Smoking Cessation Benefit Utilization: Comparing Methodologies for Measurement using New York State’s Medicaid Data

Malloy, Kevin; Proj, Anisa; Battles, Haven; Juster, Theresa; Ortega-Peluso, Christina; Wu, Meng; Juster, Harlan R.

doi:10.1093/ntr/ntx250

Cited by 6 publications

(4 citation statements)

References 7 publications

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“…Of these, 3164 members (6.0%) made a quit attempt using one or more smoking cessation medications. This utilization is lower than the 12-22% estimate reported for smokers in New York Medicaid managed care plans [11] and fee-for-service Medicaid beneficiaries in 37 US states (9.4%) [13], but higher than reported for Medicaid enrollees in Arkansas (4%) [10].…”

Section: Discussioncontrasting

confidence: 60%

“…Use is similar among government (Medicaid, 32.2%; Medicare, 28.5%) and privately (29.9%) insured populations [9]. Thus far, limited research has examined patient-level changes in medication use over time and its associated economic impact on Medicaid plans [10,11]. To inform future policy decisions regarding smoking cessation benefits for Medicaid beneficiaries, this study characterized trends in cessation medication utilization between 2006 and 2017 and estimated associated per-member per-month (PMPM) costs.…”

Section: Introductionmentioning

confidence: 99%

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Smoking Cessation Pharmacotherapy Utilization and Costs to a Medicaid Managed Care Plan

Corelli

Tu²,

Lee³

et al. 2021

PharmacoEconomics Open

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Background Medicaid coverage for smoking cessation medications has expanded; however, little research has been conducted to evaluate patient-level changes in medication use over time and its associated economic impact on health plans. Objective The aim of this study was to characterize trends in smoking cessation medication utilization between 2006 and 2017 within a Medicaid population and estimate per-member per-month (PMPM) costs to the health plan. Methods This study was a retrospective longitudinal analysis conducted among adult members of a Medicaid managed care plan in California. Pharmacy claims data from January 1, 2006 to December 31, 2017 were analyzed to estimate utilization and cost of smoking cessation medications. Additionally, data from 3164 members who filled prescription(s) for cessation medication(s) in 2017 were evaluated to quantify quit attempts and use of combination therapy. For members who had been prescribed bupropion SR, varenicline, or the nicotine patch, the extent to which the durations of therapy were consistent with the manufacturers' recommended minimum duration of therapy were also assessed. Results The average PMPM expenditures for smoking cessation medications were approximately US$0.15 in 2017, compared with US$0.01-US$0.03 between 2006 and 2013. In 2017, a total of 3164 members initiated an estimated 3850 quit attempts, most commonly using the nicotine patch (57.5%) or varenicline (32.8%). Combination therapy accounted for 2.9% of quit attempts. The median therapy duration for the nicotine patch, varenicline, and bupropion SR was 28, 30, and 33 days, respectively, and for each of these medications, fewer than half of members filled prescriptions for the minimum recommended duration of therapy. Conclusions Pharmacy claims data suggest that despite comprehensive coverage, most beneficiaries are underutilizing smoking cessation agents and are not completing the recommended treatment durations.

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Section: Discussioncontrasting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Smoking Cessation Pharmacotherapy Utilization and Costs to a Medicaid Managed Care Plan

Corelli

Tu²,

Lee³

et al. 2021

PharmacoEconomics Open

View full text Add to dashboard Cite

show abstract

“…NCQA data may have significant response bias, which may lead to under-reporting of prevalence and overstatement of cessation interventions. 5 Another perspective on tobacco cessation interventions comes from the National Health Interview Surveys, which stated that 63% of smokers reported physician advice to quit, and 6.2% were given a prescription in the most recent year sampled. 6 Sadagna, et.…”

Section: Introductionmentioning

confidence: 99%

“…14 Medical claims systems and EMR systems are likely to significantly under-report tobacco use status. 15,16 Aside from the known challenges with electronic medical records-based claims and reimbursement, 17 the potential revenue lost due to ineffective billing and underlying poor service delivery for cessation services remains largely unexplored. The lost revenue can be a marker for indicating sub-optimal interventions in health systems and quantifying the economic impact of missed tobacco cessation care.…”

Section: Introductionmentioning

confidence: 99%

Lost Opportunity in Tobacco Cessation Care: Impact of Underbilling in a Large Health System

Baughman,

Rauhut,

Anselm

2024

Preprint

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Importance: Tobacco cessation remains a critical challenge in healthcare despite the availability of evidence-based interventions, which are under-utilized. Tobacco cessation services can be provided and billed at every office visit, but full implementation is impeded by misaligned economic incentives and inadequate training. Objective: To evaluate the potential revenue loss in tobacco cessation care due to inadequate service delivery and billing practices, measuring the impact of systems-based approaches in population health for tobacco cessation. Methods: In this retrospective cohort study, aggregated de-identified patient-level health data was used to estimate smokers eligible for cessation counseling and analyze billing practices from 1/1/21 to 12/31/23. Using claims and electronic medical record data, potential revenue was calculated using the Medicare reimbursement rate and standard multipliers for smoking cessation services. Setting: Data across an 8-hospital regional health system with over 200 outpatient care locations across Pennsylvania and Maryland were examined. Participants: A total of 584,631 unique patients meeting inclusion criteria were identified, with 75,115 smokers eligible for cessation counseling. Intervention(s)/Exposure(s): Primary care encounters eligible for smoking cessation counseling (CPT codes 99406 or 99407) were analyzed over a three-year period. Main Outcome(s) and Measure(s): The billing rate for cessation counseling was calculated at both the patient and visit levels, revealing a discrepancy between eligible encounters and billed services. The estimated potential revenue loss over three years was $5,947,018.13. Results: Over the three years, 584,631 total primary care patients were seen. 75,115 (12.8%) were identified as smokers, who had 507,656 visits, and of these, only 1,277 patients were billed. This reflected a billing rate of 1.7%, with a potential unrealized revenue totaling $5,947,018.13 over three years. Conclusions and Relevance: The study identifies a disparity between potential and actual billing for smoking cessation, indicating missed opportunities for healthcare systems. This highlights a need for enhancing billing practices for smoking cessation, emphasizing the need for improved billing practices and systemic changes to enhance intervention efforts. Policy changes that incentivize proper billing could promote the public health benefits of improving smoking cessation interventions.

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A Lost Opportunity in Tobacco Cessation: Care: Impact of Underbilling in a Large Health System

Baughman,

Rauhut,

Anselm

2024

American Journal of Preventive Medicine

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Smoking Cessation Benefit Utilization: Comparing Methodologies for Measurement using New York State’s Medicaid Data

Cited by 6 publications

References 7 publications

Smoking Cessation Pharmacotherapy Utilization and Costs to a Medicaid Managed Care Plan

Smoking Cessation Pharmacotherapy Utilization and Costs to a Medicaid Managed Care Plan

Lost Opportunity in Tobacco Cessation Care: Impact of Underbilling in a Large Health System

A Lost Opportunity in Tobacco Cessation: Care: Impact of Underbilling in a Large Health System

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