Introduction

Public-Private Partnerships, including cost-sharing partnerships, are essential for creating quitline sustainability and ensuring access to evidence-based services for all people wanting to quit tobacco . The NAQC public-private partnership initiative was established in December 2011 and is currently known as the Quitline Sustainability  Initiative. This initiative strives to provide states with the knowledge, resources, and technical assistance to successfully establish partnerships with both private and public insurers, and address other elements of quitline sustainability. When partnerships are established with public and private insurance providers, they will ideally lead to cost-sharing contracts for quitline services, and may also include shared promotion and shared evaluation of the quitlineThese agreements provide quitline cessation coverage for insured quitline participant sand reserve limited state funding forthe uninsured and populations experiencing the greatest health disparities.

For a comprehensive summary of state’s experiences, successes and challenges, please download "A Promising Practices Report - Public-Private Partnership Initiative: Working to Advance Cessation Coverage among Private and Public Insurers".

Orienting Staff to the Work

NAQC’s Quitline Sustainability Initiative exists within a larger, comprehensive approach to increase access to evidence-based tobacco dependence treatment. This approach addresses access to insurance coverage, and health systems change to ensure that every patient is screened for tobacco use and offered treatment, including counseling and medications. Treatment can take place in a clinical or community-based setting, or through quitlines, or both. Orientation to insurance coverage and health systems change efforts provides states with critical foundational knowledge before they embark on quitline related partnerships for sustainability.

For new staff, orientation should begin with the American Lung Association’s Tobacco Cessation Training and Technical Assistance available at https://www.lung.org/policy-advocacy/tobacco/cessation. In particular, states are encouraged to begin with the presentation series entitled, “Tobacco Cessation Coverage: The Basics and Beyond”.

Once staff understand the primary policies and strategies related to health insurance coverage and health systems change, an orientation to the NAQC Quitline Sustainability Initiative can begin. Orientation involves a video series that provides an overview of the cost-sharing partnerships process, a tutorial on the use of NAQC's State Cessation Coverage Environmental Assessment Tool, and a brief overview of the Medicaid partnerships options available to states. Each video includes accompanying resources, and a copy of the related slides. 

Staff are also encouraged to reach out to the Quitline Sustainability Partnerships Initiative Senior Program Manager to have an initial discussion about the videos, the additional resources available including individual technical assistance, regular group discussion meetings, case studies, issue briefs, recorded presentations, and directed readings, among others.  

Staff are strongly encouraged to join the NAQC's Quitline Sustainability Partnerships monthly group discussion meetings, which are the best opportunity for peer support and access to successful and innovative strategies that are working in other states.  The Quitline Sustainability resources assist state staff as they preparing to engage and educate potential partners and stakeholders, identify effective strategies from other states, and create cost-sharing and other partnership models tailored to the state and its partners. 

Getting Started

Forming quitline sustainability partnerships can be challenging and time consuming, however states that have dedicated staff to the work, engaged internal and external leadership, taken the time to conduct an environmental assessment, developed a plan, and educated and engaged key stakeholders, have had the most success.

The following describes the process in three phases.

Phase I: Conducting a State Cessation Environmental Assessment

The first step in identifying the cessation landscape in which public private partnerships may take place is to conduct an assessment of the state’s tobacco cessation landscape.  This assessment can be completed “at your desk” with the aid of the Internet and some internal resources.

Some of the key components of an assessment include a state’s tobacco prevalence rate, insurance distribution (the percentage of public and private insured (including self- and fully-insured), cessation coverage by individual health plans, quitline utilization by largest health plans, the state’s political environment and key stakeholders.

The State Cessation Environmental Assessment Worksheet is a tool to assist staff in identifying and accessing the information and resources needed to plan and prioritize strategies to advance partnership work. A recorded Zoom orientation session providing an overview of the tool can be accessed here (Orientation Video One).

Phase I Resources - click here.

Phase II: Developing and Implementing a Plan

Once staff gave completed the state cessation environmental assessment and identified key stakeholders (Phase I), some states have convened stakeholders to collaboratively develop a state action plan. Information gathered through the assessment process is shared among stakeholders to build a common understanding of the strengths and gaps of cessation coverage within the state. Through a facilitated process, stakeholders collaboratively identify priorities and strategies to develop an action plan to engage public and private insurers in providing tobacco cessation coverage and partnering with the quitline, including covering some or all of the cost of quitline services for their members. 

Phase II Resources - click here.

Phase III: Building Support for Tobacco Cessation Coverage Through Promotion, Education, and Partnership 

The promotion of comprehensive evidence-based cessation services, educating employers and insurers on the availability of quitline services and demonstrating the benefit of providing cessation services can be instrumental in engaging both public and private insurers. During this phase of the process, staff may work with public and private health plans, large self-insured employers, purchasing groups and brokers. 

Phase III Resources - click here.