Personalities: The Search for a Better Way

Curiosity and a drive to improve healthcare has led Troyen A. Brennan, MD, MPH, on a diverse career path. He's served as president of Boston's Brigham and Women's Physician Organization and chief medical officer for Hartford, CT-based Aetna. He continues to try to improve outcomes and lower costs in his post as executive vice president and CMO for CVS Caremark.

On working in different industry segments: The surprising thing is the similarities. People think it is a lot different on the provider side as opposed to the insurer side as opposed to the pharmacy-benefit side. The issues turn out to be pretty much the same and the financial underpinnings of the organizations are the same throughout. I find the cultures to be relatively similar. The good thing about the American healthcare system is that everywhere I go people are trying to figure out how to do it a better way.

On what is needed for meaningful health reform: We have to recognize that there is a good deal of unnecessary care in the U.S. healthcare system. Almost everyone who is involved with health reform is hesitant about saying exactly how they will designate which care is unnecessary and I think that hampers our ability to get to real answers. In the pharmacy area, it may be a little bit easier because we know that low-cost generic medications in many situations work just as well as more expensive brand name medications. But in the rest of healthcare, it hasn't been so easy to do that.

On the challenge of defining unnecessary care: Even with what would be considered by most objective observers as unnecessary care, there is a doctor telling a patient that they need to get this test or procedure. People are real hesitant about interfering with that doctor-patient relationship.

On engaging consumers to be active participants in their healthcare: It is getting people when they are activated to think about these kinds of issues and pursuing different kinds of incentive approaches to ensure that they pursue healthy choices. If you are getting a prescription filled for the first time, you are at a point where we can engage you. That is the basis for a lot of our research and efforts to change behavior toward healthy choices.

—Carrie Vaughan