Title: CEO Corner: James Roosevelt of Tufts Health Plan (part 2)

" Back in the game. It's -- quarter -- change your camera and -- Mississippi now tops health plans. You want to show our viewers a snapshot of the company's financials. And this is fourth Q1 and for future -- It's not enough slots at thirteen point three million revenues one point two billion network. 577. Million that's from your news related let me widen this out. I noted that all four of the largest health insurers in Massachusetts have suffered losses so this is how reflective is this of the economy."

" Well some of that net loss is very some of our income comes from investments and we've suffered like everybody else in the investment market. Some of that does reflect. Smaller number of members within employer groups. Actually not fewer groups but smaller number of members and that certainly result of the economy and unemployment. But the most interesting factor. Is all of the health plans including ours have about twice as many members were on cobra. These are people who have lost their insurance from their employer. And they're now on cobra. And historically twice as much medical care is used by people on cobra. As -- people in the employer groups regularly. You might ask why I guess if you think about it if you've been planning to have your knee looked that. But you didn't have time unfortunately they have time."

" And dynamic I would ask you about costs. Apparently next year I in Massachusetts are premiums are going to -- seven to 12%. Why does a family here in Massachusetts have the highest premiums in the nation. Is it high tech medicine here or are there multiple reasons. We have."

" You know a higher cost of living here in New England than in most of the country. We also do have high cost. Doctors and hospitals. Here however it's not as dramatically different as you would think the media and and family premium here in Massachusetts is or about thirteen 1800. Dollars nationally it's about thirteen 1200 dollars it."

" Yeah that is that is very interesting quickly want to ask you about I a store front page in yesterday's New York Times. Health insurance premiums going up an average of 15%. Next year forced small business. They quoted one expert who said that that this may be a preemptive move on the part of health insurers this is nationwide. Because they think they're going to be losing footing through health care reform. That 15% is double what it was last year any thoughts what's happening here."

" I read that I read that story also and I. Don't know what's happening in other parts of the country can tell you around here. We have such intense competition among the insurers here but I don't think there's anything that sort of preemptive or dictated by what's going on in Washington. There is that there is what goes on year after year in terms of provider prices going up and that's 90%. Of the premium. Premium dollar. We have a proposal from the Massachusetts association of health plans which I chair of the board for small businesses would would lower their premiums 22%. And that has been sponsored in the legislature. By both the house and senate chairs of the health care financing committee. So we're hoping that that will move forward because small business in this transition is heard it."

" Absolutely. Speaking -- sort of national models of the governor did not that in The Wall Street Journal about a week ago saying Massachusetts is. The national model for health care reform do you agree with it isn't working."

" Here I do agree with Governor Patrick health care reform is working on virtually every level with some pledges to work out such as the small business issue. But we are at 97.3. Percent insured at this point. That is roughly the same percentage as the European countries that have had universal coverage for decades there's always a certain percentage it's moving in a movie out and falls between the cracks. And so on and it's important to have a safety net for them. But it's really working in terms of coverage. We know here in Massachusetts contrary to what you read in the national press. Health reform and universal coverage has not raised costs. What has happened. Is that we have some assistance from the federal government through the Medicaid waiver. In making this work the federal government has to find ways to pay for it without anyone else helping them."

" Q let me ask the governor in that same Op Ed says he's his next move is he's going after cost he wants -- reduce. He's going to hold hearings. Legislative hearings on the health insurers themselves he is looking to get more authority more power the ability to cut. Some administrative costs. He is examining the possibility of a global payments system moving from the fee for service to a global. -- payment system so again your thoughts."

" As part of health reform the legislature adopted a law giving the governor the power to hold hearings on both. Hospital and doctor costs. Hospital costs in particular and what is driving premium price increases he hasn't scheduled those yet. What he did he announced hearings on just the premiums for small business that's actually missing the underlying problem which is the increase in. Provider costs so it's not it's not the plans it's what your saying is this the providers of the hospitals that's right if your word for profit companies that were making big profits that may be some way to hold hearings about. We're a nonprofit companies that are not making. Even our operating costs. So I don't really understand the point of."

" Well let's go to the global payment system that seems to be front and center of the globe did a big piece on this. They -- and as you know basically there is a pool of money for each of us. How that we have to use -- yearly basis for all of our medical care the globe makes the point that is really going to cut. Your choices you may not be able to go to the specialist or the hospital that you wanna go to. Your thoughts about that and do we really have to limit people's choices. What we needed."

" The doctors the hospitals even the drug companies need to know that if they do things to keep people well they'll do fine. But that it doesn't pay for them to just do more for the sake of doing more that's the system we have now fee for service. Means you get paid more for doing more Connecticut's even. Worse under the following the Medicare guidelines you get paid more for doing a procedure rather than. -- and and thinking about the diagnosis. Of somebody so we really need. To change getting people -- just regulations that force people to do things or deny things. That not only makes people unhappy it doesn't solve the problem getting doctors and hospitals and drug companies to think about the right things. As is done in I'd say about 15%. Of our commercial contracts right now and and 94%. Of our Medicare contracts. That's what can affect the cost curve Andreas -- interest in it and take another break we'll be back -- CEO quarter and just a moment."