Are Counseling Programs Really Helping Smokers Quit?

Medicaid policies that require patients to undergo counseling in order to receive medications to quit smoking, in fact end up affecting the use of these medications, according to a new study. Put simply, if the Medicaid beneficiaries possess incomplete information about the tobacco-cessation programs, the counseling sessions do no good to smokers who want to quit and become a barrier to their efforts.

The study, published in the CDC’s Preventing Chronic Disease journal, talks about the barriers created by Medicaid programs for smokers who want to quit. Leighton Ku, PhD, MPH, professor of health policy and management at Milken Institute School of Public Health, Washington, DC, and fellow colleagues compiled the report to highlight the irony of such Medicaid policies.

“Many organizations encourage coverage of all FDA-approved cessation medications and counseling and elimination of barriers that might limit access,” the authors wrote. “However, these benefits may go unused if patients and physicians are unaware that they are available or are not sufficiently engaged to attempt quitting. Fewer than half of smokers in Medicaid-managed care plans reported that their physicians offered assistance, such as medications or counseling, to quit.”

Smoking—A Double Whammy

In US, smoking is the leading cause of preventable illness and disease. Furthermore, almost one-third of adults covered by Medicaid, the nation’s largest health insurance program, smokes.

By quitting, smokers can drastically reduce the risk of deadly smoking-related diseases such as lung cancer. And such policies that help smokers quit are an investment that pays off for the Medicaid program, because tobacco-related diseases cost the Medicaid program a huge amount every year. If smokers quit, a major chunk of these health expenses can be prevented.

“Policies and programs that empower low-income Medicaid smokers to quit could improve their health and help reduce healthcare costs,” Ku said in a statement.

Counseling: A Building Block or a Hurdle?

When the authors examined state-level differences in the use of anti-smoking medications by Medicaid patients between 2010 and 2014, they found that the counseling requirement in fact became a barrier to quitting smoking.

The counseling sessions are designed to help smokers quit. However, the benefits may go unused if patients and physicians are unaware of their availability in the first place. More than 50% of smokers in Medicaid-managed care plans said that their physicians were not as invested in offering assistance in terms of medications or counseling, to quit.

It is imperative for states to increase efforts to develop more comprehensive coverage and reduce barriers to coverage because:

• In US, smoking is the leading cause of preventable illness and death
• Medicaid’s low-income beneficiaries are twice as likely to smoke as the general public
• Roughly 15% of Medicaid expenditures are because of smoking-related diseases
• By lowering smoking rates, hospitals can reduce cardiovascular-related admissions

By empowering patients and providers to increase awareness of cessation benefits and undertake the difficult challenge of quitting, states can drastically reduce healthcare costs while positively impacting health. This would also prevent relapses.