New case study on the success of Federal Employees Health Benefits (FEHB) coverage for tobacco ces.
Monday, July 7, 2014
Posted by: Natalia Gromov
On July 7th, the Office of Personnel Management and Partnership for Prevention released a new report on provision of tobacco cessation coverage to federal employees. The findings in the recently released "Federal Employees Health Benefits Tobacco Cessation: Case Study” can assist states and their partners in engaging insurance plans and employers to provide comprehensive evidence-based tobacco cessation benefits. The case study findings clearly demonstrate that providing cessation coverage to employees is doable, cost-effective and reduces tobacco use among employees.
Background: The Office of Personnel Management (OPM) required all participating FEHP plans to provide comprehensive coverage, without barriers effective January 1, 2011. This requirement, along with the recent ACA guidance (see question 5, provided by the Department of Labor can serve as an excellent tool for educating insurers and employers about the benefits of providing comprehensive cessation coverage.
The following summarizes key talking points that can be used to promote cessation coverage among health plans and insurers.
The OPM used the evidence based research published in the U.S. Public Health Service Clinical Guideline onTreating Tobacco Use and Dependence: 2008 Updateto define its cessation benefit as follows:
• At least two quit attempts per year with each attempt including a minimum of four 30 minute counseling sessions. This includes proactive telephone counseling, group counseling and individual counseling.
• All Food and Drug Administration (FDA) approved tobacco cessation medications, including over the counter medications with a doctor's prescription.
• These benefits must be provided with no copayments or coinsurance and not subject to deductibles, annual or lifetime dollar limits.
Since requiring all FEHB plans to provide comprehensive tobacco cessation coverage, there has been a decline in tobacco use among federal employees.
OPM demonstrates that providing tobacco cessation coverage is doable. As described in the case study, in 2014, 97 insurance carriers offer 256 plans in the FEHB to 8.2 million individuals, with varied payment, delivery system, network, cost sharing, and pharmacy arrangements. OPM’s ability to incorporate cessation coverage among varying plans demonstrates that private payers and other public payers can offer tobacco cessation treatment as a standard benefit.
Based on a report published by Berman et al, an employer spends approximately $5,816 extra annually to employ a tobacco user vs. a non-tobacco user costing the Federal government an excess of $1.24 billion annually on the active tobacco using population. It is further estimated that if approximately 60% of current users quit using tobacco, the Federal government could save approximately $758 million annually. This simple calculation can be used with an employer to demonstrate their annual savings if they support their employees in quitting tobacco.
While all FEHP plans promote counseling and medication through traditional health care providers, many plans use vendor services to administer the benefit. Vendors can provide comprehensive services, including but not limited to: online resources, 24-7 telephonic counseling and support, local resources, in-person, internet counseling, and individually tailored programs. "The state’s quitline can provide very reasonably priced services to insurers and employers, including services …..”
Communicating through a health plan’s Open Season materials and the agency’s e-mail communication can be an effective medium of communicating the benefit availability to employees.
The case study also summarizes methods used by various health plansfor providing cessation coverage. To learn more, see the full report. Additional resources to educate and engage health plans and employers in providing comprehensive tobacco cessation coverage are available on NAQC’s Public-Private Partnership web page at http://www.naquitline.org/?page=PPP. For further partnership assistance, please contact Deb Osborne at email@example.com.