As major public health agencies such as the Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services (HHS), and state health departments face reductions in scope and resources, a unique opportunity arises for health insurers to take a leading role in improving public health, while also enhancing their own reputations and financial sustainability.
Consider tobacco use, the leading cause of preventable death in the United States, contributing to an estimated 490,000 deaths annually and accounting for over 11 percent of national health expenditures. Some organizations, like Kaiser Permanente Northern California, have made impressive strides in tobacco cessation and publish their results. Most health insurers supply coverage for treatment as required by law but do not actively promote their use.
Despite clear, well-established evidence supporting the cost-effectiveness of cessation programs, most health insurers do not prioritize this intervention. Overall, health plan performance on tobacco cessation is poor: doctors miss numerous opportunities to help their patients quit, or when they do, fail to include guideline-based advice on the use of medication and referral to counseling.
Overcoming industry excuses
When I have challenged health plans on the performance of their tobacco cessation programs, I hear two types of replies:
- Adverse selection: They don’t want to be better than other health plans because they would attract sicker patients.
- Member migration: With a 15 percent turnover each year, a successful quitter would take their future health care savings to a competitor.
If every health plan made a strong effort to treat cigarette smoking by their subscribers, then these objections would disappear, and every health plan would benefit. If health insurers collaborated on shared metrics and developed data collection and reporting for the physicians in their networks, the scale of the data available would supersede that of the recently shuttered CDC Office on Smoking and Health. The decades of successful interventions championed by that office would be sustained and enlarged.
Reimagining the insurer’s role
Health plans are under extraordinary scrutiny because of the rising cost of health care which is reflected in the premiums they charge. What if they collaborated to improve the public’s health and lower the cost of health care at the same time?
Evidence-based treatment of tobacco offers just such an opportunity. Health insurers can reimagine their roles, not just as payors, but as proactive partners in public health. By focusing on prevention and public health, they can better serve their members and improve their profitability.
Edward Anselm is a board-certified internist with a long-standing focus on public health, tobacco control, and preventive care. He earned his medical degree from the Chicago Medical School at Rosalind Franklin University and completed his internal medicine residency at Montefiore Medical Center in New York. Over the past three decades, Dr. Anselm has served in senior leadership roles across clinical, corporate, and managed-care settings, including chief medical officer positions at HIP Health Plan of New York, FidelisCare, and Health Republic Insurance of New York.
Recently retired from his role as medical director at Aetna, Dr. Anselm continues to teach at the Icahn School of Medicine at Mount Sinai as a clinical assistant professor. His current work focuses on strengthening reimbursement pathways for tobacco cessation and preventive services, helping clinicians integrate evidence-based care that improves patient outcomes while supporting practice sustainability. His research has been published in the American Journal of Accountable Care, the American Journal of Preventive Medicine, AJPM Focus, and Health Affairs Forefront, including articles on tobacco control in accountable care, underbilling of cessation services, and the financial and quality benefits of treating tobacco use as a clinical priority.
Dr. Anselm’s educational and policy work is shared through EdwardAnselmMD.com and The Anselm Nicotine Prescription, with professional updates available on LinkedIn.
