October 2, 2002 - Boston Globe: India RPCV Harris A. Berman a Pioneer in Managed Care

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India RPCV Harris A. Berman a Pioneer in Managed Care

Read and comment on this story from the Boston Globe on India PC Staffer Harris A. Berman who was a pioneer in Managed Care An infectious disease specialist, Berman spent two years as chief medical officer of the Peace Corps in India during the mid-1960s. Read the story at:

Managed care pioneer Berman set to retire as Tufts CEO next year*

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Managed care pioneer Berman set to retire as Tufts CEO next year

By Liz Kowalczyk, Globe Staff, 10/2/2002

Tufts Health Plan chief executive Dr. Harris A. Berman, a former Peace Corps worker who helped bring managed care to New England, will retire next year, the plan said yesterday. The Tufts board named president and chief operating officer Nancy L. Leaming as his successor.

Berman told the board five years ago that he planned to retire on his 65th birthday, May 30, 2003. He said he wanted to let other Tufts executives know they would be able to move up in the organization. The board planned to choose a new chief executive this fall, to give that person time to adapt to the job while Berman was still working at the plan.

Berman said he plans to teach full time after leaving Tufts, and is talking to several Boston-area universities.

An infectious disease specialist, Berman spent two years as chief medical officer of the Peace Corps in India during the mid-1960s. In 1971, he helped start the Matthew Thornton Health Plan in Nashua, one of the first managed health care plans in New England, believing it was an affordable alternative to traditional medical insurance. Berman and Leaming, who has a background in accounting and business administration, worked together at Matthew Thornton before joining Tufts.

Initially, Berman said, the founders of managed care plans viewed themselves as innovators trying to help Americans struggling to afford indemnity insurance with its high deductibles. But then, during the 1990s, consumers became angry with managed care, believing insurance executives were overly focused on controlling costs and limiting access to specialists and hospitals. As managed care became more of a target, Berman was amazed that when he started out he was called a communist, but that later he was considered a rampant capitalist, said Charles D. Baker, chief executive of Harvard Pilgrim Health Care, a Tufts competitor.

''He didn't feel he changed much along the way, but the context did,'' Baker said.

Baker called Berman ''one of the original pioneers and creators of prepaid health plans'' and said ''his influence drives the position of the industry in a particular direction.''

When Berman took over Tufts in 1986, the plan had 50,000 members, one of the state's smallest. It's now the second-largest health plan in Massachusetts, with 909,000 members. In recent years, the plan developed a reputation as an experimenter, often adopting new and sometimes controversial products and programs before rivals did. Some have caught on.

Tufts was one of the first plans in the country to introduce a health club membership benefit and a point-of-service plan, less restrictive than a health maintenance organization. Two years ago, it was the first insurer in Massachusetts to charge members a higher copayment for expensive brand name drugs in a so-called three-tier pharmacy plan - now standard practice. That was one time, Berman said, when it didn't pay to be a leader.

''We took a beating on that one,'' he said. ''From our members and from employers. That was a difficult message for them to give employees. I'd have rather been second.''

Two years ago, Tufts took a beating of another kind. The plan and Partners HealthCare, the state's largest hospital and physician network, publicly broke off contract talks, freezing Tufts members out of Partners' facilities such as Massachusetts General Hospital and Brigham & Women's Hospital. Partners was demanding steep fee increases and eventually won them because Tufts executives did not believe they could sell a network to employers without Partners hospitals and doctors.

Partners' chief executive, Dr. Samuel O. Thier, said yesterday that while feelings were tender at Tufts following the difficult negotiations, they are now mostly healed. ''Tufts has been one of the most successful HMOs, and Harris has been critical to that,'' Thier said.

Last month, Thier and Berman spoke together to a class at the Harvard School of Public Health. Thier recounted to the students the ''D'' challenges the health care system faces - dollars, development, demand for better services among them. When it was his turn, Thier said, Berman joked, ''I agree with almost everything you said, but you forgot depression.'' It was a humorous way of agreeing that the health care system is struggling, Thier said.

As for managed care, Berman said it was a victim of its own success. When the plans became popular with employers, many companies left workers no choice but to join an HMO. ''Then we became the subject of discontent,'' he said. ''We got customers who had no other choice, and those don't tend to be happy customers. We would have been better off if we had been less greedy with membership.''

Berman and Leaming said she will gradually take over the chief executive job next year. She said she will work to implement the plan's new computerized claims system, expand quality report cards for doctors' groups in the Tufts' network, and move toward a different type of cost control. Rather than target long hospital stays, as managed care plans did in the past, Tufts will focus on disease management programs that try to improve the health of the 3 percent of very sick members who contribute to 47 percent of its medical costs.

Liz Kowalczyk can be reached at kowalczyk@globe.com.

This story ran on page C1 of the Boston Globe on 10/2/2002.
© Copyright 2002 Globe Newspaper Company.

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