title: Effects of Global Payment and Accountable Care on Tobacco Cessation Service Use: An Observational Study.
abstract: Tobacco use is the leading cause of preventable death and disability. New payment and delivery system models including global payment and accountable care have the potential to increase use of cost-effective tobacco cessation services.
  
  
  
  To examine how the Alternative Quality Contract (AQC) established in 2009 by Blue Cross Blue Shield of Massachusetts (BCBSMA) has affected tobacco cessation service use.
  
  
  
  We used 2006-2011 BCBSMA claims and enrollment data to compare adults 18-64 years in AQC provider organizations to adults in non-AQC provider organizations. We examined the AQC's effects on all enrollees; a subset at high risk of tobacco-related complications due to certain medical conditions; and behavioral health service users.
  
  
  
  We examined use of: (1) any cessation treatment (pharmacotherapy or counseling); (2) varenicline or bupropion; (3) nicotine replacement therapies (NRTs); (4) cessation counseling; and (4) combination therapy (pharmacotherapy plus counseling). We also examined duration of pharmacotherapy use and number of counseling visits among users.
  
  
  
  Rates of tobacco cessation treatment use were higher following implementation of the AQC relative to the comparison group overall (2.02 vs. 1.87 %, p < 0.0001), among enrollees at risk for tobacco-related complications (4.97 vs. 4.66 %, p < 0.0001), and among behavioral health service users (3.67 vs. 3.25 %, p < 0.0001). Statistically significant increases were found for use of varenicline or bupropion alone, counseling alone, and combination therapy, but not for NRT use, pharmacotherapy duration, or number of counseling visits among users.
  
  
  
  In its initial three years, the AQC was associated with increases in use of tobacco cessation services.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA. huskamp@hcp.med.harvard.edu.
authors.forename: Haiden A
authors.initials: HA
authors.lastname: Huskamp
authors.affiliation: McLean Hospital, Belmont, MA, USA.|Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Shelly F
authors.initials: SF
authors.lastname: Greenfield
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Stuart
authors.affiliation: University of Pittsburgh School of Public Health, Pittsburgh, PA, USA.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Donohue
authors.affiliation: Blue Cross Blue Shield of Massachusetts, Boston, MA, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Duckworth
authors.affiliation: Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA.
authors.forename: Elena M
authors.initials: EM
authors.lastname: Kouri
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Zirui
authors.initials: Z
authors.lastname: Song
authors.affiliation: Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Chernew
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Colleen L
authors.initials: CL
authors.lastname: Barry
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics*; D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000191:economics; D054598:Blue Cross Blue Shield Insurance Plans / Q000191:economics; D003376:Counseling / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D058996:Quality Improvement; D012052:Reimbursement, Incentive; D012907:Smoking / Q000009:adverse effects; D020340:Tobacco Use Cessation / Q000191:economics* / Q000706:statistics & numerical data*; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000191:economics / Q000628:therapy; D055815:Young Adult
keywords: accountable care; global payment; tobacco cessation