Ruth Petersen MD MPH; Chief, Chronic Disease and Injury Section NC Division of Public Health

1. Expanding Comprehensive Coverage for Tobacco Cessation to Ensure Access to Evidence-Based Treatment in North Carolina Ruth Petersen MD MPH; Chief, Chronic Disease and Injury Section NC Division of Public Health

2. Welcome and Greetings! Meeting purpose Goals for today Context to help inform our discussions • Scope of the Problem • Current tobacco treatment services in NC • Quitline reach and funding available • Gallery Walk for further illustrations

3. Meeting Purpose PURPOSE: In order to bolster access to existing tobacco cessation treatment options and leverage current opportunities resulting from healthcare reform, the Tobacco Prevention and Control Branch of the Division of Public Health will convene representatives from diverse systems that play a role in ensuring the health and wellbeing of North Carolinians to explore strategies for incrementally reaching 8% or 123,200 of current NC tobacco users with evidence-based treatment. For the first time, this collaborative summit will bring together the public health, insurance, healthcare delivery and business sectors to create a shared vision for expanding and sustaining comprehensive coverage for tobacco cessation treatment.

4. Our Challenge for Today • Given that 62% of NC tobacco users make a serious but failed attempt to quit smoking each year; and • Given that we are currently reaching a little over 1% of NC tobacco users who want to quit with the current funding available; • Given that CDC Best Practices now recommends that state Quitlines work to reach 8 % of tobacco users who want to quit; • What do we need to set in motion today? • Can we work together to assure that 4-6% of current tobacco users who want to quit have access to QuitlineNC through public-private partnerships?

5. Director, NC Division of Public Health Penny Slade-Sawyer

6. Paradigm for Tobacco Control Making tobacco addiction easy and accessible: • Tobacco Advertising • Low price • New tobacco products Evidenced Based Interventions change social norms: • Quitlines and FDA approved medications covered for all • Price/Economic Incentives • Smoke-free workplaces and public places laws • Regulation/Liability Individual

7. More Diseases, More Deaths caused by SmokingNew Evidence from the Surgeon General is in red - 2014 Smoking Causes… Secondhand Smoke causes… In Adults: Stroke Lung Cancer Coronary heart disease Reproductive effects – LBW In Children: SIDS Lower respiratory illness Impaired lung function Middle ear disease • 12 kinds of cancer including 87% of lung cancers the new findings of colon and liver cancers. • Chronic Diseases, including coronary artery disease, COPD, stroke, diabetes, TB, asthma, atherosclerosis • Immune function disorders, macular degeneration, blindness, cataracts, hip fractures, rheumatoid arthritis • Reproductive effects in women and men, including LBW, ectopic pregnancy, erectile dysfunction, reduced fertility. • Overall diminished health.

8. NC Smoking Rates in Disparate Populations NC BRFSS 2011

9. What does smoking cost NC? • $3.8 billion per year in excess medical care costs (CDC Best Practices 2014) • Of that, at least $769 million per year in excess health care costs for Medicaid (2006). • $3.3 billion per year in productivity costs (2006).

10. We Know What Works Research indicates the most effective tobacco treatment is a combination of: • evidence-based coaching and • FDA approved medications.

11. NC Tobacco Users Want to Quit (and need help) 62% of NC tobacco users made a serious but failed attempt to quit smoking in 2011.

12. An evidence-based telephone tobacco treatment service • Consists of four treatment sessions • Special 10 treatment sessions and • protocol for pregnant women • Highly trained, professional Quit Coaches • Available to all North Carolina residents • Accessible 24 hours a day, 7 days a week • Integrated with an interactive • web based tobacco treatment program • Online registration • Web only treatment program • Two week starter nicotine patches to uninsured, • Medicaid and Medicare recipients • Eight weeks of patches, gum or combination therapy to State Health Plan members

13. Who uses QuitlineNC?

15. Insurance Coverage of QuitlineNC Enrollees (FY 2012)

16. Number of Quitline Enrollees by Commercial Health Plans – FY 2012

17. Demographics FY 2013 GENDER AGE • 16,507 enrollees

18. Education 16,507 enrollees

19. NC Current QuitlineNC Enrollment by Race/Ethnicity

20. Mental Health Conditions Collected from QuitlineNC Enrollees : FY 2013 51% of QuitlineNC enrollees reported one or more mental health conditions

21. Most Quitline Enrollees Have One or More Chronic Health Conditions FY 2013 84% of QuitlineNC enrollees reported one or more chronic health condition 84% of QuitlineNC enrollees reported one or more chronic health condition

22. Chronic Disease Referrals

23. QuitlineNC EnrollmentsJanuary 2011 – June 2013 Statewide Media Campaign April 23 – June 30 QuitlineNC state funding reinstated Free NRT |- --Jan 1 – May 21------| SHP funding only

24. QuitlineNC What is going Well?

25. QuitlineNC Annual Enrollments

26. QuitlineNC Services for Physician Network • Quitline Fax Referral Program • Physician training on incorporating QuitlineNC into tobacco treatment services • Physician resources on integrating tobacco treatment • HIPAA compliant • Physician support line for assistance in tobacco treatment questions • Physicians support for quitlines as a referral source • QuitlineNC meets a critical need of service providers

27. Health Professionals Are the Number One Referral Source to QuitlineNC in FY2013 • QuitlineNC meets a critical need of service providers NC Division of Public Health Tobacco Prevention and Control Branch -QuitlineNC Monthly Data Reports 2013

28. 98% satisfaction rate by SHP members with over 2/3 being very satisfied. • Participants are satisfied with QuitlineNC services “Thank you so much! I have been quit for almost 3 months. I can taste foods now. I can breathe again! I have COPD and my doctor was so happy when she listened to my lungs that she cut down on my other medications. My home smells good again and I am so happy. It’s affected my whole family as well. My daughter also quit for her new baby and she has been quit for 3 months now too!” Caller from Wayne County “I couldn’t have done this without your help. I have not smoked in exactly one year and just having someone to talk to throughout my quit has really helped.” A.P., Harnett County “This program works! You all have made my life better. It feels so good to live life again and not give up. I really appreciate what you have done.” Caller from Forsyth County

29. QuitlineNC Has Worked for the State Health Plan for Teachers and State Employees • QuitlineNC is high quality and effective 30 day point prevalence at 7 months from initial call

30. 6 Month Quit Rates Comparison • QuitlineNC is high quality ad effective 51%**** ****NC State Health Plan Quit Rates from members who completed four or more counseling calls plus used all 8 weeks Nicotine Patches *Fiore, Treating Tobacco Use and Dependence, Clinical Practice Guidelines 2008 Update ** Alere Wellbeing, QuitlineNC Comprehensive Evaluation Report, 2011 ***State Health Plan for Teachers & State Employees, Evaluation Report, 2010-2011 Responder rates at 30 days point prevalence

31. Six Months Quit Rates and Number of Successful Quits (30 day point prevalence1)- 5,109 Total Quitline Enrollment • QuitlineNC is very cost effective Respondents being tobacco free for the last 30 days or more at the time of the 7-month survey. This measure regards non-respondents and those who responded “don’t know” or “refused” as continued tobacco users, and thus provides a more conservative quit rate. This measure includes only those respondents reached reporting successful tobacco cessation and thus provides a higher quit rate

32. State Health Plan Costs vs. Benefits • QuitlineNC is very cost effective Annual per Capita Medical Costs of Tobacco Use $2,660 Number of individuals presumed to quit due to Quitline NC x 1,607 Estimated cost avoidance “benefit” $4,274,620

33. Annual Health Care Costs per Tobacco User and QuitlineNC Services • QuitlineNC is very cost effective

34. Cost Benefit Analysis • QuitlineNC is very cost effective Benefit $4,274,620 $3.95 ---------- = --------------- = -------- = ~ 4:1 ROI Cost $1,080,972 $1.00 For every dollar SHP spent on QuitlineNC services, SHP saved $3.95.

35. Helping NC tobacco users who want to quit Resources

36. Total QuitlineNC Funding and Enrollment

37. Most Current QuitlineNC Year (2013) Compared to Goals for QuitlineNC Reach

38. Partnering with QuitlineNC Makes Good Sense

40. Coming soon - QuitlineNC – New Resources for Public Private Partnerships Fiscal Agent Expert Advice and Technical Assistance Tobacco Prevention and Control Branch Joyce Swetlick – Key Contact Director, Tobacco Cessation Phone: 919-707-5402 Joyce.Swetlick@dhhs.nc.gov Sally Herndon Branch Head Phone: 919-707-5401 Sally.herndon@dhhs.nc.gov NC Public Health Foundation • Chuck Bridger – Key ContactOperations ManagerPhone: (919) 707-5237chuck.bridger@ncphf.org • Elizabeth MacLachlanExecutive DirectorPhone: (919) 707-5237elizabeth.maclachlan@ncphf.org