Health Plans, Employers Join President Obama in Targeting Tobacco

President Obama on June 22 signed a sweeping anti-smoking law that gives the FDA unprecedented authority to regulate what goes into tobacco products and prohibits marketing campaigns geared toward children. At the same time, many private employers, including Safeway, Inc. are working more aggressively to help their employees quit smoking, with an increasing number of businesses now using “more of a stick than a carrot” approach to create a healthier, more productive work force and reduce costs. Some health plans say they are helping to launch anti-tobacco programs for their plan sponsors, and are launching initiatives to help their own employees kick the habit.

U.S. employers showed an interest in smoking-cessation programs for their workers in the late 1990s and early 2000s, says Tina Brown-Stevenson, a senior vice president at Ingenix Consulting, who manages the firm’s employer solutions group. Then came a bout of inertia around 2003 and 2004, followed by employers’ renewed interest since about 2007 in prevention and wellness programs in general — and in getting workers to kick the tobacco habit in particular.

“I think the overall approach relative to health and wellness has become much more of a stick than a carrot,” Brown-Stevenson tells HPW. “In the past, employers gave extra rewards to encourage and positively enforce health and wellness behaviors, including smoking cessation. Now employers are saying: ‘You can’t work here,’ ‘You must pay more for health care benefits if you smoke,’ or ‘You have one year to quit — we’ll pay for smoking cessation classes — or you won’t stay employed here.’”

Employers are trying to get a handle on what works, and what doesn’t work, in their initiatives aimed at eliminating tobacco use among workers, Brown-Stevenson says. She cites several ongoing studies for major employer-group clients. In one, she says, a large transportation company, which is considering the implementation of a smoking-cessation program, is having Ingenix model such a program’s potential impact on employee health and cost savings.

Another company is working with Ingenix to figure out whether its eight-year-old program has mitigated the long-term progression of diseases associated with smoking. “Nowadays all companies are feeling some stress relative to the economy,” she says, and the need to show a return on investment for such programs is “greater than ever.”

Despite cutbacks due to the nation’s economic downturn, Watson Wyatt, an employee-benefit consulting firm, found in a survey of 489 large U.S. employers conducted in January that 58% offer “lifestyle improvement” programs in 2009, up from 43% in 2007. The survey reported that eight in 10 companies now offer health risk assessments (HRAs) for employees, up from 72% in 2007. According to Watson Wyatt, effective financial incentives are a key component in promoting worker participation in wellness programs, including HRAs. Smoking-cessation programs, offered by 40% of employers in both 2009 and 2008, frequently offer incentives for participation, the firm said. It reported that moderate financial incentives to workers of $51 to $100 helped boost participation in both smoking-cessation and weight-management programs — with the latter being offered by 34% of employers in 2009, up from 31% a year earlier.

Business Group Launches Web Site

Trying to keep pace with its members’ interests, the National Business Group on Health launched a Web site in November targeting tobacco issues, says Wendy Slavit, senior program analyst with the group’s Center for Prevention and Health Services.

The business group, which is comprised of about 300 (mostly FORTUNE 500) companies, then put out a purchaser’s guide to preventive services that includes a chapter on what to look for from health plans, Slavit says. Then the group came out with guidelines on smoking cessation, counseling and treatment options, she says, all in an effort to provide information that would help make the case for anti-smoking initiatives to upper-level management. “We’ve had several Webinars on the topic, and those have been our highest-attended Webinars. It’s seen as a great way to improve employee health,” she says, noting the group got CDC funding for its early tobacco webinars.

“The coverage is really different from employer to employer,” Slavit tells HPW. “Some cover more in the benefits plan and don’t have a smoke-free workplace. Some have a smoke-free workplace but don’t cover more in benefits.” She says the business group is finding that an increasing number of employers are using — or thinking of using — a “tobacco surcharge,” charging higher premiums for smokers’ health coverage, although some employers continue to offer positive incentives to encourage enrollment in tobacco programs. And she says more employers “now want benefits in place to help employees quit and stay quit.”

Health Plans Try to ‘Clear the Smoke’

Aetna spokeswoman Wendy Morphew conducted a quick survey of several of Aetna’s medical directors who meet frequently with customers. “They report a definite increase in employer interest in wellness programming, which would include smoking cessation as well as programs to encourage employees to adopt healthier lifestyles including healthy eating and physical fitness,” she says. “…We see employers purchasing wellness suites which include smoking cessation, but based on this anecdotal survey we are not seeing employers seek out smoking-cessation programs per se. And while there is considerable interest in these programs, very few employers have discretionary dollars right now making it a challenge to implement them.”

Asked whether employers seem to be favoring the carrot or stick approach, Morphew says that Aetna has long supported wellness strategies offering incentives and rewards for employees to participate in healthy behaviors — “and that tends to be our advice to customers. It is difficult to know how employers actually chose to implement these programs since they are typically handled by the employers themselves.”

Blues Plan Targets Its Own Employees

Blue Cross and Blue Shield of Tennessee spokesman Scott Wilson of says the state of Tennessee, which is a client of the insurer, has changed tiers for certain prescription drugs to allow a lower copayment for some anti-smoking medications in 2009. The 48,000-state-employee group also has included certain items, such as nicotine patches and gums, in its over-the-counter drug benefit packages this year, he says. Other large and midsized employer-group clients, including an automaker, are having registered nurses from the Blues plan go and talk on site to workers during their lunch hours about the benefits of kicking the tobacco habit, he adds.

Wilson notes that the Tennessee Blues plan itself is just completing the move of about 4,400 employees to a new entirely tobacco-free campus in Chattanooga; all of its campuses across the state are now tobacco free. “You can’t go to your car and smoke. There’s a ban on all tobacco products on the premises,” he says.

In some cases, health insurers are offering their own techniques on how to create a smoke-free workplace to their employer-group clients. Last fall Highmark, Inc. began offering to its employer groups a toolkit, based on its own experiences in going smoke-free in 2008. Cathy Gold, manager of innovation and strategic communication for Highmark’s preventive health services division, describes that toolkit as as “wildly popular.”

“It’s not a ‘buy-up.’ It is part of our core services…so it’s free. There’s no additional charge,” Gold says. “We send out e-mail to our accounts on smoking and offer the toolkit,” she says, “and all our smoking-cessation programs are free….We have marketing materials that employers can use…and materials [that] employers can give out saying it’s free.” The toolkit includes an introductory newsletter for the group’s employees and seven weekly customizable letters, fliers, e-mail messages or other promotional materials that can be distributed in such places as the locker room or lunch room or handed out with pay checks.

Highmark offers telephonic, online and in-person smoking-cessation options to members, all of which offer support services on stress management and the like. “We really look at a holistic approach to quitting tobacco,” she says.

According to Gold, many of Highmark’s employer groups active in wellness programs have their employees take (HRAs). Highmark gives the aggregate report to those employers large enough to avoid employee privacy concerns, she says, and the insurer would suggest appropriate interventions if it were to identify a significant number of smokers in the group.