remove arbitruary barriers that limit access to cessation treatments.5, 7
- Barriers that deny or limit treatment include:
- Requiring co-pays;
- Limiting the length, frequency or amount spent on treatments;
- Requiring prior authorization;
- Requiring quit attempts with one medication before trying another;
- And requiring counseling to be paired with medication. 8
- Conflicting and confusing contract language also may leave subscribers uncertain if tobacco cessation treatments are covered, which could discourage them from seeking these treatments.9
- Removing barriers will encourage more people to use the benefit and successfully quit tobacco.
Benefits of Adopting the Recommendations
Health insurers who have invested in adopting the recommendations have seen significant cost savings and return on investment. The estimated cost for a health plan to provide full cessation coverage to its subscribers is approximately $2.64 to $5.40 more per enrollee per year (or $0.22 to $0.45 per enrollee per month).10, 11 Furthermore, the return on investment is significant. For example, in the Massachusetts Medicaid plan (MassHealth), for every $1 in program costs, an estimated medical savings of $3.12 was received, which equates to a return on investment of $2.12 for every dollar spent.12 Another study, an economic model of bupropion and a work-site smoking cessation program, found that for every dollar spent on a smoking cessation intervention, it was estimated that between $5 and $6.50 was saved when considering both direct and indirect costs.13 Considering just the money saved on health care, between $4 and $4.70 was saved per dollar spent.13
- Hopkins DP. Recommendations to improve targeted vaccination coverage among high-risk adults – Task force on community preventive services. American Journal of Preventive Medicine. Jun 2005;28(5):231-237.
- Fiore MC. AHCPR smoking cessation guideline: a fundamental review. Tob Control. 1997;6 Suppl 1:S4-8.
- Fiore MC, et al. Clinical Practice Guideline: Treating tobacco use and dependence: 2008 Update. Rockville, MD: US Dept of Health and Human Services, Public Health Service; 2008.
- Schauffler HH. Defining benefits and payment for smoking cessation treatments. Tob Control. 1997;6 Suppl 1:S81-85.
- Fiore MC, et al. Clinical Practice Guideline: Treating tobacco use and dependence: 2008 Update. Rockville, MD: US Dept of Health and Human Services, Public Health Service; 2008. [pdf]
- George Washington University Center for Health Services Research and Policy. Sample Purchasing Specifications Related To Tobacco-Use Prevention And Cessation: a Technical Assistance Document. October 2002. [pdf]
- Centers for Disease Control and Prevention, American Cancer Society, and Wellness Councils of America. Making Your Workplace Smokefree—A Decision Maker’s Guide. 1996. [pdf]
- American Lung Association. Helping Smokers Quit: State Cessation Coverage; 2011
- Kofman M, Dunton, K., Senkewicz, MB. Implementation of tobacco cessation coverage under the Affordable Care Act: Understanding how private health insurance policies cover tobacco cessation treatments. Washington, D.C.: Georgetown Health Policy Institute;2012.
- Fitch K, Iwasaki, K., & Peyenson, B. Covering smoking cessation as a health benfit: A case for employers. 2006.
- Curry SJ, Grothaus LC, McAfee T, Pabiniak C. Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization. N Engl J Med. Sep 3 1998;339(10):673-679.
- Richard P, West K, Ku L. The return on investment of a Medicaid tobacco cessation program in Massachusetts. PLoS One. 2012;7(1):e29665.
- Halpern MT, Khan ZM, Young TL, Battista C. Economic model of sustained-release bupropion hydrochloride in health plan and work site smoking-cessation programs. Am J Health Syst Pharm. Aug 1 2000;57(15):1421-1429.