Abstract
IntroductionTobacco 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 ObjectivesWe 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 ApproachMedicaid 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 MethodsWe 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.ResultsAll 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 HealthSince 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.
Highlights
Tobacco use is the leading cause of preventable death and disease in the United States
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 Coordinated Care Organization (CCO) cigarette smoking incentive metric
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
Summary
The cigarette smoking prevalence CCO incentive metric was first reported for calendar year 2016. In 2018, all 15 CCOs met their cessation benefit requirement, all 15 successfully reported prevalence data from EHRs, and cigarette smoking prevalence had declined in 13 CCOs since 2017 [31]. In addition to benefit package improvements, Oregon demonstrated a decline in its Medicaid cigarette smoking prevalence, as measured through EHRs between 2016 and 2018 (29.3% in 2016, 28.0% in 2017, and 26.6% in 2018) [31]. Other recent statewide evaluations through CAHPS (an annual random survey of Medicaid recipients in Oregon) indicate that the CCO incentive metric has been successful in increasing provider attention to cessation. Since 2015, adult Medicaid tobacco users who reported that their doctors offered them cessation medications and other strategies to help quit has increased above baseline, with a high in 2017 and persistent gains above baseline through 2018 (Table 4) [31]
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