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MASSACHUSETTS IS ON THE VERGE OF AN UNPRECEDENTED OPPORTUNITY FOR CHANGE by James Roosevelt, Jr.

Nancy Turnbull’s year-end entry was a thought-provoking way to start the new year and as a result, generated some good discussion about health care costs and containment strategies. It is a conversation whose time has come.

The Massachusetts Association of Health Plans (MAHP) released in December a package of legislative proposals and voluntary measures its member health plans will adopt, including public disclosure of health care revenues and expenses, to help consumers and employers understand where the money is going in health care. Also in December, the Commonwealth released its Healthy Massachusetts Compact, a similar plan, which builds upon five elements to achieve its goals of ensuring access to health care; advancing health care quality; containing costs; promoting individual wellness; and promoting healthy communities.

What excites me is that health care reform has created an unprecedented opportunity—and desire—among different but related groups, all of whom have a role to play in keeping health care costs as affordable as possible. This groundswell is moving us all toward a common goal.

The first steps have been taken. Now, we must move from declaration of principles to dialogue and action, which translate into transparency of information and the ensuing scrutiny that will bring meaningful change. So be it. The health plan members of MAHP have already committed to transparency and look forward to the entire health care community joining us in an effort to make comprehensive information available in an easy-to-understand, accessible format so that consumers also can become part of this critical discussion.

Transparency is the only way that all of us – providers, health plans, legislators and consumers – will be able to identify all the factors that contribute to rising health care costs. Understanding why costs are rising is the first step to controlling them.

That is why the MAHP proposal contains four components designed to shine a spotlight on underlying health care costs and statutory changes that seek to make better use of existing health care dollars. These are the elements of the MAHP proposal:

• Annual public hearings on cost drivers. Such hearings would require health plans and providers to explain health care cost increases;

• Enhanced public reporting of health care revenues and expenses. While health plans regularly report this information to the state, it is not easy to find. Hospitals also should make publicly available data disclosing total inpatient and outpatient service revenue, total patient expenses, total capital expenses, total administrative expenses, surplus revenue, and endowment levels at a similar level of detail to that being released by health plans. While much of this data is currently filed with various state entities, it is important that hospital leaders come together to disclose this information in a format that is more easily understandable and more accessible to the public than it is today.

• Public forums to find solutions. Making better use of existing health care resources and keeping health care affordable will require the participation of everyone in health care — hospitals, physician groups, community health centers, consumer organizations, employers and state policy makers. Together we can identify and outline additional measures that control health care costs while maintaining or improving quality of care.

• A 17-point legislative package that, if enacted, has the potential to save the health care system several billion dollars.

To quote Henry David Thoreau, “Things do not change, we change.” As evidenced by the conversations I am having with other health care leaders, the interest and the action of our government leaders, and the great desire of our populace, I am convinced that we are changing, which will result in action. All parties involved won’t agree on everything, but we all agree on the most important thing—escalating, unsustainable health care costs cannot continue.

James Roosevelt, Jr. is the President and CEO of Tufts Health Plan
and Chairman of the Board, Massachusetts Association of Health Plans

This program aired on January 14, 2008. The audio for this program is not available.

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