National health care reform is nearing the finish line. We strongly support its primary goal to insure most every American against the high cost of medical care. We also believe additional coverage costs should not add to the U.S. deficit.

Many government programs are being examined as funding sources to support reform, including Medicare Advantage, which covers 200,000 Massachusetts seniors. What is at stake is the possibility that payment cuts will be so significant they will eliminate the demonstrated ability of Massachusetts nonprofit plans to support providers’ delivery of coordinated care, which improves quality and lowers costs. As the House and Senate work to reconcile differences in their bills, in the interest of Massachusetts’ seniors, we urge our Congressional delegation to consider the House version of payment revision for Medicare Advantage plans.

Medicare Advantage programs like those in Massachusetts, which emphasize coordinated care, do make a difference. They facilitate the sharing of data that allows for comparative reporting on use and cost of services and quality of care. This reporting enables provider groups to identify group-specific trends, best practices, and opportunities for improvement of patient care. Working in concert with members/patients, Massachusetts health plans and providers develop effective medical management programs such as screening for depression, malnutrition, falls prevention, skilled nursing care management and programs for chronic conditions such as congestive heart failure.

It is not only common sense to think that patients do better when their caregivers communicate; there is evidence to support the claim. Studies conducted by Medicare and Johns Hopkins University, and Tufts Health Plan’s experience with more than 80,000 seniors, 1,300 primary care physicians, and 60 medical groups, validate the fact that collaboration and coordination of care leads to better outcomes and saves health care dollars. For example, the Johns Hopkins study revealed Medicare Advantage programs do 27 percent better than Medicare fee-for-service in preventing unnecessary hospital readmissions as well as contributing to 85 percent fewer preventable hospital admissions and emergency department visits. Without oversight of a system predicated on collaboration and coordination, seniors, particularly those with a multitude of complex medical needs, are at higher risk for medication mix-ups and other errors that occur when vital information is not routinely shared by caregivers. So what is the problem?

Both the House and Senate bills call for a reduction in Medicare payments such that overall spending under the two options—traditional Medicare and Medicare Advantage—would be similar. While that would be true overall, there could be substantially different results for plans in urban areas and those in rural areas.

Whereas the House would set government rates in each area, the Senate would rely on competitive bidding between plans to set the rates. While there are multiple plans in urban areas like Boston, most rural areas have limited options. Competitive bidding in multiple plan regions is likely to reduce payments well below traditional Medicare. Thus, if the Senate version prevails, Medicare Advantage plans in the Boston and Worcester areas could witness substantial reductions in payments. This, in turn, will result in reduction or elimination of extra benefits, together with elimination of extra payments to providers for coordination of services.

Most every health policy analyst believes that if we are to reduce future health care costs without seriously jeopardizing quality we must restructure the delivery of health care and incorporate these same services of better coordination, collaboration and communication. This means eliminating the fee-for-service payment system while substituting bundled payments for all the care of a patient. Two state commissions established to identify ways to lower health care spending and improve the quality of care in the Commonwealth recommended the same changes. How ironic, this is exactly the way the two largest Massachusetts Medicare Advantage plans are paid today.

We need our Congressional delegation to support the House version of revising the way Medicare Advantage plans are paid. It would also be helpful if the phase-in time for the lower payment was increased from three to five years. We in Massachusetts can be proud of our fine health care institutions and physicians. We can also be proud of our Medicare Advantage plans that help to provide the best quality care to our seniors.

This weekend historic legislation passed in the House of Representatives. Despite 100 years of effort, no universal coverage legislation has gotten this far before. Even though it has a long way to go in the Senate and the conference committee, and there are important elements that I do not agree with and hope will be changed, this is a momentous achievement.

There will be time in coming weeks to discuss how the bill can be improved for all Americans. Today I want to highlight some concerns unique to those of us who live and work in Massachusetts. I have been vocal in my support for national health care reform, as I believe access to health care is a human right. Nevertheless, as the president and Congress are seeking to create legislation, it is worth noting that our own state’s health care reform achievements could be undermined and that the business community, particularly small business, could be burdened with additional costs.

Last week, Lisa Wangsness, of The Boston Globe, wrote an informative piece that did a good job outlining the vulnerability of the state’s subsidies and the risks of increased costs should some of the House and Senate Reform bills pass in their current form. While there is still so much that is unknown, it is in our best interest to assess exactly what is at stake for Massachusetts’ own health care reform efforts.

For example, there is a proposal to tax health insurers $6.7 billion annually for 10 years. This expense will fall on the backs of fully insured businesses, which are overwhelmingly small businesses. While it is understandable that revenue sources must be explored, this tax would greatly impede the ability to provide affordable health care coverage and devastate an already disproportionately burdened segment of the economy.

Another example, perhaps not as extreme yet still illustrative, is the contrast between what is proposed as the individual mandate and what exists here. The diluted federal individual mandate has no teeth. Without a strong individual mandate, there is a real threat of the unintended consequence of creating high-cost premiums, as those who will be seeking insurance coverage will be primarily those who need it the most. Without the ability to spread the risk to a larger pool that includes healthy people, rates will increase for everyone, once again hitting hard fully insured, small business. Spreading the risk among populations is fundamentally how insurance works.

Furthermore, in Massachusetts the combination of a strong individual mandate and employer responsibilities have had the greatest effect on employer-based health plan enrollment. (December 2008 enrollment in this category was 150,000.) In addition to expanding health care coverage to a large number of people, a great benefit brought by this population’s enrollment is that their participation has reduced the burden on the state and federal government’s subsidies. Without a strong mandate, it is unlikely this population would elect to receive coverage, as past behavior would indicate that they would opt out.

Another example of potential risk is the employer mandate. Here, employers played a key role in supporting enhanced coverage. Conversely, the Senate Finance Committee bill does not establish a “fair and reasonable” contribution toward coverage. Employers of 11 or more full-time employees are required to pay or face an annual fee of $295 per employee. In addition, federal proposals exempt small businesses with less than $500,000 in annual payroll or fewer than 50 employees. If the Massachusetts law is pre-empted, many state residents working for small employers (11 to 50 employees) will lose employer-sponsored coverage, certainly an unintended consequence of reform.

There are numerous other unanswered questions that will determine whether subsidy levels will change. Moreover, changes in definitions, such as what constitutes the federal affordability standard, have real potential to cause harm and penalize the very people who need help the most.

As the legislation takes shape in Washington, now is the time to make our case. A national health reform bill needs to address Massachusetts’ transition to a national platform plan. There needs to be state and federal coordination to ensure clarity and/or provide explicit exemption in those areas of federal reform legislation that would negatively affect what is already working well here in Massachusetts.

On Wednesday, Sept. 16, The Boston Globe published a front-page story that highlighted health insurers’ 2010 premium rate increases, which run, on average, seven to 10 percent.

This is not good news for anyone, though I was pleased to see acknowledgement that medical costs play a role in the dilemma of rising annual premiums. In the piece, local health care professionals said that rising costs are a result of greater use of medical services by aging baby boomers, costly technology and expensive drugs, while the reporter highlighted an over-reliance on Boston’s excellent medical centers as another element contributing to rising costs. All true.

Nevertheless, I will go one-step further: It is a fundamental fact that rising medical costs accelerated by our societal desire and values, which support access and medical innovation—are the primary drivers of unsustainable increases in overall health care expense.

Moreover, I predict further escalation of medical expense due to even greater use of services, at least through the first quarter of 2010.

Recent experience has shown, that due to the economy, health plans are experiencing higher COBRA enrollment, and the unsurprising increase in the use of medical services from this sector. This is coupled with greater use of services overall, presumably due to the uncertainty of continued employment. It makes sense. If people fear that they will lose employment and thus health care coverage, they will attend to any outstanding medical concerns facing their families. Eligibility for COBRA’s extended benefits cease at year’s end, but coverage will last through September of 2010. In addition, we simply do not know the extent of H1N1 and the effects of the annual flu season.

To be clear, I want people to receive necessary health care services. Increasing access to health care by increasing access to health care coverage was the whole point of Massachusetts health care reform legislation. What I am saying, is let us be clear about what is driving escalating health insurance costs. As the debate for national health care reform continues, there has been scant attention paid to this fact.

The argument that health insurers’ high administrative costs are part of the problem is not unique to Washington; more to the point, it is untrue. The Massachusetts not-for-profit health plans tightly manage administrative cost, and pay, on average, 90 cents of every dollar to medical expense. Profit margins are in the neighborhood of one to two percent. In the national debate, casting insurance companies as greedy villains is easy, but also incorrect. In the first half of this year, these same Massachusetts insurers lost money.

While common sense recommendations such as payment reform are coming from the State House, I suggest that local health care leaders sit down together with the governor and legislators, to identify specific medical cost drivers now so that we can find ways to: support prevention/wellness; make primary care more attractive to young physicians and increase utilization of ancillary primary care providers such as nurse practitioners; and, make a concerted effort to set a common goal to reduce waste in the system.

Doing these things will identify opportunities to provide the right care at the right time, and in the right setting, which is in everyone’s best interest.

It has been my privilege and good fortune to know and work with Sen. Kennedy for many years, both on politics and policy. My wife, Ann, also worked on his staff in the early 1970s, where he fostered her lifelong dedication to environmental issues by his leadership in the areas of energy policy and conservation. When I would meet her outside the Senate Office Building at the end of a very long day, Sen. Kennedy would still be at the office or just leaving the building, carrying a bulging bag of reading material in preparation for the next day’s work.

In my mind, his success in the Senate derived from his innate ability to create consensus among those with disparate points of view, and his fundamental belief that the role of government was to help its citizens. That clarity drove his actions. He remained focused on achieving an outcome that, in some way, would improve the life of an average person, and those most in need. He used his charm, his wit and his power—everything available in his arsenal—to reach his goal, which was always to make our country more humane and to ensure that America’s benefits were accessible—in equal measure—to all its citizens.

This was never truer than in his fight for universal health care coverage. I heard him tell this story when asked how he could support universal coverage that did not include the controversial single payer system. He said, “Years ago, there was a young geography teacher who had moved down to a rural area in the south, and was looking for a job. The local school board was split between evolutionists and creationists. This young man knew that he would be asked his opinion, and that his answer would decide his future. At that fateful moment in the interview when asked how he would teach his students geography, he answered, ‘I can teach it round or I can teach it flat.’”

That was Ted Kennedy. He could teach it round or teach it flat. He understood that differences could be overcome, and that what was most important was finding a better way forward. We claim him as a son of Massachusetts, but as with a select few before him, he now belongs to the nation, and there will never be another like him.

After clearing security, attendees gathered on the White House lawn, and for a brief period listened to a Marine Corps trio, though we quickly retreated inside as the heat, humidity and insects made it too uncomfortable to congregate. I saw some people I knew and enjoyed meeting others—and all of us were excited to be there. It was a diverse group of health care providers, insurers, policy experts, medical/nursing students, human resources representatives, business people, and others from all walks of life and political points of view, all invited because we each have a vested interest in the final shape and success of a national health plan.

ABC asked us to submit a question in advance for the president. My question was, “We have real life experience in Massachusetts with success of covering nearly 98 percent of our population in less than three years without raising health care costs and without the expense and unintended consequences of a government-run plan. Why can’t the nation follow our example?” Though I did not get to ask the president my question, it is my understanding that all questions were forwarded to the president’s staff following the program. Concern about a government-run plan was one of the central topics of the evening.

Dr. Tim Johnson, who categorized the evening’s content as access and coverage, effective treatment, and cost control, set up the questioning. Taped at 8 p.m. in the East Room of the White House, the exchange between ABC news anchor Charlie Gibson and the president was unscripted. He and Good Morning America host Diane Sawyer were just as you see them on TV, polished and professional. Questions were thoughtful, represented general concern about quality, rationing of care, a potential lack of choice, and of course, cost. How do we as a nation pay for national health care reform and what does it look like, were themes at the core of every question.

The president answered questions without notes or a teleprompter, and graciously shook hands during each commercial break. Though there was not a great deal of technical detail, he effectively laid out his view on a health care reform plan. It was clear that his thinking had evolved since the campaign and his early conversations with Congress. While the format did not allow for an extensive review of his health plan proposal, it did surface issues in a more comprehensive way than the average American might otherwise hear this early in what will be an evolving political process. The timing of this event was fortuitous, as some feared that this great public policy effort of providing universal coverage to the country was going off track as costs are beginning to be calculated. I believe that this attention will keep the conversation going in households across America.

Aetna President Ronald A. Williams asked a version of my question regarding a government-run health plan, making the analogy that it is difficult to compete against a player who is also the person refereeing the game. The president acknowledged that Aetna is a well-managed company, and responded to Mr. Williams by emphasizing that a public plan would have to abide by the same rules set for private insurers, and that an incentive for private insurers is the potential for tremendous growth through the enrollment of millions of uninsured Americans. That growth opportunity, said President Obama, should sharpen competition by precipitating a change in some practices, such as coverage for people with pre-existing conditions. That said, in my opinion, it is hard to believe that in practice this would work.

Nevertheless, at the end of the one and a half hours, I felt that the debate had been advanced, and that the president had shown flexibility in answering controversial questions.

I was privileged to be a part of the evening. While I have been to the White House before, I always get a special, hard-to-describe feeling when I am there—it is the Peoples’ House. Just as the president must do, there is something about being there that makes me think about the needs of the country and the responsibilities we have for each other as fellow citizens. It is profound and humbling.

On balance, I did not agree with every premise or details of every answer, though I believe that the president and ABC News took some additional, important steps and should be commended for their efforts. Universal health care coverage is a topic worthy of debate, but more importantly, is worthy of implementation. We must keep the dialogue going.

James Roosevelt, Jr.
President and CEO, Tufts Health Plan

Why is this conversation so important now? It is my belief that we are at a critical juncture as evidenced by the federal government’s attention on health care, the state’s payment reform initiatives and as part of that—the convening of the Commonwealth’s Special Commission on the Health Care Payment System, which seeks to evaluate the use of differing reimbursement models between payers and providers.

The reality is that fair contracts and aligned goals have a role a play in keeping health care costs reined in as medical expense is the greatest driver of rising expense. Moreover, the merit of quality incentives extends far beyond cost saving to improving health, as this action is one way to move from a paradigm of illness to one of prevention and wellness. It must be said, however, that quality incentives in provider contracts is not a new phenomenon. Aligning the interests of health plans and physicians in order to improve quality and curtail waste has existed to some degree throughout the past years, including the period when most providers shifted financial risk back to the insurers, but as I have said before, this is unprecedented moment.

What has not been covered to a large degree by the press or successfully articulated in other forums is what I have learned from my own experience as the president and CEO of Tufts Health Plan. And that is, there is no “one size fits all” when it comes to partnering with providers to achieve fair contracts. It is a mistake to make such an assumption. We use a variety of payment models, which depend heavily on the type of business for which we are contracting (fully insured commercial, self insured commercial or Medicare), as well as the type of provider, their ability to invest in infrastructure to manage care and their scope of services.

To enhance quality and increase the likelihood of a successful partnership, health plans must be prepared to support providers with data and effective process support in their management of financial risk. This includes sharing of best practices among medical groups and more robust reporting to identify opportunities for more efficient delivery of care. Thoughtful medical management that reduces variations in health care practice and provides information on best practices using evidence-based medicine does align the interests of health plans, providers and ultimately health care consumers.

The reality is that for whatever differences that must addressed during a negotiating session, health plans and providers share the same goals: we both want a high degree of patient and member satisfaction, high quality care, fair payment that takes into account opportunities to reduce waste in the system, and ultimately, a healthier community. Together, we have reason to be optimistic that these efforts are underway and working for all of us.

James Roosevelt, Jr.
President and CEO, Tufts Health Plan

The audience for our discussion is a national gathering of CEOs, physicians, other health insurers and legislators. Representing Tufts Health Plan, I will be sharing the stage with Charlie Baker, CEO of Harvard Pilgrim Health Care, Eric Schultz, CEO of Fallon Community Health Plan, and Dolores Mitchell, executive director of the state’s Group Insurance Commission, who will moderate our discussion. All are familiar to readers of this space. The topic of our conversation is “Quality Realized: Insights from America’s Best Health Plans.” These three Massachusetts-based, not-for-profit health plans rank among the best in the nation, a distinction worth noting, and apparently of great interest to NCQA’s guests.

Our country’s leaders look to much of what is already in place in our state as guidance for developing national health care reform. There are a number of provisions being discussed at the national level such as guaranteed issue and no pre-existing condition exemptions, which we take for granted but constitute a huge leap for other states. I believe that this framework of inclusion is based on fundamental fairness, which originates from our citizenry’s values and the predominance of not-for-profit health care institutions whose highest priority is the delivery of quality health care to patients, and not-for-profit health plans, whose highest priority is service to their members, not shareholder dividends.

For example, Tufts Health Plan works to manage medical trend so that care is neither over delivered nor under delivered in order to improve quality and keep costs as affordable as possible. Having similar, and in most cases the same, provider networks as the other not-for-profit health plans, contributes to our costs but our customers tell us that they want hospital and physician choice.

Instead of competing with network designs, not-for-profit health plans compete for business based on our prevention/wellness programs and our medical management, which is central to our core quality efforts. This focus results in lower costs. We reinvest resources into partnering with providers for clinical improvements. And, benefits, which cover high cost care such as infertility treatments, remain rich compared to what is available in other parts of the country. Moreover, the Commonwealth’s excellent hospitals do not turn away people because they can’t pay—this can’t be said in many other states.

I recognize there are readers who will claim I am being wrongly self-congratulatory as the American health care system doesn’t work for many Americans. Of course, I am well aware that the system is seriously flawed and that there is ample opportunity for improvement. That is why I am such an advocate for the approach of not-for-profit health plans–and our national quality rankings support my endorsement. We have shown that within the current framework we can provide access and coverage in a manner that improves quality care. Can we do things better? Yes, of course. Doesn’t working with the foremost physicians and hospitals in the country contribute to high quality? Yes, of course; they are central to delivering the high quality care that all of us expect here. Aren’t health care prices unsustainable? Yes, of course. Is health care a right? Again I would say, yes, of course. The good news is that we have an administration that shares the belief in the fundamental right of access to health care for its citizens and the momentum exists for meaningful change.

In the end, I believe that on a local and national level we must continue our focus on finding ways to rein in unsustainable health care costs by creating public policy that supports disclosure of quality and cost information, focuses on prevention and wellness, improves technology in health care and works to eliminate waste in the system. At the same time, we should also take a moment to recognize the value of what we have in our own backyard. It’s worth noting.

James Roosevelt, Jr.
President and CEO
Tufts Health Plan

I’m pleased to report that times have changed. Last week, I represented the national association of health plans, America’s Health Insurance Plans, in a press conference in Washington to announce its series of proposals designed to support the national adoption of universal coverage.

The announcement said many things, but my quote that found its way to daily newspapers was this one, “The heart of our proposal is a public-private partnership that builds on the employer-based coverage that 170 million Americans rely on today. We have laid out a workable, realistic path to universal coverage and we want to ensure that no one falls through the cracks of our health care system because of age, health status, or income.”

While it is only the beginning of the national health reform discussion, the ideas put forth by AHIP have merit. No less an advocate than Sen. Kennedy has called for serious consideration of the AHIP proposals for a workable, realistic path to universal coverage. No one should accept the status quo in health care. Calling upon the nation to get serious about cost containment and highlighting the link between quality and rising cost is responsible and the right thing to do. I am proud that the leadership of the national health plan community has united in this way and is serious about fulfilling our obligation to be part of the solution.

Even as I am heartened that AHIP is engaged on a national scale, I am reminded that much of what they and others are fighting for in regard to access to care is already available to those of us in Massachusetts. Even before we implemented our own state-based health care reform legislation, we enjoyed the reputation of having the nation’s leading hospitals and not-for-profit health plans right here. The Commonwealth’s citizens had access to the brightest minds in medicine together with advances in treatment and research unavailable in many parts of the country. There were no denials of care due to pre-existing conditions, no six-month waiting periods before new insurance coverage kicked in, nor the requirement of payment prior to life saving treatment, as there continues to be in some states.

I’m not saying we don’t have a tremendous amount of work to be done—we do. We must continue in the daunting tasks of creating change in our own backyard. At the very least, we must eliminate waste in the system, work toward transparency of cost and quality data in an ongoing effort to identify where the costs drivers are, and highlight the opportunities for improved quality. And finally, we must also fundamentally shift our perspective from illness to wellness and move the discussion of prevention of disease to public policy status. We must keep the dialogue going because we all have a stake in the outcome.

I’d like to believe that we can continue to lead and play a role on the national level. Based on what Massachusetts has done to date, we can continue to share what we have learned, improve our policies at the same time and move the nation closer to a future where all its citizens have access to health care coverage. Not only because the timing is right, but because it is the right thing to do.

James Roosevelt, Jr.
President and CEO
Tufts Health Plan

Briefly, as described by Health Affairs, a policy journal, Sen. Obama’s health care proposal focuses on expanding insurance coverage and provides new subsidies to individuals, small businesses, and businesses experiencing catastrophic expenses. The analysis reports that the plan greatly increases the federal regulation of private insurance and creates questions about fiscal sustainability. (His plan includes a National Health Insurance Exchange, much like the Commonwealth Health Connector like we have in Massachusetts.)

Health Affairs explains that Sen. McCain’s health plan makes employer provided health benefits taxable as income for employees and in return, gives each employee a refundable tax credit– $2500/individual and $5000/family–for those who purchase coverage. The analysis predicts increased costs to employees, reduced benefits and fewer consumer protections.

Both proposals seek to reduce administrative and medical costs in a variety of ways, but they also offer insight into a larger philosophical perspective on the role of government in the marketplace. Independent of the presidential race, however, there are opportunities today for those of us in the health care community to identify cost savings. A common, though no less staggering, statistic estimates that 30 percent of annual health care spending is unnecessary, which adds up to $600 billion annually. (There are some studies that are not so conservative and say that the figure is closer to $800 billion in unneeded services.) Either way this is money that we can ill afford to waste.

In my past blogging I have written about the necessary societal shift to prevention and wellness to improve health and reduce health care costs, but that shift doesn’t happen in a vacuum. There are other, related actions that improve quality, reduce or eliminate unneeded services and save money.

According to a study released earlier this year by the New England Healthcare Institute titled, “Waste and Inefficiency in the U.S. Health Care System,” there are numerous opportunities for dramatic costs saving in today’s health care system by eliminating waste, which was defined as health care spending that can be eliminated without reducing the quality of care.

In general, none of the findings were surprising. For example, the overuse of non-urgent emergency care and the overuse of antibiotics for respiratory infections are practices that are well known. But the area that has the most opportunity for improving quality and reducing costs is reducing variation in intensity of medical and surgical services, which can be done by using evidence-based data to identify best practices. In other words, ensuring that the right care is being delivered at the right time and in the right setting.

At Tufts Health Plan, our medical directors and clinical staff work closely with our providers to implement evidence-based programs. Our own experience has shown improvements in outcomes and in cost savings that we have been able to pass on to our customers. Finally, our experience has reinforced my belief that together with wellness and prevention, evidence-based medicine is an effective tool that should be more broadly adopted—no matter who becomes president.

James Roosevelt, Jr.
President and CEO, Tufts Health Plan

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.