TABLE 3—

Perspectives on Cost Sharing: April–May 2014

State	State Department Strategy	Role of Service Provider	Private/State Quitline Relationship
1	SH: Yes, regardless of the ACA, we ask the insurers to at least cover the drugs and the next step is the quitline. We show what “no action” on cessation is costing those groups and then talk about the cost of evidence-based treatment and implementation.	SH: [Service Provider] would be more than willing to come in to make the pitches to employers and insurers with direct contract, not cost sharing, in mind.	HP1: Use the state quitline and pay for any services not covered by the state quitline
		P: When an employer or other organization reaches out to us we also describe our “direct contract” option, meaning no cost share; they won’t piggyback off the quitline service. . . . We want to make sure when those groups reach out to us that they are aware of the benefit of a direct contract.	B: I do know about our own state quitline. People ask me about it and I do give them that since it’s free.
2	SH: We will support [Service Provider] to pursue building those [Health Plan] relationships.	SH: [Service Provider] has relationships with insurers already and it made the most sense to have them pursue those relationships further.	B: Not familiar with state quitline.
		P: We will [encourage health plan contracts]. We have not as of yet. The state is in the process of finalizing an interagency agreement for counseling reimbursement for Medicaid populations. Once that’s implemented, my plan is to encourage the payers to do the same, as a sustainability initiative.
3	HP: Currently waiting on the commissioner to give guidance on next steps; currently in the planning stages and hope that this [cost sharing] is the direction we are heading.	SP: There has been a lack of vision at the state level with respect to cost sharing with the state plans. The state has this quitline program and for me as a vendor to say “hey you want to do cost sharing”—without the state, it doesn’t work.	HP1: [State] quitline is free of charge and not sure what kind of partnership we can be engaged in which will have a cost associated with it.
			HP2: One of the reasons why the nurse practitioners refer clients to the quitline is because of the recognition of them being evidence-based tobacco cessation service.
4	SH: We are trying to encourage pilots and trials for insurers with the intent that the quitline will have its own financial engagement with these insurers—that the cost sharing would be between [Service Provider] and the private insurer.	P: [State Health] has put an edict out that for 2 years [they] are willing to pay for quitline services for anyone. We will provide reporting, including to health carriers and employers. The message is to use the quitline service and see what it provides, then in 2 years you can pay if you like it. So we have 5 employers who have signed up who have built this into their benefits package to save costs.	B: I am exceptionally impressed with our state quitline. Also each employer can setup an account with [State Quitline], and they can get info on where their employees are registered with the quitline, so they can see what benefit the quitline is providing to their employees.
			HP: We are using the service [state quitline] at no fee. We had some conversations beyond that, but one of the key components is individual level reporting that is needed prior to driving calls to the quitline and we want to overcome that hurdle before we have cost-sharing discussions.

Note. B = Insurance broker; HP = health plan representative; P = quitline service provider; SH = state health department.