National Jewish QuitLine Program

1. National Jewish QuitLine Program July 2010 David Tinkelman, MD QuitLine Medical Director Donna Churchey QuitLine Executive Director Cindy Haugland Business Development Manager Hilary Baca Client Manager

2. National Jewish Health Denver, CO

3. National Jewish HealthAs an Institution • World-recognized Academic Medical and Research Center for 111 Years • Non-profit, non-sectarian • Call center operations for more than 30 years • Lung Line and Physician Line (Over 1.4 million calls) • Disease Management (Over 80,000 enrolled) • Quit Line (over 570,000 participants) • Weight Management (8,000 enrolled) • Major effort for growth and expansion in Cardiology, Lung Cancer, and Infectious Diseases • Number One Respiratory Hospital since 1998

4. National Jewish HealthMission and Vision We are at the forefront of a new era in health care - Personalized Medicine. Our basic commitment to science as the basis from which we perform research and treat disease will lead to significant benefit for physicians and patients throughout the world. Our science is truly transforming the lives of millions. Science Transforming Life Is not just the new National Jewish slogan It is our Promise

5. National Jewish Wellness Programs National Jewish Health has developed wellness programs to address the leading causes of preventable mortality in the United States: Tobacco and ObesityQuitline:QuitLogix™FitLogix®

6. National Jewish Wellness Programs • Address disease states caused by behavioral dysfunction • Produce sustainable results • Have measurable results • Have strong participant engagement, completion and • satisfaction rates • Produce better health AND a positive ROI

7. National Jewish QuitLine What Sets Us Apart • The Tobacco QuitLine services from National Jewish • are medically-oriented • The QuitLine is part of the # 1 Respiratory Center in the US • Integration with Pulmonary and Psych/Social Departments • at National Jewish Health • Two Medical Directors on site • Software support built on a Stage of Change model

8. National Jewish QuitLine Value Added Services • NRT Distribution – Volume Pricing • NRT Partnership Program in Ohio • Colorado QuitLine – Health Plan Partnership • ClearWay Program with Ceridian and QUITPLAN at Work • Iowa Medicaid Partnership • Montana – Chantix & Buproprion Delivery • New Mexico – Partnership with all Health Plans QL’s • Opportunities to publish papers • Presentations at Statewide Meetings

9. National Jewish Health Provides QuitLine services for: • Colorado QuitLine – December 2002 As of July 2007 – QuitLine and QuitLogix • Ohio Tobacco Quit Line – August 2003 • Montana Tobacco Quit Line – May 2004 • Idaho Tobacco Quitline – February 2005 • Quitline Iowa – December 2007 • New Mexico Tobacco Helpline – July 2008 • QUITPLAN Helpline - ClearWay Minnesota – September 2009 • UtahTobacco Quit Line – November 1, 2009 • Kentucky’s Tobacco Quitline- July 1, 2010

10. National Jewish Health Provides QuitLine services for: • Presbyterian Health Plan of New Mexico– Nov 2006 • JSI – Overflow vendor for Massachusetts campaigns • CSX Railroad– March 2008 • QuitLine and QuitLogix • Medical Mutual – Carolina Care Plan – Consumers Life April 2008 • Teletech- January 2010 • VF Corporation- Launching August 2, 2010

11. National Jewish Health Over 7 years of Successful Partnerships with State QuitLines As of June 30, 2010: 573,763 Total Contacts to the QuitLine Over 30% of all calls to 1-800-QUIT-NOW are routed to National Jewish

12. National Jewish QuitLine Staff • Currently, National Jewish has 96 staff members dedicated to its QuitLine. • 21 Customer Service Representatives • 52 QuitLine Coaches • 9 Administrative/Web administration/Data/Client Management • 7 Management Staff • All members work on site at National Jewish • Staffing models for increased call volume

13. The QuitLine Management Team • Michael Salem, MD – CEO and President • David Tinkelman, MD – QuitLine Medical Director • Donna Churchey, QuitLine Executive Director • Tracy Hudson, QuitLine Assistant Director • Amy Lukowski, PhD – Clinical Director • Cindy Haugland – Business Development Manager • Hilary Baca - QuitLine Client Manager • Scott Campbell – QuitLine Operations Manager • Bethany Bartley – Quitline Call Center Manager • Cara Messick – QuitLine Training Manager

14. Who are the QuitLine Coaches? • Coaching staff trained to meet ATTUD competencies including comprehensive training for NRT. • Motivational interviewing and behavioral modification training by National Jewish faculty • Bachelor’s degree in psychology, sociology, or health related field or comparable work experience • Call Center staff supported by a clinical care team • Staff diversity – 25% of staff are bilingual • Ethnic/cultural background, gender, age • Special Guidelines for specific populations

15. Quitline Clinical Overview • 5 proactive calls over 6 - 8 weeks • Unlimited reactive calls • Guides participant through quitting process • All types of tobacco – cigarettes, cigars, pipes, spit tobacco • Structured clinical protocols • Special protocols for diverse populations • Comprehensive educational materials • Guidance and provision of pharmacotherapy

16. Quitline Clinical Overview All Coaching Sessions based on the • PHS /USHHS Clinical Guidelines: Treating Tobacco Use and Dependence (Fiore et al.) and 2008 Updates • NAQC Advisory Board • Recent Scientific Publications on Tobacco Cessation • Coaching Protocols • Educational/Self-help Materials

17. Motivational Interviewing? • Very specialized set of therapeutic skills that facilitates “change talk” • Change talk is when the clients argue for change, not the therapist/coach • MI promotes: • -accurate empathy • -meaningful questions that generate self-exploration

18. Fax Referral Program • Over65,000Total Fax Referrals to date • Sent from Providers or other referrers • Called within 24 hours • 3 attempts to reach • Tracked by Referrer • Confirmations sent • When Fax Received • When we cannot reach after 3 attempts • When we reach and they decline • When Patient enrolls • When Patient completes the program

19. QuitLine Outcomes and Quit Rates • Telephonic surveys conducted by an independent outside research agency to avoid bias (Pegus Research) • 50% to 100% of all tobacco users randomly selected • Attempts to contact at 3, 6 and 12 months • Calculate: • Responder Rate • Intention to Treat quit rates • Financial analysis

20. QuitLine Outcomes and Quit RatesOne Client 2009 7 Day Quit Rates 30 Day Quit Rates

21. Research Opportunities • NRT Doses • QuitLines and the Utilization of Chantix • Providing QuitLine services to Disparate Populations • QuitLine services for those with Chronic Illness • Private and Public Funding Resources • Retention Rates • Coaching at the Ambivalent Stage • How many calls does it take?

22. Customized Clinical Protocols • Pregnancy – Postpartum • Partner support • Additional support calls • Spit Tobacco • Education about nicotine absorption, addiction and NRT options • Teens • NRT program not available for callers <18yrs • KY- Must be 15 or older for Coaching

23. We Look Forward To Working With You! Thank You