It is safe to say that for 20 years quitlines have depended on partnerships of various shapes and sizes with many different goals in mind. Certainly, partnerships play a role in promoting quitline services, increasing quitline reach, and ensuring access to cessation at a population level. Over the past few years quitlines have also come to know the value of partnerships in building and ensuring financial sustainability. As we explore the future of our work and the ways in which it will best be accomplished, we thought it would be important to ask, "What role can cost-sharing partnerships play in ensuring sustainable quitline services in states and provinces?” Julie Rainey, Vice President, Professional Data Analysts, Inc. (PDA), along with a few members of the PDA team, helped to clarify the valuable roles of these types of partners and their potential contributions to the work ahead!

A recent blog post described the value that tobacco quitlines bring to the table in public-private partnerships: quitlines provide an effective service with a substantial return on investment for partners in the form of health impact and cost effectiveness. On the other side of the equation, there are key roles that cost-sharing partners can play which improve the sustainability of state and provincial quitlines.

For the purpose of this discussion, cost sharing is defined as the sharing of the financial burden of providing tobacco cessation quitline services between a state agency and other entities which have a vested interest in the provision of cessation services. The potential partners of publicly-funded quitlines are health care providers, public and private health insurance providers, employers, unions, and social service agencies.

The most direct way that cost-sharing partners contribute to quitline sustainability is by financial contribution. Partners may cover some or all of the costs incurred by the state or provincial quitline to serve this population, or they may pay a flat fee or per registrant fee to support quitline services or fax and electronic referral systems. These partner activities offset quitline costs, thereby reducing pressure on public funding sources, replacing lost public funds, or freeing up resources that can be used to increase quitline reach or to redirect public dollars to serve priority populations.

Partners can also reduce the burden on quitlines by directly providing cessation services to their members, employees, clients, or patients. This can be done independently of the quitline, through in-house cessation services or through direct contracts between the partner and a quitline service provider. This practice contributes to quitline sustainability by reducing the number of tobacco users the quitline must serve with public funds.

Quitlines seeking to establish cost-sharing agreements will likely face challenges. Many states and provinces have long offered free quitline services to all residents, or at least to some priority groups of tobacco users. However, this practice provides no incentive for private payers to fund services. In the absence of a mandate for private payers to cover cessation treatment costs, it is only through voluntary agreements that this can be accomplished. It is important for quitlines to highlight what partners stand to gain from cost-sharing arrangements. The most direct benefit is the return on investment in the form of improved health, reduced employee absenteeism, and reduced insurance and health care costs realized when people quit tobacco. There is also a potential public relations benefit. For some partners, connecting tobacco users with quitlines aligns with the partners' organizational mission to improve the health and wellbeing of communities they serve. By publicizing their involvement with the quitline, partners may gain recognition and increase their competitive edge in the marketplace.

Another role partners can play is to build or strengthen sustainable referral networks, which facilitate the connection of tobacco users to quitline services and reduces the need for costly media promotions.

• Healthcare providers may build or expand fax and electronic referral networks. Once established, the identification and referral of tobacco users becomes a routine process.
• Partners may promote the quitline to their members/employees, and encourage its use through incentives.
• Partners who serve priority populations can provide effective outreach to tobacco users within the communities they serve. This can be especially effective within populations with high tobacco use prevalence, who may not be easily reached through mass media promotion of the quitline.

These partner activities provide a continuing source of new tobacco users coming to the quitline and reduce promotion costs, contributing to quitline sustainability.

Finally, partners can provide support by endorsing the quitline or lending their name to enhance quitline credibility. Potential partners may not fully trust quitlines or may not be aware of their effectiveness. This is an important barrier that needs to be addressed if these partnerships are to work. It is especially important for the first partners on board to share their experiences with colleagues. Attesting to the quality of quitline services, the outcomes achieved, and the money saved will be the most convincing evidence for other potential partners. The more that respected organizations support the quitline, the more accepted and trusted the quitline will be.

Cost-sharing partnerships contribute to quitline sustainability. Such partnerships equitably distribute costs between the state or provincial tobacco program and other public entities (e.g., Medicaid) or private payers. Sharing costs of cessation services for tobacco users, whether through direct financial support, through providing promotion and referral, or by offering endorsement and symbolic support, serves the public good.

Thank you, Julie! It is important to note that many of these observations come from PDA’s direct experience evaluating and researching quitlines in the U.S. We invite our Canadian colleagues to add their experiences and ideas about the roles that partners may play. How have partnerships with private and/or public entities played a role in the sustainability of your quitline?