Effects of Global Payment and Accountable Care on Tobacco Cessation Service Use: An Observational Study

Abstract

BACKGROUND: Tobacco use is the leading cause of preventable death and disability. New payment and delivery system models including global payment and accountable care have the potential to increase use of cost-effective tobacco cessation services. OBJECTIVE: To examine how the Alternative Quality Contract (AQC) established in 2009 by Blue Cross Blue Shield of Massachusetts (BCBSMA) has affected tobacco cessation service use. DESIGN: We used 2006-2011 BCBSMA claims and enrollment data to compare adults 18-64 years in AQC provider organizations to adults in non-AQC provider organizations. We examined the AQC's effects on all enrollees; a subset at high risk of tobacco-related complications due to certain medical conditions; and behavioral health service users. MAIN MEASURES: We examined use of: (1) any cessation treatment (pharmacotherapy or counseling); (2) varenicline or bupropion; (3) nicotine replacement therapies (NRTs); (4) cessation counseling; and (4) combination therapy (pharmacotherapy plus counseling). We also examined duration of pharmacotherapy use and number of counseling visits among users. KEY RESULTS: Rates of tobacco cessation treatment use were higher following implementation of the AQC relative to the comparison group overall (2.02 vs. 1.87 %, p < 0.0001), among enrollees at risk for tobacco-related complications (4.97 vs. 4.66 %, p < 0.0001), and among behavioral health service users (3.67 vs. 3.25 %, p < 0.0001). Statistically significant increases were found for use of varenicline or bupropion alone, counseling alone, and combination therapy, but not for NRT use, pharmacotherapy duration, or number of counseling visits among users. CONCLUSIONS: In its initial three years, the AQC was associated with increases in use of tobacco cessation services.

Capsule Commentary on Huskamp et al., Effects of Global Payment and Accountable Care on Tobacco Cessation Service Use: An Observational Study

“…Unfortunately, despite decades of smoking cessation effort, 18% of US adults smoke. 1 In this study, Huskamp and colleagues 2 found that an Alternative Quality Contract, in which accountable care organizations receive incentives for improving care performance on 64 measures, reduced smoking (from 2.02 to 1.87%). This is despite the fact that tobacco cessation was not 1 of the 64 measures of care.…”

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“… McWilliams et al (2013) found significant reductions in spending for FFS Medicare beneficiaries served by provider organizations in the AQC compared with beneficiaries served by providers not in the contract, suggesting a positive spillover effect. Uptake of tobacco cessation treatment slightly increased in the AQC population ( Huskamp et al, 2016 ). Song, Fendrick, Safran, Landon, and Chernew (2013) provide evidence that providers participating in the contract used lower priced facilities and services more often than providers outside the contract.…”

Medicare Shared Savings ACOs and Hospice Care for Ischemic Stroke Patients

“…Health status measures included laboratory values (continuous), ability to ambulate (binary), the modified Rankin Scale (categorical, 0‐5), and chronic kidney disease (categorical, estimated creatinine clearance ≥60, 45‐59, 30‐44, 15‐29, or <15) . Models included 5‐year age categories as well as the interaction of sex and age groups to allow for different effects by age and sex . Models controlled for any evaluation and management visit the year before incident stroke.…”

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