Tobacco Cessation Provider Toolkit 2015 Dear Doctor: L.A. Care Health Plan is pleased to provide you with this copy of the Tobacco Cessation Quality Improvement Toolkit. Tobacco use represents an important public health challenge that is preventable. Tobacco use remains the single largest preventable cause of death and disease in the United States. In Los Angeles County, tobacco use claims 8,500 lives annually, tobacco-related diseases cost $4.3 billion dollars each year, and the current smoking prevalence is 14%. Smoking during pregnancy is associated with premature birth, low infant birth weight, miscarriage and complications of pregnancy. Additionally, smokers expose others to secondhand smoke which causes other health problems, including a 20-30% increased risk for lung cancer for non-smokers exposed to secondhand smoke at home. L.A. Care Health Plan is taking an active role in addressing this personal and public health challenge. This toolkit is an example of our efforts to assist you with the evaluation and management of this condition. More effective education, monitoring and treatment of tobacco use can improve patients’ quality of life, and reduce avoidable ER visits and hospitalizations. Evidence based guidelines now recommend initial and annual monitoring of each member for tobacco use. This toolkit offers clinical guidelines and patient education materials to assist you in the care of your members. We hope you find the enclosed guidelines and patient education materials useful. We urge you to utilize the information and resources we have provided and to join us in the tobacco cessation effort. Thank you for joining us in this effort. Please contact Jasmine A. Mines, MPH, CHES at (213) 694- 1250 ext. 4937 or email [email protected] or Callum James, RN at (213) 694-1250 ext. 6383 or email [email protected] if you have questions, would like to provide feedback, or would like further information. Sincerely, Trudi S. Carter, MD Chief Medical Officer http://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html http://publichealth.lacounty.gov/ha/reports/habriefs/2007/Cigarette_Smoking_Cities_finalS.pdf Tobacco Cessation Provider Toolkit Contents Material Sources A.DHCS Requirements Department of Health 1 Minimum Requirements for Tobacco Cessation Services Care Services and L.A. Care Health Plan Policy Letter 14-006: Comprehensive Tobacco Cessation Services for Department of Health 2 Medi-Cal Members; Preventing Tobacco Use in Children and Care Services Adolescents B. Provider Guidelines U.S. Public Health Service and American 1 Clinical Practice Guidelines College of Chest Physicians 2 Smoking Cessation Medications Available on L.A. Care Formulary L.A. Care Health Plan C. Additional Resources New England Journal of 1 Trends in Smoking Related Mortality in the United States Medicine Clinics in Chest 2 Smoking and Smoking Cessation in Pregnancy Medicine Journal American Journal of 3 MaternalSmokinginPregnancyandAsthmainPreschoolChildren Respiratory and Critical Care Medicine Parental Smoking During Pregnancy, Early Growth, and Risk of American Journal of 4 Obesity in Preschool Children Clinical Nutrition Health Education 5 Smoking Cessation in Pregnancy: What’s a Man to Do? Journal Journal of the 6 Parental Smoking Cessation to Protect Young Children American Academy of Pediatrics Journal of the 7 Parental Smoking Exposure and Adolescent Smoking Trajectories American Academy of Pediatrics Centers for Disease 8 Use and Effectiveness of Quitlines for Smokers with Diabetes Control and Prevention Contents Material Sources C. Additional Resources (cont.) 9 Tobacco Cessation Community Resources L.A. Care Health Plan Additional Materials available: L.A. Care Website @ http://www.lacare.org 10 http://www.lacare.org/providers/resources/healtheducation/order- L.A. Care Health Plan form D.Member Health Education Resources Annual Tobacco Cessation Mailing All L.A. Care Members Receive 1 L.A. Care Health Plan (English/Spanish) 2 Quitting Smoking During Pregnancy (English/Spanish) L.A. Care Health Plan 3 Quitting Smoking for Older Adults (English/Spanish) L.A. Care Health Plan 4 Quitting Smoking for Teens (English/Spanish) L.A. Care Health Plan MINIMUM REQUIREMENTS FOR TOBACCO CESSATION SERVICES OVERVIEW As per MMCD Policy Letter 14-006, effective November 1, 2014, Primary Care Physicians (PCPs) are required to adhere to the following minimum requirements for tobacco cessation services for Medi-Cal members. The full policy letter can be found at: http://tinyurl.com/pxpe2j5 At minimum, PCPs must: Conduct an initial and annual assessment of tobacco use for each member (in addition, pregnant women are to be asked about their exposure to tobacco) Document tobacco use in the patient’s medical record Ask tobacco users about tobacco status at every visit Complete an Individual Comprehensive Health Assessment, including the Staying Healthy Assessment (SHA), for all new patients within 120 days of enrollment Tobacco Cessation Service Requirements Tobacco cessation medications and services are covered for at least two separate quit attempts per year. Tobacco Cessation Medications: Bupropion Nicotine Nicotine Nicotine nasal Nicotine Varenicline Health Plan Nicotine gum (Zyban) & SR patches lozenges spray inhaler (Chantix) (Wellbutrin) PA required, PA required, PA required, PA required, PA required, PA required, Formulary, no Care1st smoking smoking smoking smoking smoking smoking PA or ST Health Plan certificate no certificate no certificate no certificate no certificate no certificate no requirement longer needed longer needed longer needed longer needed longer needed longer needed Anthem Formulary Formulary Formulary PA PA Formulary PA Formulary, no Formulary, no Formulary, no Formulary, no Formulary, no Formulary, no Formulary, L.A. Care PA or ST PA or ST PA or ST PA or ST PA or ST PA or ST with PA Health Plan requirement requirement requirement requirement requirement requirement requirement PA= Prior Authorization ST= Step Therapy Individual, Group and Telephonic Counseling Individual, group, and telephonic counseling must be offered. Refer to L.A. Care Health Education at http://tinyurl.com/qce58cd . CA Smoker’s Helpline, 1-800-NO-BUTTS . Healthycity.org o Pregnant women must be offered at least one face-to-face counseling session per quit attempt. o School aged children and adolescents must be provided interventions to prevent tobacco use. 5 A’s of Tobacco Cessation Counseling o Providers are encouraged to use the 5 A’s when counseling patients: Ask, Advise, Assess, Assist, and Arrange. Physician Training and Monitoring For more information and additional training, including L.A. Care’s Tobacco Cessation Provider Toolkit, please visit www.lacare.org. L.A. Care will monitor provider adherence to the new tobacco cessation requirements. Details to follow. Please call the Provider Service Line at 1-866-522-2736 with questions. State of California—Health and Human Services Agency Department of Health Care Services TOBY DOUGLAS EDMUND G. BROWN JR. Director Governor DATE: SEPTEMBER 3, 2014 POLICY LETTER 14-006 TO: ALL MEDI-CAL MANAGED CARE HEALTH PLANS SUBJECT: COMPREHENSIVE TOBACCO CESSATION SERVICES FOR MEDI-CAL MEMBERS; PREVENTING TOBACCO USE IN CHILDREN AND ADOLESCENTS PURPOSE: The purpose of this Policy Letter (PL) is to provide Medi-Cal managed care health plans (MCPs) with minimum requirements for comprehensive tobacco cessation services. BACKGROUND: Tobacco use is the leading preventable cause of death in the United States and Medi-Cal members have a higher prevalence of tobacco use than the general California population.1 Tobacco cessation services have been demonstrated to be both clinically effective and cost effective.2 Research shows a return on investment of 3:1 for dollars spent on smoking cessation services in Medicaid populations.3 The Department of Health Care Services’ (DHCS) Medi-Cal managed care contracts require MCPs to provide all preventive services identified as United States Preventive Services Task Force (USPSTF) grade “A” and “B” recommendations. The USPSTF recommends (grade A) that health care providers ask all individuals ages 18 and older about tobacco use and that providers offer cessation interventions to those who use tobacco products. 1 UCLA Center for Health Policy Research, “California Health Interview Survey, 2011 to 2012,” http://healthpolicy.ucla.edu/chis/design/Pages/questionnairesEnglish.aspx. 2 2008 US Public Health Service Clinical Practice Guideline, “Treating Tobacco Use and Dependence,” http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/index.html. 3 Patrick, R. West K, Ku L, “The Return on Investment of a Medicaid Tobacco Cessation Program in Massachusetts,” PLOS One, January 6, 2012, http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0029665. Medi-Cal Managed Care Division 1501 Capitol Avenue, P.O. Box 997413, MS 4400 Sacramento, CA 95899-7413 Telephone (916) 449-5000 Fax (916) 449-5005 Internet Address: www.dhcs.ca.gov POLICY LETTER 14-006 Page 2 Augmented pregnancy tailored counseling should be offered to pregnant women who smoke.4 Successful implementation strategies for primary care practice include instituting a tobacco user identification system, promoting clinician intervention, and dedicating staff to provide treatment. The USPSTF also recommends (grade B) that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use in