Smoking Cessation Benefit Utilization: Comparing Methodologies for Measurement using New York State's Medicaid Data

Area of Science:

• Public Health
• Health Services Research
• Tobacco Control

Background:

• Pharmacotherapy and counseling are proven methods for smoking cessation.
• Medicaid programs are mandated to cover tobacco cessation services.
• Accurate monitoring of service utilization is essential for program evaluation and quality improvement.

Purpose of the Study:

• To evaluate the utilization of smoking cessation services within New York State's (NYS) Medicaid program in 2015.
• To compare utilization across different populations (fee-for-service vs. managed care) and service categories.
• To assess the impact of various smoker identification methods on utilization estimates.

Main Methods:

• Utilized Medicaid claims and encounters data.
• Incorporated four sources for smoking prevalence estimation: two population surveys, one Medicaid enrollee survey, and diagnosis codes.
• Compared the percentage of estimated smokers utilizing cessation services and the average number of services used.

Main Results:

• Smoking prevalence estimates varied widely (10.9%–31.5%) depending on the data source.
• Diagnosis codes identified less than 45% of smokers compared to survey estimates.
• Counseling services were utilized by more members (126,839) than pharmacotherapy (91,433), despite similar service counts.

Conclusions:

• Survey-based smoking prevalence estimates significantly exceed those from diagnosis codes in NYS Medicaid data.
• Relying on diagnosis codes for analyzing smoking cessation benefit utilization may lead to overestimation.
• Methodological choices, particularly the source of smoking prevalence data, critically impact utilization estimates and comparisons.