The Medi-Cal Incentives to Quit Smoking Project: Impact of Statewide Outreach Through Health Channels

Am J Prev Med. 2018 Dec;55(6 Suppl 2):S159-S169. doi: 10.1016/j.amepre.2018.07.031.

Abstract

Introduction: Little is known about how incentives may encourage low income smokers to call for quitline services. This study evaluates the impact of outreach through health channels on California Medicaid (Medi-Cal) quitline caller characteristics, trends, and reach.

Study design: Longitudinal study.

Setting/participants: Medi-Cal quitline callers.

Intervention: Statewide outreach was conducted with health providers, Medi-Cal plans (all-household mailings with tracking codes), and public health organizations (March 2012-July 2015). For incentives, Medi-Cal callers could ask for a $20 gift card; in September 2013, callers were offered free nicotine patches.

Main outcome measures: Caller characteristics were compared with chi-square analyses, joinpoint analysis of call trends was performed accounting for Medi-Cal population growth, referral source among Medi-Cal and non-Medi-Cal callers was documented, and the annual percentage of the population reached who called the Helpline was calculated. Analyses were conducted 2016-2018.

Results: Total Medi-Cal callers were 92,900, a 70% increase from prior annual averages: 12.4% asked for the financial incentive, 17.3% reported the mailing code, and 73.3% received nicotine patches while offered. Among the two thirds of callers who completed counseling, 15.5% asked for the financial incentive, and 13.6% reported the mailing code. A joinpoint analysis showed call trends increased 23% above expected for the Medi-Cal population growth after mailings to providers and members began, and decreased after outreach ended. Annual reach increased from 2.3% (95% CI=2.1, 2.6) in 2011 to peak at 4.5% (95% CI=3.6, 5.3) in 2014. Among subgroups with higher reach rates, some also had higher rates of asking for the financial incentive (African Americans, American Indian), reporting the tracking code (whites), or both (aged 45-64 years). Medi-Cal callers were more likely than non-Medi-Cal callers to report providers (32.3% vs 23.8%) and plans (19.7% vs 1.4%) as their referral source, and less likely to cite media (20.2% vs 44.4%, p<0.001).

Conclusions: Statewide outreach through health channels incentivizing Medi-Cal members increased the utilization and reach of quitline services.

Supplement information: This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • California
  • Counseling / statistics & numerical data
  • Female
  • Health Promotion / economics
  • Health Promotion / methods*
  • Hotlines / methods*
  • Hotlines / statistics & numerical data
  • Humans
  • Longitudinal Studies
  • Male
  • Medicaid / economics
  • Medicaid / statistics & numerical data
  • Middle Aged
  • Motivation
  • Patient Participation / economics
  • Patient Participation / psychology
  • Patient Participation / statistics & numerical data
  • Poverty / economics
  • Poverty / psychology*
  • Poverty / statistics & numerical data
  • Program Evaluation
  • Reimbursement, Incentive / economics
  • Reimbursement, Incentive / statistics & numerical data
  • Smokers / psychology*
  • Smokers / statistics & numerical data
  • Smoking Cessation / economics
  • Smoking Cessation / methods*
  • Smoking Cessation / statistics & numerical data
  • Telephone
  • Tobacco Use Cessation Devices / economics
  • United States