"The Time Has Come For a Societal Shift" by James Roosevelt, Jr.

For those readers who routinely follow the dialogue of the health care community, it is no surprise that on some issues of implementation of universal health care, my point of view is dramatically different than that of Dr. David Himmelstein, a vocal advocate of the single payer system. However, after reading his CommonHealth blog entry, it is clear that Dr. Himmelstein and I agree on at least two fundamental issues that have the potential to improve the nation’s health status and save significant health care dollars. One, the inappropriate and overuse of technology in health care is not good medical practice and is a major cost driver that affects all of us. And two, wellness and prevention warrant more attention and hold real promise as meaningful ways to manage health care costs and improve health status.

In a study released earlier this week, PriceWaterhouseCoopers predicts that the nation’s medical cost will increase 9.9 percent in 2008 and an additional 9.6 percent in 2009, which is more than double the annual inflation rate. We simply must do something to address the unsustainable increases facing all of us. The timing is right for a societal shift in thinking.

As the CEO of Tufts Health Plan, my goal is for our members to have access to high-quality health care that is affordable. I believe my organization is contributing to that goal by working with physicians to help them deliver the right care at the right time, and in the right setting. This kind of medical management covers a broad spectrum, and yes, it includes prior authorization for some non-emergency, outpatient radiology procedures such as CT scans and MRIs. It is clear that our approach has contributed to improved health care delivery and has saved money for our employers and our members.

But beyond implementing evidence-based guidelines to measure and ascertain what exactly high-quality care is today, the timing is right for medical management to evolve to include what we call “member engagement.”

This initiative represents the next step in the cost and quality continuums by helping members not only effectively navigate the health care system, but also help them better manage their care and treatment, and lead a healthier lifestyle. People must assume more control of their own health.

Why am I so sure that the timing is right for an initiative like this? Because recently, Tufts Health Plan tested the public’s appetite for whether or not they are/or would be willing to make changes in their behavior to achieve lower health care costs. Just as news reports tell us that the sales of SUVs and other large vehicles are declining due to the rising price of gasoline, this blinded, statewide survey told us that nearly 80 percent of the more than 1300 respondents who completed the survey were already taking action to improve their health to avoid paying increased health care costs.

The people who responded to this survey were not necessarily our members, which reinforces for me the ground swell of readiness for change. These actions ranged from participating in stress-relieving activities, improving diet, adding exercise, and/or other weight-reduction activities, to taking prescribed medications as directed, and following doctor recommendations.

The implications of this small, yet statistically significant survey signal that society may be ready to begin to shift its thinking about health. That's a great thing, not only for helping rein in the unsustainable increases in health care costs, but also for helping all of us attain a better quality of life through managing our health.

James Roosevelt, Jr. is the President and CEO of Tufts Health Plan.