Tufts Health Plan's Roosevelt Issues Cost-Cutting Challenge

Tufts Health Plan chief James Roosevelt, Jr. has just issued a public challenge to the Massachusetts medical community: to work together to cut medical costs, just as it did to reach consensus on the landmark 2006 reform that expanded access to health insurance.

Roosevelt spoke to the Boston Business Journal's "Champions in Health Care" ceremony on Friday. Here is an excerpt from his speech:

"So, where do we start? The first place is reclaiming that spirit of cooperation and shared responsibility that animated phase one of health care reform. All of us here today, together with business and government leaders must set aside our differences and recreate that big, inclusive table.

I believe that we must make progress on four different fronts.

They are: payment reform; enhanced transparency in information sharing; greater acceptance of evidence-based care and a renewed emphasis on primary care, which fosters coordinated care.
Progress on each of these fronts is necessary, but no one area is sufficient to create the kind of transformative change that will place health care costs on a different trajectory.

Let me say a brief word about each.

First, we need to move more quickly in the direction of a risk-sharing model that rewards quality rather than quantity, value more than volume, and aligns incentives that contribute to the appropriate delivery of high quality, cost effective care.

We must reframe our thinking.

I know there are varying points of view, but the state’s Payment Reform Commission has already endorsed a move to global payment. More to the point, many of us in the room already have successful experience with this payment model.

I am also aware that the MHA has released a series of white papers on payment reform, and has taken the position that health plans are assuming a regulatory role. I strongly disagree that is the case. But this is exactly what I am talking about… We must have a dialogue.

It is my belief that shifting to shared risk will not only achieve greater efficiencies and improved quality, but will eliminate some of the subtle pressures reinforcing that uniquely American notion that doing more is always better.

I am well aware that a transition to such a system will require flexibility to accommodate a variety of providers, practices, and arrangements and sizes of groups.

Our own experience at Tufts Health Plan has shown us that full risk is not necessary. In addition, we support building in protections such as provider liability caps into a risk sharing system. But, we must begin the conversation.

Second, we need enhanced transparency. Markets depend upon price information to function. Without prices, consumers and providers cannot make rational decisions. The public is right in asking how do we lower costs if we don’t know the cost?

I would argue that most practicing physicians don’t know the cost of the drugs they prescribe or the tests they order. We need to collect and make available reliable and comparable cost and quality data, not only for providers, but also for the public. Without this, we undermine incentives for high quality, cost effective care.

Third, we need to encourage best practices that are consistent with scientific medical evidence. Comparative effectiveness research has been shown to reduce unnecessary care and enhance the use of proven medical interventions. This improves quality, which everyone in this room supports.

Our experience at Tufts Health Plan has shown that providing physicians with blinded, comparative data on the use, cost and effectiveness of treatments has led to improvements in the quality and value of care delivered in both our commercial and Medicare populations.

Finally, we need to restructure the health care delivery system to support a primary care model that influences and improves the overall coordination of care, as it is central to improving quality and reducing cost. The importance of primary care in directing patient care needs to be recognized and rewarded.

In large part, because of national health care reform, I am optimistic that transformational thinking is already underway. Fundamentally, we must move from a less coordinated system to one that is more coordinated. In addition to what I have just mentioned, there are other elements, which must contribute to system reform.

The use of data and the role of technology, electronic medical records and a focus on prevention and wellness—all of this is relevant and inter-related."

Comments, anyone?