Reducing Tobacco Use in Oregon Through Multisector Collaboration: Aligning Medicaid and Public Healt
Monday, December 21, 2020
Posted by: Natalia Gromov
Catherine
J. Livingston, Sarah E. Bartelmann, Nancy M. Goff, Kirsten G. Aird
Reducing Tobacco Use in
Oregon Through Multisector Collaboration: Aligning Medicaid and Public Health
Programs.
Prev Chronic Dis. 2020 Dec 10;17:E155. doi: 10.5888/pcd17.200220.
Introduction:
Tobacco use is the leading cause of preventable death and disease in the United
States. Oregon's coordinated care model for Medicaid provides an opportunity to
consider novel ways to reduce tobacco use.
Purpose and objectives:
We sought to evaluate the changes in tobacco cessation benefits, patient access
to cessation interventions, and cigarette smoking prevalence before and after
introduction of the statewide Coordinated Care Organization (CCO) cigarette
smoking incentive metric for Medicaid members.
Intervention approach:
Medicaid and public health collaborated to develop a novel population-level
opportunity to reduce tobacco use. In 2016, an incentive metric for cigarette
smoking was incorporated into Oregon's CCO Quality Incentive Program, which
holds Oregon's CCOs accountable for providing comprehensive cessation benefits
and for reducing tobacco use prevalence among members.
Evaluation methods:
We evaluated the changes in tobacco cessation benefits, patient-provider
discussions of smoking cessation, and cigarette smoking prevalence before and
after the introduction of the statewide CCO cigarette smoking incentive metric.
Results:
All 15 CCOs now cover cessation counseling (telephone, individual, and group)
and pharmacotherapy (all 7 FDA-approved medications). The number of CCOs
requiring prior authorization for at least 1 FDA-approved pharmacotherapy
decreased substantially. From 2016 through 2018, the percentage of Medicaid
members who reported that their health care providers recommended cessation
assistance increased above baseline. The incentive metric and aligned
interventions were associated with a reduction in cigarette smoking prevalence
among Medicaid members, as indicated by the electronic health record metric.
Thirteen of 15 CCOs demonstrated a reduction in smoking prevalence with the
statewide prevalence rate decreased from 29.3% to 26.6%.
Implications for public
health: Since incentive metric implementation, progress has
been made to reduce tobacco use among CCO members. Cross-agency partnerships
between Medicaid and public health contributed to these successes.
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