What are private health plans doing (or not) about smoking cessation?

The U.S. Public Health Service urges clinicians to screen their patients for smoking and advise those who smoke to quit. Yet, these practices are not widely implemented into clinical practice. We document the national prevalence of requiring screening for smoking and distributing relevant guidelines in private health plans, including health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point of service (POS) plans. Although smoking cessation activities are conducted by health care providers, health plans can influence providers' behavior through such requirements, information distribution, and incentives.

The data come from a nationally representative survey regarding the 2003 benefit year for 347 private health plans, reporting on 771 products (83% response rate). Respondents were asked about their practices regarding screening for smoking, guideline distribution, and incentives for guideline adherence.

Only 11% of products require, and 15% verify, that primary care practitioners screen for smoking. HMO products are more likely to require screening than either POS or PPO products. Only 22% of health plan products distribute smoking cessation guidelines to primary care providers, and as with screening, HMOs are more likely to do this. Nearly one-third offer training related to the guidelines. The most frequently used tool to encourage adherence to guidelines was feedback to primary care practitioners.

Understanding the reasons for these low rates of attention to smoking cessation is critically important because 97% of Americans with employer-based insurance are enrolled in managed care organizations. Increasing health plan involvement is necessary to reduce tobacco use and concomitant disease in the U.S.