Recommendations for HMOs, PPOs, and ACOs

1. Measure your current performance in tobacco treatment using medical and pharmacy claims and outcomes from case management.

2. Enhance identification of tobacco use system wide. Medical claims significantly under-report tobacco use as do EMRs. The routine screening and updating of EMR data is an essential platform for any subsequent interventions. The exemplar for this process is Kaiser Permanente of Northern California.

3. Create a registry of tobacco users. Using claims, EMR, encounter and HRA data, create and maintain a registry to track outreach and engagement of tobacco users.

4. Engage tobacco treatment specialists TTS as part of the case management team. The role of counseling cannot be emphasized enough.

5. Develop a provider strategy focused on implementation of the new HEDIS measure which will closely resemble this draft.

6. Develop a member strategy focused on empowering tobacco users to use all available resources and benefits including Apps, Quitlines, and case management.

7. Consider partnering with the state Quitline for additional sessions.

8. Identify cohorts of members at special risk for more intensive interventions: Persons with mental illness, members with a recent hospitalization, seniors, members already in case management.

9. Eliminate barriers to medication access embedded in pharmacy claims that may limit prolonged use of medications or use of multiple medications.

10. Consider medication sampling or trial of quitting strategies

11. Consider harm reduction strategies for members with the greatest difficulty in stopping.