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March 3, 2011 Volume VII, No. 34

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

Have payment and shipping bans for online cigarette purchases decreased traffic to cigarette-selling Web sites? Find out in this week's issue, along with the kind of smoking cessation messages that get smokers to quit in four months.

Also this week, learn how incentives can improve health outcomes and change end-of-life behavior, and take our second annual Health & Wellness Incentives Use e-survey.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Cigarette-Selling Web Sites
  2. Smoking Risks in Pregnancy
  3. Incentives for End-of-Life Behavior Change
  4. How Incentives Can Improve Outcomes
  5. Who is Administering ACOs?
  6. Benchmarks in Tobacco Cessation
  7. Smoking Cessation Messages
  8. Health & Wellness Incentives Use in 2011

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Publisher:
Melanie Matthews, mmatthews@hin.com

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Payment, Shipping Bans Stub Out Cigarette-Selling Web Sites

Bans on using credit cards to pay for cigarettes bought on Internet sites — combined with bans on commercial shippers delivering the products — appear to have effectively reduced the size and reach of the online cigarette sales industry, a new University of North Carolina at Chapel Hill study shows. The study found that such bans lowered the number of vendors offering cigarettes online and reduced consumer traffic to the most popular cigarette-selling Web sites.

According to researchers, "Most Internet vendors offer tax-free cigarettes, making them cheaper than those sold at stores. This undermines the impact that higher prices have on reducing smoking." Aside from violating tax laws, most online cigarette vendors have weak age verification and sell to minors. This led to landmark voluntary agreements in 2005 with major credit card companies and private shippers to ban payment transactions and bar commercial shippers from transporting all Internet cigarette sales.

Researchers studied the bans’ effectiveness by examining the sales practices of hundreds of Web sites one year before and two years after the agreements went into effect. They also compared the number of unique monthly visitors to the 50 most popular cigarette vendor sites to determine whether the bans altered Web traffic.

The study found that following the bans, many Web sites closed down. There was also a 3.5-fold decline in traffic to the 50 most popular vendor sites, resulting in an estimated 1.25 million fewer visits per month before the end of the 2005. And although an influx of new vendors initially saw a net increase in the number of sites, their numbers fell markedly over the following year, resulting in an overall drop in the total number of vendors. Researchers also found that the proportion of vendors accepting credit cards and PayPal dropped from 99.2 percent to 37.4 percent after the bans, and the proportion offering to ship via UPS, FedEx and other commercial shippers dropped from 32.2 percent to 5.6 percent. However, there was a corresponding increase in vendors offering non-banned payment options (such as personal checks) and shipping options (including the U.S. Postal Service, which did not ban cigarettes). This indicated that the Internet vendors actively exploited loopholes in the voluntary agreements, the study noted, although a new federal law signed by President Obama last year has strengthened the provisions of the voluntary agreements and made tobacco non-mailable matter through the U.S. Postal Service.

To learn more about this research, please visit:
http://uncnews.unc.edu/content/view/4326/107/

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Smoking Early in Pregnancy Raises Heart Defects Risk in Infants

Maternal cigarette smoking in the first trimester was associated with a 20 to 70 percent greater likelihood that a baby would be born with certain types of congenital heart defects, according to a CDC study. Congenital heart defects are the most common type of birth defects, contributing to approximately 30 percent of infant deaths from birth defects annually.

The study found an association between tobacco exposure and certain types of defects such as those that obstruct the flow of blood from the right side of the heart into the lungs (right ventricular outflow tract obstructions) and openings between the upper chambers of the heart (atrial septal defects). Based on the findings of this study and others, eliminating smoking before or very early in pregnancy could prevent as many as 100 cases of right ventricular outflow tract obstructions and 700 cases of atrial septal defects each year in the United States. For atrial septal defects alone, that could potentially save $16 million in hospital costs.

Congenital heart defects can result in an increased likelihood of death or long-term disabilities. They affect nearly 40,000 infants in the United States every year. It is estimated that right ventricular outflow tract obstructions affect approximately 2,500 infants per year and atrial septal defects affect approximately 5,600 infants per year in the United States. In 2004, U.S. hospital costs for all congenital heart defects were estimated at approximately $1.4 billion.

To learn more about this research, please visit:
http://www.cdc.gov/media/releases/2011/...

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Using Incentives for End-of-Life Behavior Change

Getting people to think about dying is not the first health behavior that comes to mind when employing incentives. However, incentives can be used anywhere in the healthcare continuum — including end of life — to influence behaviors, notes Neal Sofian, MSPH, director of member engagement at Premera Blue Cross. Sofian describes the barriers individuals face at this time in their lives and how the use of incentives can result in exactly the kind of care these patients want and need.

To listen to this complimentary HIN podcast, please visit:
http://www.hin.com/podcasts/podcast.htm#144

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How Incentives Can Improve Outcomes

This week's expert is Dr. Elizabeth Rula, principal investigator of Health Outcomes Research at Healthways Inc.

Question: How do incentives impact health outcomes?

Response: Incentives will increase enrollment in a program, but incentives can also improve outcomes. In a study of 1,550 employees involved in wellness programs that were either incentivized or not incentivized, over a single year, the number of high-risk individuals dropped by 16 percent in the programs with incentives, but only dropped about 8 percent in the programs without incentives. As a whole, more individuals in the incentivized programs were shifting toward low-risk categories compared with the non-incentivized programs.

For more information on health and wellness incentives use, please visit:
http://store.hin.com/product.asp?itemid=4046

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

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Who is Administering ACOs?

Accountable care organizations (ACOs) create integrated delivery systems that encourage teams of physicians, hospitals and other providers to collaboratively coordinate care for ACO members. We wanted to see who is administering ACOs in today's marketplace.

Click here to view the chart.

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Healthcare Transparency: 2010 Performance Benchmarks in Tobacco Cessation

This white paper summarizes results of the Healthcare Intelligence Network’s second annual Tobacco Cessaton & Prevention e-survey conducted in November 2010, revealing the efforts of 84 healthcare organizations to curb these trends, including program availability, program components and reimbursement trends.

To download this complimentary white paper, please visit:
http://www.hin.com/library/registertcp2010.html

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Individually Tailored Smoking Cessation Messages Get Smokers to Quit Quickly

People who demonstrated a stronger brain response to certain brain regions when receiving individually tailored smoking cessation messages were more likely to quit smoking four months after, a University of Michigan study found. The new study underscores the importance of delivering individually tailored public health messages to curb unhealthy behaviors. It also begins to uncover the underlying neural reasons why these individually tailored messages are so much more effective than a one-size-fits-all approach.

Researchers have known for 15 years that tailored public health messages that account for a person's individuality work better at curbing unhealthy behaviors but until now, they haven't known why. For this study, researchers hypothesized that portions of the brain activated during self-related processing were also engaged when people received individually tailored health messages, and that this brain activity accounted for the increased effectiveness of tailored messages. For the study, the research group assessed 91 people who wanted to stop smoking, and based on those answers they designed an individual smoking cessation program for each subject.

Next, researchers imaged subjects' brains with MRI to see which portions responded to tailored and untailored messages about smoking cessation, and also to neutral messages. They then compared the brain response to the brain response during a self-appraisal task in which participants, still in MRI, made yes-no judgments to self-related statements such as "I am shy" or "I am athletic." Several brain regions activated during the self-related task also appeared to activate during the tailored messages in the same group of smokers. After the scan, participants completed the full smoking intervention program that was designed for each subject. More than 50 percent of people quit after the four month follow-up; most smoking cessation programs range from 15 to 30 percent success. According to the researchers, "People who are more likely to activate self-related regions of the brain during tailored message processing, particularly dorsomedial prefrontal cortex, are more likely to quit four months after." Some people had a stronger brain response than others to the tailored messages, but it's not clear why. It may be that their brains are hardwired to process information differently, or that those people had a stronger desire or commitment to quitting, according to the researchers. "However, the desire is not just motivation, because there was no difference in motivation between quitters and non-quitters," said the researchers.

The findings have broad public health implications. According to researchers, "The bigger picture of this is advertisers are increasing using functional MRI to test advertising. If you can imagine that people who create fast food or who sell cigarettes are doing this in an effort to convey a stronger message, we really need to better understand the ways our health messages can be more effective." It was stressed that researchers don't want to use functional MRI as a predictor for success of public health messages; it's simply not economically feasible. They do, however, want to better understand and eventually map the portions of the brain responsible for making decisions that will improve their health.

To learn more about this research, please visit:
http://ns.umich.edu/htdocs/releases/story.php?id=8285

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Health & Wellness Incentives Use in 2011

Healthcare companies have grown increasingly creative in their use of incentives to drive engagement and participation in health and wellness programs. Please share your experiences with incentives by completing HIN's third annual survey on this topic by March 31, 2011. You'll receive a free executive summary of the compiled results, and your responses will be kept strictly confidential.

To participate in this survey and receive its results, please visit:
http://www.surveymonkey.com/s/incentives

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