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Healthcare

Rewards used to halt puffing while pregnant

A health care group will offer gift cards to expectant mothers who test negative for nicotine

 

 

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An organization whose aim it is to improve health care for some of Lane County’s poorest residents has picked smoking by pregnant women as its first major target, using financial incentives as part of a program to help mothers-to-be kick the habit.

Trillium Community Health Plan, the Coordinated Care Organization that provides Medicaid services in Lane County, says cutting the extremely high rate of smoking among its pregnant members will have the triple benefit of improving the health of the mothers, improving the health of their babies and attacking the skyrocketing cost of medical care.

An estimated 35 percent to 40 percent of pregnant women in Lane County receiving Oregon Health Plan benefits — Oregon’s version of Medicaid — smoke, endangering their health and the health of their babies, said Dr. Holly Jo Hodges, Trillium’s medical director.

Babies are born smaller and earlier if their mothers smoked during pregnancy, compared with women who didn’t smoke during pregnancy, Dr. Rick Kincade said. Kincade is a member of the Trillium board and of the committee of clinicians that recommended that Trillium pursue this anti-smoking program.

The incidence of respiratory disease, particularly asthma, is much higher in children whose mothers smoked during pregnancy, he said.

And Trillium estimates that up to $1 million a year in medical costs could be avoided if its pregnant members quit smoking.

Kincade said both panels advising the Trillium board on prevention initiatives named an anti-smoking program for pregnant members as a top priority.

“Both groups identified it as No. 1 right out of the chute.”

One reason why the issue was so compelling were some startling statistics in a comprehensive Lane County Community Health Needs Assessment released late last year.

The report found that the rate of women who smoke during pregnancy is higher in Lane County than other parts of the state, and 70 percent higher than nationally.

“We were all shocked at how high the numbers were, and we felt this would be a great group to start with,” said Tara Davee, a Springfield resident and Oregon Health Plan member who serves on Trillium’s Community Advisory Council and Trillium’s Prevention Work Group.

“I think most women who are pregnant don’t want to smoke — most people who smoke don’t want to — but it’s an addiction,” she said.

“I know people who are pregnant, or have been, and smoke, and it’s really hard to watch because they don’t know what to do,” Davee said.

That should start to change, she said, when Trillium rolls out this prevention initiative.

“Our goal is to have it ready to go by July 1.”

Gifts are in the cards

Trillium plans to spend nearly $180,000 on various efforts to encourage its pregnant members to quit smoking.

The effort will include training 40 health providers to screen patients and connect them with resources, training 20 tobacco cessation counselors, and spending $105,625 on a gift card incentive program for patients who test nicotine free at several points during their pregnancy and after delivery.

The gift card amount will increase at each of four check points, from $20 at the first urine test at 12 to 16 weeks to $100 at 6 weeks postpartum, Kincade said.

The most generous gift card is offered after the baby is born to try to prevent the mom from relapsing, he said.

“Almost half of women who stop (smoking) because they’re pregnant restart soon after their delivery, and we wanted to curb that as much as possible,” Kincade said.

Trillium figures about 400 women will participate in the incentive program, and each would be eligible for $200 in gift cards, he said.

Trillium is still working out the gift card details with local retailers, Hodges said.

“It won’t be anything that could be used for tobacco or alcohol,” she said, adding that “hopefully it will be more geared toward the needs of the baby.”

Various studies have shown success with this type of incentive. One study showed a quarter of pregnant women who smoked were able to stay tobacco free throughout their pregnancy, Kincade said.

“I feel like it’s going to be very successful,” Davee said. “Most people like an incentive, whether it be $5, $10 or a gift card.”

Trillium’s initiative will put more tools in the hands of health providers and incentives in the hands of patients, Hodges said.

“From my previous life as an obstetrical provider, you’d identify the patient,” she said. “You’d tell them to quit smoking. You’d hand them some pamphlets and you’d hope for the best. There wasn’t much more you could do because of the constraints of how medicine was practiced.

“With the CCO we can go specifically into the provider and say here’s (the recommended screening and intervention),” Hodges said. “You can refer people for tobacco cessation counseling — here’s when the groups will meet. We can facilitate those groups and we can give them the tools and protocols and give (patients) the incentive.

“ It’s a hugely different approach to tobacco prevention in pregnancy than I’ve seen in my 19 years of trying to beg, plead and convince pregnant women to quit smoking.”

Getting into the game

Trillium’s initiative also funds education for children to try to prevent them from ever lighting up.

Trillium will spend $20,200 on the The Good Behavior Game, a behavior modification program that will be integrated into the first-grade curriculum at 13 grade schools in Lane County, and another $20,000 on a program to remind retailers to check identification so minors can’t purchase tobacco products.

Studies show that when first-graders who played The Good Behavior Game enter their teen years, they’re significantly less likely to start smoking or to use hard drugs, Hodges said.

They also show other benefits, such as higher high school graduation rates and more college-bound students.

“This is an investment in the future,” Kincade said. “We won’t see the return on that investment for a decade, but our organization felt we needed to make that investment if we ever have a hope of controlling the costs of health care.

“We have to have a healthier population of younger people over time, and if we don’t make those changes now they won’t happen.”

There’s no simple explanation for why smoking rates among pregnant women in Lane County are so high.

“In general, tobacco use seems to be higher in lower socioeconomic groups,” Hodges said. “Sometimes that may be attributed to stress, unemployment and financial constraints.”

The smoking rate also is high among Lane County teenagers, which indicates stress and vulnerability in that group, as well, Kincade said.

The anti-smoking program for pregnant Trillium members is just one prevention focus for the Coordinated Care Organization. Trillium has dedicated $1.33 per member per month, a total of $800,000 a year, for prevention efforts, Hodges said.

Other areas that the organization will be focusing on include more effective screening for depression, increasing immunization rates among children and addressing obesity, Kincade said.

“There’s a lot of urgent need,” he said. “What we’d like to do is move as many things forward as possible because we know we can’t just hit one place.

“We need to hit all of these areas if we’re going to improve overall community health.”

Trillium Community Health Plan, which serves 55,000 members, is one of 15 CCOs in Oregon. Its mission is to provide better health care at lower cost to more than 650,000 Oregon Health Plan members.

It plans to do that through better coordination of services, a payment structure that rewards doctors and other providers for keeping patients well, and by focusing on prevention.

 

 
 

 

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