Stimulus Funding for U.S. Quitlines

Summary of Conference Call

September 2, 2009

Welcome and Call Logistics

Linda Bailey, President and CEO of NAQC welcomed participants to the call and noted that follow up questions related to this topic can be emailed to .

The call included three presentations:

·  Stimulus Funding for Quitlines: How Likely Is it and What Will It Look Like? – Linda Bailey, President and CEO of NAQC

·  Planning and Preparations: Quitline Manager/Tobacco Control Program Perspective – Judy Martin, Tobacco Control Program Manager for Nebraska and a member of NAQC’s Advisory Council

·  Planning and Preparations: Quitline Service Provider Perspective – Mary Kate Salley, Vice President of Business Development, Free & Clear and a member of NAQC’s Advisory Council

Stimulus Funding for Quitlines: How Likely Is it and What Will It Look Like?

Introduction

The American Recovery and Reinvestment Act of 2009 (ARRA), otherwise known as the stimulus package, set aside $650 million in funding for a Health and Wellness Fund. Over the past ten months, NAQC and other national organizations have been talking with colleagues at CDC and HHS about the funding. Although there are many priorities for this funding, we have been advocating that some of this funding should be earmarked for quitlines.

There is no guarantee, but the likelihood of stimulus funding for quitlines looks positive. Information shared during this call is intended to help quitlines begin planning for possible funding, using it to achieve the greatest possible impact on cessation and demonstrating progress through reach, quit rates and job creation.

Summary of Current Information

The U.S. Department of Heath and Human Services (HHS) is considering a stimulus package for state quitlines that MAY include the following:

·  Up to $45-50 million to be divided between all state and territorial quitlines

·  Funding through CDC in a new cooperative agreement

·  Distribution formula similar to other CDC formulas. It is likely there will be a core amount for each state and then a distribution based on size of population and prevalence of tobacco use

·  Match requirements that would discourage states from replacing current quitline funding with the stimulus funding

·  Quarterly reporting requirements that may include some MDS data and information on job creation

·  Likely to include performance goals related to reach and quit rates

·  Funding as early as November 2009 and expenditures allowed over two years

Process

·  Information about the use of the funding has NOT been forthcoming, but NAQC has recommended that state quitlines should be able to use the funding for a wide range of quitline activities including counseling, medications, media and infrastructure expansion

·  Although CDC/OSH is participating in decisions on the stimulus funding, final decisions will be made by HHS and likely reviewed by OMB/White House

·  CDC will provide details on the contracting mechanism once they have HHS approval. They will convene conference calls with the states and will give all states time to submit their proposals. CDC wants to minimize the burden on states. CDC has emphasized the importance of demonstrating an impact from this funding.

·  OSH is committed to the best funding description possible and ensuring the mechanisms are supportive of quitline growth.

·  NAQC and its partners are doing all we can to make sure that the stimulus funding will be allocated to quitlines, but there is no guarantee that this will happen.

QUESTIONS/COMMENTS

Questions and concerns to share with CDC:

·  Reporting requirements should not create more of a burden on callers during the intake process.

·  Will these monies be able to override state restrictions on promotions?

·  Careful planning will be important to avoid disruptions when funding stops. Response: To address this, the consensus seems to be that spending should be distributed over two years.

·  Demonstrating job creation benefits could be challenging for individual states. Response: Recommended discussing with service providers and reviewing the NAQC Issue Paper: Tobacco Cessation Quitlines – A Good Investment to Save Lives, Decrease Direct Medical Costs and Increase Productivity at http://www.naquitline.org/?page=issuepapers.

·  States would need time to demonstrate that prevalence rates have decreased. Response/Clarification: It looks like prevalence will be part of the funding formula but not required for reporting. Shorter term measures (i.e. reach and quit rates) are more likely to be required for reporting.

·  When will the guidance be released? Timing is a great concern. Response: We are hoping for release before November with proposals due before the end of the year.

Participants wanted to know if the funding could be used for the following:

·  Face-to-face counseling

·  Quitline promotions

·  Infrastructure upgrades (operating systems)

·  Pharmacotherapy

·  Evaluation

What is the proposed time frame for quit rates?

Response: We are asking CDC to be consistent with current practice and are encouraging use of NAQC’s annual survey data, MDS questions and quit rate and reach standards.

Resources available at http://www.naquitline.org/?page=issuepapers:

·  NAQC Issue Paper: Measuring Reach of Quitline Programs

·  NAQC Issue Paper: Measuring Quit Rates http://www.naquitline.org/resource/resmgr/docs/naqc_issuepaper_measuringqui.pdf

How will quitlines differentiate tobacco users reached as a result of stimulus funds versus those reached through normal operating funds? Will separate reporting be required?

Response: NAQC has shared this concern with CDC.

Has NAQC made recommendations regarding types of promotions or focus on priority populations?

Response: Most of our efforts to date have been related to securing funding. We are just now talking with CDC about the components of the package and have advocated for promotions money. We have heard that there may be some measures related to priority populations.

Planning and Preparations: Quitline Manager/Tobacco Control Program Perspective

Introduction

An investment of $45-50 million over the next two years will significantly increase the budgets of many quitlines. This level of funding can greatly increase quitline reach and service levels. Based on current information that the funding is likely to be distributed in Nov/Dec, require quarterly reports and be linked to accomplishing increased reach, below are some of the issues and key questions to consider:

Alerting Agency Management

·  Who needs to be informed of the pending stimulus funding – your supervisor? Chief medical officer? Governor’s office?

Writing a Proposal to CDC

·  This is a new funding stream, so proposals are likely to be required.

·  Demonstrating impact will be important.

·  Prepare information on current quitline status including successes and our challenges. Pull from recent CDC grant application.

·  Consider what CDC is likely to want. Does Best Practices give us a likely idea? Increase reach to 8% and provide counseling and medications (2 weeks to all callers and 4 weeks for uninsured/Medicaid).

·  Integration is important. Is CDC likely to want to see ways in which the quitline is being integrated into other partnership efforts throughout the health department (chronic, diabetes, maternal child health, etc), with healthcare partners (health plans, insurers, hospitals) and with community partners (other cessation groups at local level, priority pop groups, etc)

·  * Action: work with tobacco control staff to identify how to spend the funding, what it will cost, the likely impact and how to monitor spending, quitline services and outcomes and new job creation.

·  After internal discussions, discuss potential plans with service provider to assure proposed changes/expansion can be accommodated.

Receipt of Funding from CDC

·  Other ARRA funding has been provided through new contract mechanisms. This means the funding is NOT likely to be added to existing coop agreements.

·  Are there things I can do at the health department to prepare the contracting officers?

·  Will this require a new bid process or will the state allow for an amendment to existing quitline vendor contract?

·  How long will it take to complete the contract or contract amendment?

·  What will be the start date for new activities?

·  Do we want to spend state funding at higher levels once the CDC announcement is made and then rely more heavily on ARRA funding when available?

·  *Action: need to work with tobacco control staff, contract officer and service provider to determine at what point we change our services.

Contracting for Quitline Services and Reporting

Need to coordinate with our service provider to discuss:

·  Is it possible to increase capacity? If so, how long will it take to recruit, hire and train new staff?

·  If not, will we need to contract with a back-up vendor and for how long?

·  If we are not providing medications, what will it take to build that capacity and how will we plan to distribute meds (voucher, mail, other?) Will my service provider do this work or do I need to contract with another firm?

·  What additional reporting will the service provider need to provide? Can they do it?

·  How will we and the service provider, if appropriate, track job creation?

·  How long will it take to modify our contract?

·  When can new services begin?

Contracting for Other Cessation Services

·  Do I need to add other services such as Internet, medications, face-to-face counseling, language services?

Promotion

·  How will we make sure that the increased capacity gets used? Do we want to promote the quitline via TV ads, radio or other effective means (e.g., free medications, partnerships with health care, community groups, etc)?

·  What is our current reach and what will it take to get 6-8% reach? Where can we get help on these issues?

Coordination with Partners

·  Need to coordinate with existing partners and think about new partnerships (consistent with OSH’s integration focus).

·  Partnerships can help increase reach.

Complying with Reporting and Other Requirements of the CDC

·  It is likely that we will have to provide new quarterly reports on services delivered and outcomes.

·  Can my service provider do that?

·  What resources do I need to make sure the quality of reporting is good?

QUESTIONS AND COMMENTS

Do others have issues regarding competitive contracting/bidding?

If an amendment to existing contract is not possible, states may have to go out to bid extending implementation timelines. Perhaps sole source contracts might be one way to get around the competitive bidding requirement.

Research: Consider developing and implementing health care services collaborative research projects using this funding to continue to advance and improve telephonic interventions. [Note: it is unlikely that funding can be used for research.]

Priority populations: This may be a great opportunity to focus on priority populations.

Response: We have conveyed priority population needs to CDC. We are still lacking data (prevalence, reach and quit rates) in this area as a quitline community. There may be an opportunity for research or evaluation projects.

Delegate authority to service provider: Would it be possible to delegate authority so funds go directly to service providers rather than to the state?

Response: Will follow up with CDC.

Adding NRT/medications: Consider risks of creating obligations using temporary funds. Is it sustainable to provide medications?

When primary funder is NOT a state health department: Will funding be disbursed to the primary funders of quitlines regardless of whether the funders are state health departments? Response: We are waiting for a response from CDC on that issue.

Re-granting money: Will states be allowed to re-grant money to businesses and insurers to contract for quitline services? Response: Have not heard anything about re-granting. New York has had some re-granting success giving start up money to health plans to get key stakeholders engaged. These plans are now providing quitline services to members leaving public funds for the uninsured.

Fax referral training (promotion of the quitline): Will money be allotted for training? Response: There is a good evidence base for referral efforts and NAQC is pushing for full use of the funding.

Planning and Preparations: Quitline Service Provider Perspective

Introduction

This information was prepared to assist service providers of all sizes and funders. We have a huge opportunity to demonstrate effectiveness by creating jobs and helping people quit which ultimately drives down medical costs. We can demonstrate cost effective health care delivery. All we do is measurable. Our quit rates can demonstrate fairly quick return on investment.

Preparations

Initial preparations can include:

·  Building network capacity

·  Upgrading software and licenses

·  Determining how to spread out use of current state funds to prevent ramping up systems or employees and then having to scale back later.

Translating budgets (services and promotions) into services

·  Assess when calls will come in monthly and the staffing levels needed to address these calls

·  Use telephony equipment and software to help project staffing needs or map out day-to-day flow and use safety nets such as web enroll options, voice mail or overflow staff

·  Review promotions plans and consider:

-  individual states

-  bordering states

-  national promotions

-  earned media

·  Set clear expectations with funders and participants

Staffing – Timeline

Think about reverse timelines, titrating between state and stimulus funding and what staffing will be needed to handle the first wave of callers. Other considerations:

·  Allow for recruiting, hiring and training

·  Plan for continuation of services while recruiting

·  Cross-train staff to take registration calls

·  Hire part-timers who can flex up to full time

·  Schedule split shifts

·  Prepare for training needs

·  Add trainers and/or supervisors

·  Consider overflow support

Hiring Process

·  Estimated number of staff needed to meet service levels

·  Approval process for hiring

·  Short term strategies versus longer-term planning

·  Hiring process and budgets. Will call volumes be sustained to justify staffing up?

Contracting

·  Consider all parties involved (CDC, funder, service provider)

·  Process includes timing and turn around for amendments with service providers

·  Provide legal support if possible and necessary