As major public health agencies such as the CDC, HHS, and state health departments face reductions in scope and resources, a unique opportunity arises for health insurers to take a leading role in improving public health, while also enhancing their own reputations and financial sustainability.
Consider tobacco use, the leading cause of preventable death in the United States, contributing to an estimated 490,000 deaths annually (1) and accounting for over 11% of national health expenditures (2). Some organizations, like Kaiser Permanente Northern California, have made impressive strides in tobacco cessation, and publish their results (3). Most health insurers supply coverage for treatment as required by law, but do not actively promote their use.
Despite clear, well established, evidence supporting the cost-effectiveness of cessation programs (4,5), most health insurers do not prioritize this intervention. Overall, health plan performance on tobacco cessation is poor: doctors miss numerous opportunities to help their patients quit, or when they do, fail to include guideline-based advice on use of medication and referral to counselling (6).
When I have challenged health plans on the performance of their tobacco cessation programs, I hear two types of replies: Adverse selection- they don’t want to be better than other health plans because they would attract sicker patients; and, member migration- with a 15 percent turnover each year, a successful quitter would take their future health care savings to a competitor. If every health plan made a strong effort to treat cigarette smoking by their subscribers, then these objections would disappear, and every health plan would benefit. If health insurers collaborated on shared metrics and developed data collection and reporting for the physicians in their networks, the scale of the data available would supersede that of the recently shuttered CDC Office on Smoking and Health. The decades of successful interventions championed by that office would be sustained and enlarged.
Health plans are under extraordinary scrutiny because of the rising cost of health care which is reflected in the premiums they charge. What if they collaborated to improve the public’s health and lower the cost of health care at the same time? Evidence-based treatment of tobacco offers just such an opportunity (7). Health insurers can reimagine their roles—not just as payors, but as proactive partners in public health. By focusing on prevention and public health, they can better serve their members and improve their profitability.
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1. Eliminating Tobacco-Related Disease and Death: Addressing Disparities
2. U.S. healthcare spending attributable to cigarette smoking in 2014 - ScienceDirect
3. 300,000 quitters and counting; A systematic approach to tobacco cessation - ScienceDirect
4. Cost Effectiveness of Smoking-Cessation Therapies | PharmacoEconomics,
6. Adult Smoking Cessation — United States, 2022 | MMWR (cdc.gov)
7. Better Treatment for People who use Tobacco — Edward Anselm, MD
If you require copies of these references, please contact me at eanselm@msn.com.