Tobacco Control in Managed Care: Implementation Effectiveness & Impact of Cost of Care

Tobacco use remains the number one cause of preventable morbidity and mortality in the United States, and is a major contributor to excess medical care costs. Despite this fact, health care systems have been slow to deal effectively with this problem.

This study is designed to examine current tobacco control policies and procedures in nine managed care systems, assess the actual implementation of smoking cessation services in those systems, examine the relationship between smoking cessation services and patient smoking rates, and then conduct an analysis of the medical care costs for those patients who continue to smoke compared to never smokers and to those who quit. The results of this study will help clarify the relationships between organizational policies and implementation of tobacco cessation programs, and their effects on patient smoking cessation. The study will also yield data on the validity and usefulness of HEDIS tobacco measures and help HMO decision makers implement more effective, and cost-effective cancer prevention programs.

Data collection was comprehensive and included:

• a baseline survey of 41,600 members, and a follow-up survey among over 3,800 smokers or recent quitters, as identified by self-report in the baseline survey;
• three policy surveys with two to four key informants from each of the nine participating plans;
• a survey of 100 primary care providers from each plan; and
• medical record reviews for approximately 1,800 current and former smokers across the nine plans.

Preliminary findings are available from the policy surveys, which show that the CRN HMOs are in the vanguard of development and dissemination of tobacco control guidelines, and that these plans excel in the "Ask" and "Advise" stages of provider-assisted tobacco cessation for patients. Improvements can still be made in the areas of system support for "Assisting" smokers and moving guidelines into areas of the delivery system beyond primary care.

The HMOs Investigating Tobacco (HIT) study goals are consistent with the NCI 2003 objective to expand translation of research findings about tobacco use into clinical intervention research. The project team has presented results from their policy surveys at national conferences including Addressing Tobacco in Managed Care, Society for Research on Nicotine and Tobacco, and Society of Behavioral Medicine. Abstracts from study publications can be found in the CRN Publications.

Project Status: This project was funded with the CRN's original grant application in January 1999. Study analyses and reporting of results is continuing. The project leader is Victor Stevens, PhD, of the Kaiser Permanente Northwest Center for Health Research.

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