Plan of Action

Expand access to comprehensive tobacco cessation treatment to 50% of smokers by 2015, and 100% by 2020

Everyone has a critical role to play. The following are actions that various stakeholders should commit to:

Provide barrier free access to comprehensive coverage of all treatments recommended by the PHS tobacco cessation guideline in accordance with model benefit recommendations, including quitline services and over-the-counter medications.
Promote the company’s cessation benefits and provide non-punitive incentives for employees to utilize treatment.
Provide access to onsite programs and services, and/or contract with the state quitline or with a quitline vendor, to provide telephone counseling services and FDA-approved cessation medications.
Organize educational programs for employers, unions, and purchasing coalitions on the value and importance of covering comprehensive tobacco-use treatment benefits.
Support the creation of business incentives (premium discounts, etc.) for the provision of comprehensive cessation benefits.
Take advantage of the heightened interest in quitting (and increased success) that accompanies worksite or community policy changes, such as smokefree places and increased tobacco taxes, by providing enhanced cessation support prior to, and after, such policy changes.

Provide comprehensive coverage for all treatments recommended by the PHS tobacco-use treatment guideline into all health plan offerings (individual, group, or telephone counseling, prescription medications, and over-the-counter medications) and inform eligible enrollees of their benefits.
Support the removal of barriers (e.g., deductibles, co-pays, prior authorization, stepped-care therapy, requiring counseling in order to have medications covered) for cessation treatments.
Report on the number of covered lives with access to comprehensive treatment benefits.
Support the creation and implementation of business incentives (public recognition, higher consumer rankings/recognition, etc.) for the provision and use of comprehensive cessation benefits.
Provide incentives for health systems and providers to improve the delivery of effective treatments.

Promote the urgency of quitting as early in life as possible.
Promote the importance of using proven treatments when making a quit attempt.
Promote the benefit of barrier free access to comprehensive cessation benefits to employers and insurers.
Support comprehensive coverage for all federal and state employees, and under Medicaid, Medicare, and all publicly funded insurance programs.
Support state funding of/for cessation services at CDC recommended levels, including funding of state quitlines and their promotion, to guarantee the provision of comprehensive treatment services to all tobacco users interested in quitting.
Advocate for strong tobacco-use treatment performance measures for accreditation of health plans and hospitals.
Include strong tobacco-use treatment performance measures in “pay for performance” metrics for healthcare providers and health systems.
Advocate for the inclusion of access to comprehensive tobacco use treatment in chronic disease and health promotion programs, such as heart disease, stroke, diabetes, cancer, asthma, etc.
Advocate for funding of media campaigns that encourage cessation, educate tobacco users about effective treatments, and provide information about how to access these treatments.

Implement systems that ensure that all individuals seen in the healthcare system are screened for tobacco use.
Ensure health care providers offer Public Health Service Guideline-recommended treatments to tobacco users at every clinical encounter.
Develop effective referral systems to community resources, quitlines, and/or tailored print or web-based interventions.
Develop reporting systems to track and evaluate tobacco cessation screening, treatments and referrals.
Educate providers regarding appropriate CPT and ICD-10 codes to improve reimbursement.
Develop competency based cessation training in health professional schools.
Strengthen Joint Commission, NCQA, and pay-for-performance measures to ensure the routine treatment of tobacco use in all healthcare encounters.

Require the reporting by payers (major insurers) of information on the number of covered lives with access to comprehensive smoking cessation benefits through publicly funded health programs.
Support inclusion of comprehensive coverage in all federally-funded or authorized health programs (e.g., Medicare, Medicaid, FEHBP, ERISA), and within the framework of health reform.
Examine state and federal insurance regulation definitions of addiction and, where applicable, ensure tobacco-use is included.
Create incentives for the provision of comprehensive treatment benefits.
Develop coverage standards and measurements through accrediting bodies (e.g., NCQA, Joint Commission).
Take advantage of the heightened interest in quitting (and increased success) that accompanies community policy changes, such as smokefree places and increased tobacco taxes, by providing enhanced cessation support prior to, and after, such policy changes.

Promote the inclusion of highly cost-effective preventive services (e.g., tobacco-use treatment) in health reform proposals.
Call upon the Healthy People 2020 Advisory Committee to include insurance coverage, quitline access, and use of evidence-based treatments in the most recent cessation attempt as HP2020 measures.
Actively promote greater access to comprehensive tobacco use treatment services.
Encourage tobacco-users to advocate for barrier-free access to effective treatment services.

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Mar 04, 2010
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National Working Group for ACTTION