Tufts Health Plan on "Affordable" Coverage by CEO, James Roosevelt

Gov. Deval Patrick’s announcement this past weekend that seven health plans will be submitted to receive a seal of approval from the Connector was momentous.

How the health care sector achieved these new, lower rates is a story of determination and leaving no stone unturned. When health care reform was passed, everyone hailed its arrival but all of us in the field knew that it had many unanswered questions.

As chief executive officer of a local health plan with a national reputation for quality, and with more than 25 years of experience in health care and public policy, for me, its passage marked the beginning of a sea change. Health care reform has been attempted many times in the past but has been crippled by the weight of its complexity.

Those of us involved in developing and enacting Chapter 58 recognized that we needed to be willing to change in order to reach the July 1 mandatory starting line.

So last month, when Gov. Patrick called and asked me to lower the average premium for our proposed plans, we at Tufts Health Plan rolled up our sleeves and challenged ourselves to reach that goal.

Tufts Health Plan’s submission to the Connector is a plan with prescription drug coverage that for a typical 37-year old uninsured Massachusetts resident will cost $241 per month. That premium can be reduced to $149 if paid for with pre-tax dollars (for more on buying health insurance pre-taxes click here). All office visits are covered with a copayment and excluded from the medical deductible of $2,000. Young adults can purchase a plan with drug coverage for as low as $206 per month.

To create these plans, we started by reaffirming our commitment to access, affordability and quality. We acknowledged that we had to use our available resources to address the underlying cost of health care. We identified the services that promote health and wellness – office visits, prescription drugs, preventive health screenings and wellness programs – and provided the highest level of coverage for them.

The plan includes our nationally recognized evidenced-based medical management programs. While health care has more than its fair share of jargon, I will share how the physicians at Tufts Health Plan who run this program describe it to me. The program uses the latest available medical science and research to develop standards of care. The medical management program helps reduce variation in practice such as when two patients with identical conditions receive different care. It also provides nurse case managers to those members dealing with complex issues, such as high-risk pregnancy, to help them understand and implement their physician’s care plan.

We reviewed market research that showed that people prefer to have a smaller network of hospitals rather than having lower benefits. Many of the hospitals and physicians in the Tufts Health Plan network stepped up to the plate, agreeing to lower rates in this select network plan because they believe in health care reform and want to see it succeed.

The hospitals included in this plan are of the highest quality and meet our rigorous credentialing standards. For example, a member of this plan can receive cardiac care at Mount Auburn Hospital, a Harvard University teaching hospital in Cambridge. Monday morning, I received an e-mail from Dr. Kim Saal, chief of cardiology at Mount Auburn. He wrote,

“We have expanded our division this past year with the addition of a cardiologist who specializes in electrophysiology and a second cardiologist who specializes in cardiac imaging. Our approach to cardiac imaging at Mount Auburn Hospital is unique as all CT
angiograms and cardiac MR studies are performed and read jointly by cardiology and radiology. This summer we will be adding another electrophysiologist who will be working both at Mount Auburn Hospital and at the Beth Israel Deaconess Medical Center The collegiality that exists between cardiology and cardiac surgery since the appointment of Dr. Vladimir Birjirniak as Chief of Cardiac Surgery has fostered a single front to our approach to our patients that I believe is second to none. Our quality indicators in both cardiac surgery and interventional cardiology continue to stand out as one of the leaders in the state as they have done since the onset of these quality tools.”

Certainly, more change is on the way. Individuals who previously opted to forgo coverage will now need to consider their options. Ideally, this legislation will inspire more robust information on the quality and cost of health care than what is currently available.

For today, I am going to take satisfaction in knowing that my health care colleagues, with the leadership of the Governor, the Legislature, Jon Kingsdale and the staff of the Connector, have achieved a historic step in providing a fundamental social benefit.

James Roosevelt, Jr., president and chief executive officer
Tufts Health Plan