Title: CEO Corner: James Roosevelt of Tufts Health Plan

" Welcome to say yes corner every week we go one on one with new England's top CEOs to learn the secrets to their success. This week we have Jim Roosevelt who is the CEO -- tufts health plan welcome jumped. Great to be reviewing your viewers Marianne thank you what to begin the program by hearing your assessment of the whole swine flu situation. The president declared a national emergency over the weekend. 46 states have widespread instances of the disease. And on the other hand. New York Times Wall Street Journal everybody is reporting it. This shortage of vaccines. One half the number that was supposed to be delivered nationwide. By the end of October that's all we're getting we were supposed to get thirty million were only getting sixteen million it almost seems like the perfect storm. You have what some are calling it a peak in October of this flu which is very unusual and we don't have the necessary vaccines. Your concerns and perspectives."

" the vaccine is very important for the vulnerable populations and that's particularly younger people who don't have the immunity that people born that. Before about 1950 have. And for people with underlying health conditions most of big tragic cases that we hear about. From people who have come demos my food -- people who had other underlying health conditions. So it's important that people who have diabetes pneumonia and so on. I get the vaccine as soon as it's available. However. We find that for that have when you take it on average and of course if you're sick if you're not the average. But if you take it on average so far the effects are about like the seasonal."

" What I understand they're they're really chase -- one is fairly mild in the -- what can cause viral pneumonia. And is rather dangerous -- it now appears that way yes -- I want to ask you about the acceleration of the number of cases there was headline in the global on Friday it is really accelerated in Massachusetts. In the past week as I said it is it. 46 states and a widespread basis. I wonder what you're seeing are you seeing anything yet through your membership."

" We're not seeing the great numbers of -- in patients admitted to hospitals yet. And that's what we would hear about right away. Now people may be talking to their doctors on the phone are going in for an office visit we as a health plan wouldn't see that yet. But I think that. Over the next week or so will begin to get some information as."

" Patterns The Wall Street Journal last week reported on a poll of emergency room physicians. And the readiness of their yards for an onslaught of this disease 90%. Said they didn't think that there Yaris were prepared. So I wonder again your perspective. How prepared. Is the health care system nationwide. If this is really that."

" Well in urban areas especially emergency rooms operate close to capacity a lot of the time. And so. There will definitely have to be triage. Which cases get priority. The big movement of course that we're all trying to have with better health care coverage is to have people. Not bring their problems to the emergency room can be seen by -- primary care physician. Or -- walk in clinic. Or an urgent care setting as opposed to an emergency room and that's going to be even more important right."

" Absolutely I noticed as part of declaring a national emergency. That allows hospitals to set up alternative sites for care more rapidly so this is kind of been addressed I think about it by the president. Yes the emergency declaration it it's not like a hurricane. Or forest fire something after the fact this is to permit. Yeah handling things rationally. As the situation develops -- even a step back for a moment sure our viewers a little bit of corporate background on tufts health plan. It was founded in 1979. Headquartered in Watertown. Focusing not for profit provider of health insurance coverage. Network 86 hospitals and 22000 clinicians members 724000. Net worth. 577. Million I'm I'm really interested in the fact that the plan is expanding into Rhode Island at this time. True were in a recovery but it's a very tentative recovery. And that's state was hit rather hard sew up the strategy behind this and -- going."

" Rhode Island has been hit quite hard economically they have a on the unemployment rate that is about it. About a third higher than Massachusetts for example. But they also have a health insurance situation where they only have to insurers. For the general population. And one of them is a for profit insurer. So we thought that bringing aid health plan that's rated number two for equality in the in the United States. That is very competitive in terms of benefits. And and price. Two Rhode Island it was important for the consumers in Rhode Island. And we think over time it'll be a very important part to have felt."

" Play what you consider the key differentiator for -- tufts health plan. As I was driving appear hurt commercial on radio and -- that you were voiceover and talking about this -- Discounts to go to gyms. And things like that I thought of the top ten K 8000 women and a few men. Running recently had a big emphasis on personal management and responsibility. For a healthy lifestyle."

" But at tufts health plan I think we have a number of differentiators. In particular that we've had it in the area of care management. Up to now. But what we're really most known for. Is we were the first health plan. In that New England to offered. Discounts for gym memberships. And other. Healthy lifestyle. Options. We continue to do that. Something that happens in health insurance is it's pretty easy for your competitors -- follow your lead but that's fine if we're setting the standard were happy with that. The tufts health plan ten K for women is our signature event. We're really thrilled to have a record number of runners mostly. Women and but a few brave man 8600. Runners."

" Saturday's meeting that I know it's one of the biggest in the country want to ask you really it's domestic policy issue of our day. And the health care reform nationally. I read a presentation you gave and you say universal access is a right. That's a rather unusual thing for the CEO of that health plan. To say so. Given that. Why is it right and do you think it's gonna happen this year."

" I do believe that health care is as much -- right as shelter and clothing and food. Now that doesn't mean that everybody is all the living -- just bear for you. But mechanisms that both let you earn it and that when you are for some reason in a vulnerable situation. Cover you much as we have done with those other necessities in our society. I believe health care falls into that category."

" Can -- let me ask you on the last week the House Judiciary Committee. Pass legislation has to go way beyond there. But that -- and the exemption that -- health insurers have concerning anti trust laws. The eight. In the congress on the health insurance industry for basically criticizing. President for Barack Obama's efforts on health care reform. You're one of those CEO's what do you think."

" Well I don't know what the motivation is it's actually a solution to something that is a problem. There. -- until the amendment was introduced. In congress to do away with the exemption. Virtually none of us that industry knew we had it because we compete like -- All the time. And it turns out yes there is a certain amount of cooperation. Allowed under the federal law but most states have any state antitrust laws. That prohibit what's already. What's already about to be. Part of the repeal of the exemption so it really isn't a great significant."

" And still interesting perspective can I wanna step back again -- our viewers a little bit of personal background. -- it's very just distinguish educated Harvard College Harvard Law School. Experience he was a partner with truthful Stewart chief legal counsel to the Massachusetts Democratic Party co chair of the rules. And bylaws committee of the Democratic National Committee associate commissioner for retirement policy at the Social Security Administration. He joins hostile planet -- VP and General Counsel. And then in June of 2005. Became the president CEO. Jim let me go back on to the health care reform issues they the public piece of this. It's coming back it's not in the back -- bill but house speaker Pelosi is pushing forward very hard the president wants it to GOP thinks that it would. Quite private insurers out of business. What do you think do we need a public option are you expecting it would hurt your business. I don't think the."

" The public option that isn't by any means the most important thing in healthcare reform the most important thing is regulation. Insurers not in Massachusetts in the four other northeastern states that really regulate health insurance from a consumer point of view. Things like no preexisting condition guaranteed renewal ability that sort of thing. But a public option depending on how it's. Defined. Can have an effect that when I -- of how it's defined. If a public option means that there is a health plan set up by the government that pays Medicare rates that's going to be a big problem for everybody because Medicare. Under pays hospital and doctors' costs by about. 30% or so right now that shifted over to being paid by people who have private insurance. If obviously nobody can compete with that kind of a cost. Differential. If that. Became widespread. You'd see a great reduction in our health -- resource -- the devil is in the details here for sure absolutely we're gonna take our first break we'll be back with more CEO quarter just a moment."