Some new faces on the list

Modern Healthcare - - Cover Story -

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

—Re­becca Ve­sely

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.

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