Effects of Global Payment and Accountable Care on Tobacco Cessation Service Use: An Observational Study
- Resource Type
- Authors
- Colleen L. Barry; Michael E. Chernew; Elena M. Kouri; Kenneth Duckworth; Zirui Song; Shelly F. Greenfield; Elizabeth A. Stuart; Haiden A. Huskamp; Julie M. Donohue
- Source
- Journal of General Internal Medicine. 31:1134-1140
- Subject
- Adult
Counseling
Male
medicine.medical_specialty
Quality management
Adolescent
030204 cardiovascular system & hematology
Ambulatory Care Facilities
Young Adult
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Pharmacotherapy
Environmental health
Internal Medicine
medicine
Humans
030212 general & internal medicine
Young adult
Varenicline
Reimbursement, Incentive
Original Research
Nicotine replacement
Tobacco Use Cessation
Bupropion
Social Responsibility
Accountable Care Organizations
business.industry
Smoking
Capsule Commentary
Tobacco Use Disorder
Middle Aged
Blue Cross Blue Shield Insurance Plans
Quality Improvement
Tobacco Use Cessation Devices
Massachusetts
chemistry
Family medicine
Female
Observational study
Health Expenditures
Tobacco Use Cessation Products
business
medicine.drug
- Language
- ISSN
- 1525-1497
0884-8734
Tobacco use is the leading cause of preventable death and disability. New payment and delivery system models including global payment and accountable care have the potential to increase use of cost-effective tobacco cessation services. To examine how the Alternative Quality Contract (AQC) established in 2009 by Blue Cross Blue Shield of Massachusetts (BCBSMA) has affected tobacco cessation service use. We used 2006–2011 BCBSMA claims and enrollment data to compare adults 18–64 years in AQC provider organizations to adults in non-AQC provider organizations. We examined the AQC’s effects on all enrollees; a subset at high risk of tobacco-related complications due to certain medical conditions; and behavioral health service users. We examined use of: (1) any cessation treatment (pharmacotherapy or counseling); (2) varenicline or bupropion; (3) nicotine replacement therapies (NRTs); (4) cessation counseling; and (4) combination therapy (pharmacotherapy plus counseling). We also examined duration of pharmacotherapy use and number of counseling visits among users. Rates of tobacco cessation treatment use were higher following implementation of the AQC relative to the comparison group overall (2.02 vs. 1.87 %, p