mn clinic fax referral program. what is it? the mn clinic fax referral program allows you to easily...

MN Clinic Fax Referral Program

What is it?

• The MN Clinic Fax Referral Program allows you to easily refer any of your patients to appropriate tobacco quitline services via a single form. It is FREE for all Minnesotans.

• The program is sponsored by Call it Quits,a collaboration between seven of Minnesota’s major health plansand ClearWay Minnesota.

Why phone counseling?• Statistics show that fewer than 1 in 20

smokers will be successful in quitting tobacco and staying quit.1

• With tailored phone-based coaching, nearly 1 in 3 will be successful in quitting and staying quit.2

1 CDC Analysis of data from the 2000 National Health Interview Survey indicated that 4.7% of smokers quit and maintained abstinence for 3-12 months.

(CDC. Cigarette Smoking Among Adults – United States, 2000. MMWR. 2002;51:642-645)2 Free & Clear performance metrics for Blue Cross and Blue Shield of Minnesota, 2006. Based on a 30 day quit rate and a 12 month follow-up.

Program Components

• A series of individually-tailored calls from a quitline coach

• No limit to the number of calls to quitline coach while enrolled• Program materials mailed to each participant• Quit Aids (nicotine gum, patch, lozenge)

available via direct mail to enrolled participants**costs vary depending on benefits of the individual

• Patient visits clinic.

• Ask patient if he/she uses tobacco.

• Assess, are they interested in quitting?

• Assist, offer phone support through quitlines.

How it works…

How it works…

• Briefly explain about the tobacco quitline services:– Free– Confidential– Increases quitting

success– Available regardless of

insurance coverage

MN Clinic Fax Referral

Member agrees to be contacted

xJohn Doe

How it works…

• If interested, patient completes consent form.

• If Electronic Health Record (EHR) is used, verbal consent is documented in record.

How it works…

Consent form or

EHR record

is faxed to a single, centralized triage number

for all patients regardless of insurance status.

• Tobacco quitline will contact patient within 3 days.

• Calls are 15-20 minutes in length and emphasize support and successes.

How it works…

• Your clinic will receive a follow-up fax from the quitline with the referral outcome for your patient records.

• Reporting will also be available to view your clinic efforts.

How it works…

THANK YOU

Together we’ll make it easier for your patients to take the next step toward

becoming tobacco free.

If you have questions, please contact your clinic administrator.

To Sign Up and Begin Referring

• Call Kim Winter at (651)662-6879• Visit Center for Prevention website

http://www.preventionminnesota.com/• Complete and fax the combination clinic

registration and order form to enroll your clinic• A unique clinic ID and referral forms will be sent

to you