A new report from the National Business Coalition on Health finds that employer-sponsored health plans play an integral role in administering smoking cessation benefits.

The report also urges physicians and other providers to hone in on smoking cessation programs through education, tools and incentives. "Tobacco cessation is a complex issue for employers and health plans. There is a significant process from identification of individuals needing support to successful treatment," says Dennis White, senior vice president for value-based purchasing at NBCH.

White also notes that research shows 80% of health plans are adopting evidence-based benefit design, incorporating counseling and using FDA-approved medication with positive results.

But before employers can help their puffing workers, they need to identify them, something with which many have difficulties. The Centers for Disease Control and Prevention has found that 21% of the population smokes, yet health plans report that the range of smoking rates covered in their population is between .1% and 19%, with an average of 4%.

Often employers use health risk assessments to identify smokers, with 37% citing the form as the most effective method in identification, and 90% currently identifying smokers in that manner. Nevertheless, HRAs have a mere 4% average completion rate, so not everyone is recognized, according to the NBCH report.

About 85% of health plans screen through disease management programs, 85% rely on self-referral (which 47% of employers believe to be the most effective method) and only 7% ask members upon enrollment.

To get the word out, 94% of employers provide general information about tobacco use through their Web site and/or newsletters. Further, 79% provide a "quit kit" for members by mail, NBCH found.

Testimonials and cold turkey sandwiches

Quest Diagnostics, one company leading the charge against smoking, uses employee testimonials to engage their workers. Quest taps volunteer leaders, many of whom have successfully quit the habit, for each company site to educate and encourage their population.

"We wanted to encourage employees to improve their health, but we certainly didn't want to provoke World War III. We had sites with good leadership who were able to go tobacco-free before others and share the secrets of their success," says Fred Williams, the director of health management strategies at Quest Diagnostics.

Further, they make use of national events that call attention to the problem, such as offering free cold-turkey sandwiches as a way to good-naturedly "heighten employees' consciousness of the initiative during the Great American Smokeout and Kick Butts Day," Williams adds.

They also offer employees their own HRA, Blueprint for Wellness, which includes a panel of 30 lab tests as well as biometric measurements, and an incentive of lowering biweekly premiums by $15. Quest boasts an 80% participation rate among those enrolled in their health plans. This helps the company identify aggregate risk for certain behaviors, like smoking.

It started its smoking cessation program in 2005 to promote healthier behaviors in their employees and those living under the same roof. In the first eight months, nearly 1,200 people enrolled to quit smoking, far exceeding expectations. In total, over 3,800 people have now enrolled.

Part of the program's success was implementing gradual changes as employees steadily embraced behavior change. The program now consists of individual counseling - though employees also choose to form support groups on their own - nicotine replacement therapy, behavioral work and five outreach calls per employees, while enabling employees to make as many support calls as they wish over a 12-month period.

In November 2008, in concert with the Great American Smokeout, Quest Diagnostics announced that on January 1, 2009, smoking in company cars would be prohibited and on April 1, 2010, every company facility would go tobacco-free. The mere mention of these impending programs served as an impetus for people to quit.

"Whenever we make an announcement like that, the numbers go off the chart in the weeks afterwards with people thinking 'This is what I need to kick the habit,'" says Williams.

This year, the company will go even further in trying to remove barriers to quitting by offering free over-the-counter drugs, as well as eliminating copays for prescription drugs that help smokers stop.

Cessation without alienation

Nevertheless, employers need to be careful not to alienate employees. They can avoid this common trap by employing gradual changes with a good deal of public support and dialogue. Williams also recommends giving employees three-to-six months notice before initiating a tobacco-free zone.

"The way you get over the alienation is you're open, you're transparent, and you have as many communication sessions as you're able so that by the time these bans were in place, it was most often a nonevent," he says.

Overall, the company reduced the percentage who smoked from 18% in 2004 to 12% last year, and Williams predicts this number to decline even more because of the smoking ban. He goes on to stress that if an individual attempts to quit cold turkey on their own, they stand a one-in-20 chance of success, whereas if they use the company's program they have a 40% chance.

The ROI of smoking cessation programs is also strong, with the Centers for Disease Control and other published studies estimating that an employer could save $5,000 to $6,000 each year in medical costs and productivity, says Williams.

"For monetary and health reasons, make your program a priority, advocates Williams. Positive reinforcement is a must, as the great majority, 70%, of American smokers try to quit each year.

"If we're helpful in making [workers] successful, it's a huge employee satisfaction. This is not at all punitive; it's a win-win," Williams says.

Health plans also are involved in physician-patient relations when it comes to screening for tobacco use and encouraging treatment. Currently, 15% of plans provide member-specific reports or reminders to screen to physicians, and 33% hand out member-specific reports or reminders to treat, the report notes. Only 11% of plans have incentives for practitioners to screen for tobacco use, and 12% provide incentives to refer the member to a program or to treat the member.

Other key findings from the report include:

•  Nearly 85% of health plans provide telephonic counseling support, with 77% providing a minimum of at least four sessions.

•  The more person-to-person contact and the greater the intensity, the more effective the program will be, research has found. Yet, only 37% of plans offer in-person or group programs.

•  Eighty-one percent of plans provide access to over-the-counter nicotine replacement medications, and 68% offer incentives for patient use of these medications. Although 74% to 80% provide access to tobacco cessation prescription medications, only 25% to 33% provide incentives to members for these medications through lower copayments or deductibles.

•  Employers clearly see the worth in implementing a comprehensive smoking cessation program, with 96% saying that it would be beneficial to have such a program. Nonetheless, only 20% of employers in the survey offered all four of the criteria recommended by the CDC.

Follow EBN on: Twitter | Facebook | LinkedIn | Podcasts