News & Trends

Minnesota Blues Get Serious About Smoking Cessation; the cost of insuring the uninsured; and the FMLA case of Byrne v. Avon Products Inc.



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Blue Cross and Blue Shield of Minnesota has released the first-ever recommendations for health plans' roles in cutting down on tobacco use — the leading cause of preventable death in the U.S. — and is acting on its own advice. The guidelines, which are called the 5Cs, include:

  • Cover effective treatment — Provide benefit coverage for cessation medications and health care provider counseling. (The Minnesota Blues now cover over-the-counter items such as the nicotine patch or gum, as well as prescription drugs like Zyban. They also reimburse providers for time spent counseling and offer them financial incentives for pushing smoking cessation.)
  • Counsel members who smoke — Offer no- or low-cost access to behavioral counseling. (The plan offers the personalized BluePrint for Health smoking-cessation program, which includes phone counseling outsourced to Behavorial Solutions.)
  • Capitalize — Dedicate staff and significant financial resources to reducing tobacco use. (The Minnesota Blues are offering the 5Cs as a valued-added service with no increase in premiums.)
  • Collaborate — Add tobacco control to health plan policy agenda; organize clinical and community cooperation. (The Minnesota Blues supports the Diverse Racial and Ethnic Groups and Nations Project (DREGAN), which focuses on tobacco-eduction for minorities at a community level through public awareness programs.)
  • Count — Conduct research to monitor progress, measure ROI and improve quality of cessation services. (The Minnesota Blues has a number of studies in development.)

Meanwhile, two recent reports demonstrate the powerful grip of tobacco, even in the face of severe consequences. Only 16.5 percent of smokers with chronic obstructive pulmonary disease whose doctors advise them to quit remained smoke-free after a year, according to a study from the Institute of Tuberculosis and Lung Diseases. The study found 8.4 percent of smokers with normal lung function able to quit. A separate study published by the American College of Chest Physicians found 35 percent of adults with asthma were smokers vs. 24 percent of the population at large.

Fifty-six percent of employees are postponing vacation time until the current work situation improves, reveals a recent ComPsych poll. And 44 percent are taking limited vacation time this year, all due to the dire job situation. Huge workloads and a feeling of job insecurity are high on the list of reasons keeping employees close to the office.



If the United States adopted one of two approaches to providing health care to the uninsured, it would increase health spending's share of the gross domestic product by less than one percentage point. So says a new report prepared for the Kaiser Commission on Medicaid and the Uninsured.

The study also concludes that there would be an increase of 3 to 6 percent of total health care spending. In terms of dollars, the cost of expanding the country's insurance coverage would be in the range of $34 billion to $69 billion. Far from inexpensive, but still a small fraction of what the U.S. already spends.

The study measured the direct cost of care if all the uninsured were offered coverage and used the system at the same rate as the insured population. Two approaches were used to assess the problem. One assumed the newly insured's spending would be similar to lower- or middle-income people covered by average private insurance policies. The other assumed spending would be most like those covered by the average public insurance policy. The private and public approaches represent, respectively, the high and low ends of the spending estimate.

Spending on Direct-to-Consumer (DTC) drug advertising has more than tripled from $800 million in 1996 to $2.7 billion in 2001, according to a new study. Surprisingly, DTC advertising did not boost brand sales or encourage switching to more expensive products. Instead, it increased sales for entire classes of competitive drugs.



The 7th Circuit Court of Appeals in Chicago recently ruled that an employee fired for "sleeping on the job" is entitled to return to work under the Family and Medical Leave Act (FMLA).

The case of Byrne v. Avon Products Inc. (No. 02-2629, 7th Cir. 5/9/03), involves a highly regarded stationary engineer on the night shift at Avon Products. Considered a model employee prior to November 1998, Byrne suddenly began sleeping and reading on the job. When managers tried discussing the matter with Byrne, he had already left work early. Calls to his home were answered by his sister, who told Avon he was "very sick." Byrne finally agreed to discuss the issue at a meeting, but failed to show. Consequently, Avon fired him for missing that meeting plus sleeping on the job.

Byrne had a good reason for missing that meeting, though, as he was suffering from depression, hallucinations and panic attacks, and had even attempted suicide. After two months of treatment, Byrne was ready to return to work. When Avon wouldn't rehire him, he filed suit. A federal district court ruled in favor of Avon, and Byrne appealed.

The Seventh Circuit overturned summary judgment, stating that news of Byrne's hospitalization, as well as his sister's "very sick" comment, may have been sufficient notice to Avon to implicate FMLA. The case was therefore returned for a trial. The court held that Byrne's final two weeks of sleeping on the job should have classified that time as medical leave and he is entitled to reinstatement.

Men are just as likely as women to be primary caregivers for elderly parents, says a new study for the MetLife Mature Market Institute. Men are more likely to live an hour or more from the care recipient and perform money management tasks. They're less likely than women to discuss caregiving with co-workers and supervisors, and to perform more personal tasks including bathing, dressing and feeding. Only one in three of the survey's respondents was aware of their company's eldercare programs.


News & Trends.

Business and Health

Jun. 15, 2003;21.