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.
The ONLY solution to the health care crisis is to stop paying out BILLIONS of insured premiums to do-nothing CEO’s.
Insurance is meant to provide assistance to the insured NOT to line the pockets of greedy corporate officers and share holders. Insurance AND health care BOTH should NEVER HAVE BEEN ALLOWED TO BE PRIVATIZED.
As a consumer I am sick and tired of the greed factor in this country. It’s high time we got back to basics.
Similar to the question, “Why has the price of gas gone up so much?”, the question, “Why does health care cost so much?” is confusing conundrum to answer. If one were to ask a healthcare provider such as a hospital administrator, they might blame the insurance industry. A health insurance company president might blame the public. A member of the public might blame the hospitals or the insurance company. Everyone shares a bit of the blame. Indeed, as Roosevelt states, the public needs to take better care of themselves. We’re facing an epidemic of health issues with record amounts of people suffering from obesity and all around poor health. Yet, if we do get sick, are not supposed to go to the hospital? And why is so easy to fall into the trap of living an unhealthy lifestyle? Doesn’t the government share the blame for their lack of in action in providing the public with a health environment with inexpensive organic food instead of bounty of cheese doodles and Big Gulps? Yet, is that once again our fault that we haven’t voted inept politicians out of office or run for office ourselves. Or is that the fault of the corporations who have many huge contributions to politicians and spend millions on lobbyists to control government?
Which brings us to this idea of Capitalism ruining the health care “industry” by route of health insurance providers and companies being for profit (sometimes indirectly even if they are non-profit) and health care insurers selling “products” to the public. Could they be driving up prices just a tad if doctors, hospitals, medical suppliers, pharmaceudical company, et all are using making more billions as their driving force for providing “better health care”?
And what about the rampant inefficiency of health care insurance companies? Currently, we’ve got the 31 flavors of different health insurance comanies all vying for you to buy their plan. By having so many insurers, each with a different billing system, different forms and rules, the billers from providers need to employ someone who specializes in handling each insurance companies billing system. Meanwhile, their computer system run on Atari 2600 archaeic systems that they are unwilling to update. Sure, they might put a new web based claims system but the main system that all of your records are on is some dos based system from 1985. How efficient do you think that is in the high tech world we live in today? And they blame us?
True, we can’t be victims and blame everything on others yet not holding the health care industry, government and general corporate greed accountable is even worse. Yet, how can one fix this perfect storm of an inefficient health care system with sky rocketing costs fed by We the People in poor health. I say we take ownership of all of it as Roosevelt stated and hold ourselves and the healthcare industry accountable for what is going on. Let’s up off of our behinds and do something about it. Yet, what is it that we need to do?
[...] my past blogging I have written about the necessary societal shift to prevention and wellness to improve health and [...]