Some new faces on the list
Eighteen new faces debuted on our list of this year’s 100 Most Powerful People in Healthcare. The majority ascended to power in Washington over the past two years. These include six serving in the Obama administration: Margaret Hamburg, commissioner of the Food and Drug Administration (No. 15); Mary Wakefield, administrator of the Health Resources and Services Administration (No. 27); Regina Benjamin, the U.S. surgeon general (No. 31); Francis Collins, director of the National Institutes of Health (No. 82); Thomas Frieden, director of the Centers for Disease Control and Prevention (No. 91); and Yvette Roubideaux, director of the Indian Health Service (No. 95).
Mary Kay Henry, the new president of the Service Employees International Union, debuted at No. 18 on the list. Henry was elected in May to succeed Andy Stern in the top job at the SEIU.
Four interest group leaders made it on the list for the first time: Beverly Malone, CEO of the National League for Nursing (No. 29); Kathy Warye, CEO of the Association for Professionals in Infection Control and Epidemiology (No. 46); Barbara Crane, president of the National Federation of Nurses (No. 48); and Angela Gardner, president of the American College of Emergency Physicians (No. 83). the Heritage Foundation. He directed the conservative think tank’s Center for Health Policy Studies from 2003 until June 2010.
Two health insurance executives made it onto the list for the first time: Gail Boudreaux, president of UnitedHealthcare, the largest division of UnitedHealth Group, in Minnetonka, Minn., came in at No. 53. Scott Armstrong, president and CEO of Group Health Cooperative in Seattle, a system that provides insurance and outpatient services in Washington state, debuted at No. 38.
Neurosurgeon and CNN chief medical correspondent Sanjay Gupta rounded out the list at No. 100.
Robert Wachter, a quality expert at the University of California at San Francisco and a national leader in the hospitalist movement, joined the list at No. 72 this year. Wachter writes a popular blog called “Wachter’s World,” and he speculates the blog’s loyal readers may have helped him land a spot on our list.
“It’s sobering and humbling to look at the company I’m in,” he says. “These are heads of large organizations that control large budgets. They have the ability to change the world.”
Only two hospital executives debuted on the list this year: David White, chairman and CEO of Iasis Healthcare in Franklin, Tenn. (No. 30); and Michael Connelly, president and CEO of Catholic Health Partners in Cincinnati (No. 60).
There was one new policy analyst on the list: Robert Moffit (No. 73), senior fellow at
tively. This year, Gates ranks No. 8—probably more for his commitment to improving public health worldwide through his $34 billion foundation than for his tech clout. Schmidt fell off the list entirely.
Carolyn Clancy, director of the Agency for Healthcare Research and Quality, stood at No. 31 on the list three years ago. This year, just as in 2009, she holds the No. 7 spot.
Clancy’s clout has risen with the agency, which was created 20 years ago to support and conduct healthcare outcomes research. Today, thanks to the Patient Protection and Affordable Care Act of 2010, as well as the American Recovery and Reinvestment Act of 2009 (better known as the stimulus law), AHRQ’s profile is higher than ever.
“The role of improving quality and linking science to policy is a much stronger feature of the Affordable Care Act. It’s all over the act. We’re incredibly excited” that Congress understands that, Clancy says.
AHRQ was allocated $300 million in the
stimulus law to conduct comparative-effectiveness research, and is also managing the $400 million allocated to the HHS secretary for this effort, Clancy says. With help from a 15-member council, AHRQ and related agencies will decide how to spend this windfall. Clancy calls the funds a “down payment” for quality improvements in healthcare.
Soon, AHRQ and coordinating agencies will release more information on what kinds of research on comparative effectiveness these dollars will fund. “We are wrapping up the details,” she says. Priorities will include patient-and data-centered outcomes research, she says.
“We will be making investments in activities like patient registries,” Clancy says, citing an example of safe surgery practices at the Veterans Affairs Department.
“It’s all about collecting data, and taking a hard look at outcomes and becoming best in class,” she says. “We have to involve people in the front lines of care.”
Every year, AHRQ documents statistically significant improvements in quality. “The challenge is to accelerate the pace of improvements,” she says. “I think we are well-positioned as a nation to do that.”
While some fear that comparative effectiveness research could lead to rationing of healthcare, or curtailing physicians’ ability to make treatment decisions, Clancy says that’s not the agency’s intent.
“We want to help physicians take the best science and tailor it to the individual,” she says. “We stop where the evidence stops.”
Comparative effectiveness is an opportunity to further the dialogue about best practices in patient care, Clancy says. “We hope this is a basis for informed discussions,” she says. “Clinical care and decisionmaking are pretty nuanced.”
Leading the change
Managing all the changes coming fast and furious from Washington is top of mind for those who made it onto this year’s 100 Most Powerful list.
Scott Armstrong, president and CEO of Group Health Cooperative in Seattle, debuted at No. 38. Group Health was in the national spotlight last year as Congress pondered whether to replicate the health cooperative model in other states through the healthcare reform bill. The idea of setting up co-ops across the country to compete for health insurance business did not ultimately gain traction, but Group Health earned new admirers for its ability to improve quality while reining in costs.
“The question is how we implement it and make this real,” says Armstrong, who was also
recently appointed as a commissioner to the Medicare Payment Advisory Commission. “I run a company that is demonstrating how to make this possible.”
Armstrong called the Patient Protection and Affordable Care Act a “great first step,” by expanding access to the nation’s uninsured. “But it really is only a first step,” he adds. “It sets us up to get into a whole body of work on changing the care delivery system.”
Group Health has 26 primary-care centers across Washington state, and no inpatient facilities. About two-thirds of patients are cared for in a group practice, while the rest use contractors. The co-op is experimenting with payment models besides fee-for-service, and working to increase quality.
For instance, partnering with community hospitals, Group Health has managed to lower hospital 30-day readmission rates by 9.5% over the past year, saving at least $50 million annually. Group Health did this by standardizing the patient experience as patients transitioned from a hospital to an outpatient setting, Armstrong says. The readmission rate overall hovers around 14%. Rolling out a medical home to 400,000 patients at all 26 care centers is also
reducing hospitalizations. One pilot study of this program showed a 29% reduction in hospital days, according to Group Health.
As the CMS and private insurers stop paying for hospital readmissions that happen within 30 days, payers and providers need to up the ante, Armstrong says. “We have to look at other ways to drive change,” he says. Halting payments for readmissions “forces change, but it doesn’t answer the question, ‘How do you change?’ We have to look at the underlying critical-care process.”
That’s the challenge for those in the delivery system: Staying ahead of all the new regulations coming down the pike while excelling in the current system. It’s a topic that came up again and again in interviews with those on the Most Powerful list this year.
Nearly two years ago, Joel Allison, president and CEO of Baylor Health Care System in Dallas (and No. 23 on this year’s list), created a seven-point vision for 2015. The vision included a patient-centered model of care and a new information technology system to provide a more seamless patient experience and improve quality and efficiency.
Like many other large systems, Baylor has set itself up as an accountable care organization called the Baylor Quality Healthcare Alliance, with a patient-centered medical home and more focus on pay for performance, wellness and outcomes. The health reform law authorizes Medicare to contract with ACOs, which are networks of providers that agree to work together to improve quality and reduce costs.
“It’s a tall order, but it’s also a huge opportunity,” Allison says.
Right now, Baylor is working to come up with specific requirements and commitments from partners outside of Baylor that will participate in the ACO, such as home health companies, Allison says. These Baylor requirements include 12 “must-haves,” such as that all aspects of the organization must be devoted to serving patients.
While building an ACO, Allison says he worries about the rising costs of care until 2014, when many of the reform law’s benefits kick in. “The high cost of care has to do with the fragmentation of the system,” he says.
Straddling the current system while preparing for what’s coming is critical, and tough right now, agrees Dan Wolterman, president and CEO of Memorial Hermann Healthcare System in Houston, and No. 36 on this year’s 100 Most Powerful list.
“We have to continue to do well in the current fee-for-service environment while preparing to jump to another environment,” Wolterman says. “We’ve got to manage both
Among the 18 newcomers on this year’s list are three prominent physicians: Regina Benjamin, left, Sanjay Gupta and Robert Wachter.