1. The New Smoking Cessation
Imperative
A review of current trends in
programming, incentives and plan design
November 16, 2012
© 2012 beBetter Health, Inc. Confidential. Do Not Distribute.

2. Introduction
Speakers
Learning objectives :
 To understand the facts of tobacco use Gary B. Sams MS
Chief Wellness
 To review current trends in tobacco cessation Officer
 To review and discuss benefit plan and
incentive program design issues
 To understand resources available to support Cameron Smith
the development and delivery of effective Regional Sales
tobacco cessation programs Director

3. Company Background
WE FOCUS ON
WELLNESS ESSENTIALS
eatBetter maintain a healthy diet
moveBetter get enough exercise
breatheBetter don’t smoke
The presence of just one healthy behavior compared
with none cuts chronic disease risk in half. (CDC)

4. beBetter products and services
have helped millions address
their challenges with tobacco use
and nicotine addiction since 1977
The Tobacco Cessation Products and Services of beBetter Health
Program
Consultation Web Based Marketing
NRT Sales Coaching
& Evaluation Programming Support

5. Tobacco Use Facts:
According to the 2010 U.S. Surgeon General's report, 443,000 U.S. adults die from smoking-
related illnesses each year. Smoking costs the United States $96 billion in direct medical
expenses and $97 billion in lost productivity annually.
 Among daily smokers, the proportion who smoked ≥30 cigarettes per day (CPD)
declined significantly, from 12.6% in 2005 to 9.1% in 2011, whereas the
proportion of those who smoked 1–9 CPD increased significantly, from 16.4% to
22.0%.
 Overall, among current smokers and those who had quit during the preceding
year, 51.8% had made a quit attempt for >1 day during the preceding year.
 Current smoking prevalence declined most markedly from 2005 to 2011 among
adults aged 18–24 years (from 24.4% to 18.9%), and this age group, which had
the highest prevalence in 2005, now has the lowest of any group aged <65
years.
Source - Morbidity and Mortality Weekly Report (MMWR)
Current Cigarette Smoking Among Adults — United States, 2011
November 9, 2012 / 61(44);889-894

6. Employer Response:
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2012.

7. Employer Response:
 Workplace tobacco use policies
 Hiring and Personnel Policies
 Health Benefit plan design modification
 Employee Health and Wellness Programs
Recommended Reading
www.no-smoke.org

8. Tobacco Cessation
Programming Trends
 Goals
 Programs
 Success
 Incentives and Premium Differentials
 Program Planning
 Communication

9. Tobacco Cessation
Programming Trends
Tobacco Cessation Program Goals
 Reduce health care & lost productivity costs
 Support tobacco-free campus policies
 Implement Tobacco Premium Differentials,
Surcharges and Incentives
 Improve employee health!

10. Tobacco Cessation
Programming Trends
Types of Programs
 On-site face-to-face coaching
 Web-based programs
 Texting & Mobile
 Telephonic coaching

11. Tobacco Cessation
Programming Trends
Successful Programs
1. Participation
2. Quit Rate
• Communication
• Incentives
• Vendor Selection
Recommended Reading
TowersWatson 2011/2012 Staying@Work Survey report

12. Tobacco Cessation
Programming Trends
Types of Incentives
 True premium surcharge or discount
 HSA or FSA Contribution
 Wellness Credits
Premium Differentials
 Identifying tobacco users
i. Affidavit
ii. HRA
iii. Biometric testing or Cotinine testing

13. Tobacco Cessation
Programming Trends
Programming Plan for Incentives
• Timeline: offer tobacco cessation program
6 months to 1 year in advance
• Tie premium differential/incentive to
participation
• Allow year-round opportunity for incentive
• Clear communication strategy
Recommended Reading
Centers for Disease Control and Prevention. Quitting Smoking Among
Adults—United States, 2001–2010. Morbidity and Mortality Weekly
Report [serial online] 2011;60(44):1513–19 [accessed 2012 Jun 7].

14. Tobacco Cessation
Programming Trends
Communication
• Carrot vs. Stick (reward vs. penalty)
• Offer spouses support
• Clearly communicate what needs to
be done
• Identify outbound calls to tobacco
users
• Support executive management

15. Legal Considerations
 Individual state laws vary around
smokers’ rights laws and lifestyle
statutes
 Just because it is legal to test for
tobacco use doesn't mean it’s the right
thing to do
 There are many complicating issues to
consider, such as 2nd-hand exposure
through family member use
 The rising use of e-cigarettes
 Consider alternatives and company
culture
Recommended Reading
The Trouble with Tobacco Testing
Human Resource Executive Magazine Online
Jill Cueni-Cohen- Tuesday, October 9, 2012
Link: http://www.hreonline.com /HRE/view/story.jhtml?id=534354450

16. Legal Considerations (Wellness)
The Five Criteria
1. Limited to 20% Differential
2. Must Be Tied to Wellness
Programs
3. Annual Qualification
4. Provide Alternative Standards for
Medical Exceptions
5. Disclose Alternative
Recommended Reading
Results-Based Wellness Incentives
How to Strategically Tie Your Wellness Program to A Benefit Plan Design with Premium Differentials
An Industry Brief by beBetter Health, Oct. 2012 – available upon request
www.beBetterhealth.com
For additional information, see the DOL FIELD ASSISTANCE BULLETIN 2008-02.10 -Taken from
the Department of Labor website

17. What’s the ROI?
Workplace Costs of Tobacco Use
Employer Direct Costs Examples
 Greater health insurance costs and claims
 Greater life insurance premium costs and increased claims
 Greater disability costs
 Greater worker's compensation payments and occupational health awards
Employer Indirect Costs Examples
 Recruitment and retraining costs resulting from loss of employees to
tobacco-related death and disability
 Lost productivity
 Greater amount of work time used on tobacco-use habits and routines
Recommended Reading
Smoke-free work sites top ten financial benefits to employers. Western CAPT/CASAT. University of Nevada, Reno.
Center for Health Promotion Publications. The Dollar (and sense) Benefits of Having a Smoke-Free Workplace. Lansing,
Michigan Tobacco Control Program; 2000.
Centers for Disease Control and Prevention. Making your Workplace Smoke-Free: A Decision Makers Guide. Available at:
http://www.cdc.gov/tobacco/secondhand_smoke/00_pdfs/fullguide.pdf. Accessed: September 10, 2007.
NBGH – Tobacco: The Business of Quitting- An Employers Website for Tobacco Cessation. Accessed: November 1, 2012

18. What’s the ROI?
Investments in smoking cessation save health plans and
employers money in the short and long term.
Research has shown that health plans investing $35-$410 to help a person
quit over the course of a year generate positive return on investment (ROI)
within 3 years. Simulation models using health plan data to estimate ROI for
smoking cessation indicate that spending $0.18-$0.79 PMPM generates
positive net ROI of over $1.70-$2.20 after five years. This model also
demonstrates positive ROI for employers beginning in the first year that the
investment was made and continuing over the five-year period. 1
Smoking cessation increases productivity.
The American Productivity Audit, a national survey of over 29,000 workers,
found that tobacco use was a leading cause of worker lost production time—
greater than alcohol abuse or family emergencies. Quitting smoking
improves a worker’s productivity.2
Recommended Reading
1-“Making the Business Case for Smoking Cessation Programs” A report by America’s Health Insurance Plans.
http://www.businesscaseroi.org/roi/apps/execsum.aspx
2-Stewart, WF, Ricci, JA, Chee, E, Morganstein, D. Lost productivity work time costs from health conditions in the United States: Results from the American
Productivity Audit. Journal of Occupational and Environmental Medicine 2003;45(12):1234-1246. ClearWay MinnesotaSM and Minnesota Department of
Health. Minnesota Adult Tobacco Survey: Tobacco Use in Minnesota: 2010 Update. 2011

19. What’s the ROI?
http://www.businesscaseroi.org/roi/default.aspx

20. Employer Resources
There are a tremendous number of resources available for
employers who want to develop or improve tobacco cessation
programs for their employees. Below are links to some of the most
prominent organizations offering assistance.
Centers for Disease Control and Prevention – Smoking & Tobacco Use
www.cdc.gov/tobacco/quit_smoking/cessation/index
American Cancer Society Quit for Life Program
www.acsworkplacesolutions.com/quitforlife.asp
Fundamentals of Smokefree Workplace Laws
www.no-smoke.org/pdf/CIA_Fundamentals.pdf
Employers’ Smoking Cessation Guide:
Practical Approaches to a Costly Workplace Problem
www.endsmoking.org
Tobacco: The Business of Quitting
An Employer’s Website for Tobacco Cessation.
www.businessgrouphealth.org/tobacco
1-800-Quit-Now
www.smokefree.gov/quitlines-faq.aspx - http://betobaccofree.hhs.gov/

21. Employer Resources
www.breathebetter.me
This program is free for consumers and employers within
basic set up parameters.
Some fee for service features are available such as private
labeling, telephonic coaching and special NRT options.

22. Thank You
For a copy of today’s presentation slides
and additional resources, please visit:
www.bebetter.com/hplive
For follow up information please contact:
Cameron Smith
Regional Sales Manager
beBetter Health, Inc.
325 W. Huron Street
Chicago, IL 60654
512.213.7910
cameron.smith@bebetter.net