Health Care Benefits and Services

There are three components integral to creating policies for expanding coverage of and access to tobacco cessation treatments for smokers through health care benefits and services.

Counseling, Pharmacotherapy and Physician Intervention
Out-of-Pocket Costs
Reminder Systems

Counseling, Pharmacotherapy and Physician Intervention

Three critical approaches have been proven effective to increase tobacco use cessation rates. These include counseling, pharmacotherapy, and physician intervention. Alone, each of these interventions has been demonstrated to increase quit rates, but when combined success rates increase dramatically. For instance, if counseling is combined with pharmacotherapy, the effectiveness of treatment doubles or triples compared to counseling alone.

Counseling can be provided in a number of different venues, including face-to-face (individual or group) or via telephone.

Pharmacotherapy includes Food and Drug Administration approved nicotine replacement treatments such as gum, patch, nasal spray, and inhaler or the drug buproprion, which is marketed under at least two different brand names.

Intervention by the physician (including the 5 A’s of asking if patients smoke, advising them to quit, assessing readiness to quit, assisting with counseling and pharmacological treatments, and arranging for follow up) was found to be an effective intervention.

Find out more by exploring the following items:

Physician Intervention, Counseling and Pharmacotherapy as Part of What Works
Overview of the Clinical Practice Guideline
Key Research on Physician Intervention

Out-of-Pocket Costs

Reducing financial barriers such as “out of pocket costs” for cessation treatment are an important component of a well-designed health benefit. This includes reducing costs through reduced “co-pays” or other reimbursement mechanisms. Reducing patient expenditures on counseling and pharmacotherapy will increase the number of people who attempt to quit as well as improve the chances that those quit attempts will include use proven therapies. According to research, this will result in an increase in the number of people who quit successfully.

Find out more by exploring the following items:

Reducing Patient Out-of-Pocket Costs for Cessation Treatment as Part of What Works
Overview of the Clinical Practice Guideline
TTAC Strategies: Tobacco Cessation Benefits Coverage
Key Research on Reducing Out-of-Pocket Costs

Reminder Systems

Provider reminder systems involve creating mechanisms to help clinicians to identify patients who use tobacco products and prompting these providers to discuss with their patients the importance of quitting. Health care providers can receive reminders through stickers on patients’ charts, vital sign stamps, medical record flow sheets, checklists, or by computer.

Organizations should establish system-wide policies that guarantee that health care providers receive reminders consistently. A system designed to provide prompts and motivate providers to follow-through should include a tobacco-user identification system in every clinic. The policy should provide for education, resources, and feedback to promote provider intervention as well as include the interventions among the defined duties of clinicians. It is also important to allow for dedicated staff to provide tobacco dependence treatment and assess the delivery of this treatment in staff performance evaluations. The system should promote hospital policies that support and provide inpatient tobacco dependence services. Finally, the policy must ensure inclusion of effective tobacco dependence treatments as paid services for all subscribers or members of health insurance packages based on the clinical practice guidelines and reimburse clinicians and specialists for delivery of effective tobacco dependence treatments.