Who's No. 1?

Wash­ing­ton in­sid­ers hold sway over our ‘100 Most In­flu­en­tial’ rank­ing, but real change seems to be com­ing from else­where

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Twenty-seven new­com­ers make this year's rank­ing, in­clud­ing No. 1 and No. 2, who don't see eye to eye on the govern­ment's role in health­care

The na­tion’s po­lit­i­cal forces are bit­terly di­vided over is­sues rang­ing from rais­ing the coun­try’s debt ceil­ing to the use of en­ergy-ef­fi­cient light bulbs, so it’s no sur­prise that the govern­ment’s role in health­care is also the source of in­tense de­bate. That di­vi­sion is re­flected in Mod­ern Health

care’s rank­ing of the 100 Most In­flu­en­tial Peo­ple in Health­care, with House Bud­get Com­mit- tee Chair­man Paul Ryan (R-Wis.)—who seeks to re­make the na­tion’s Medi­care and Med­i­caid sys­tems—fin­ish­ing first, and Ver­mont Gov. Peter Shum­lin—who seeks to make his state the first in the union to adopt a govern­ment-run sin­gle-payer sys­tem—com­ing in sec­ond.

Oth­ers in this year’s Top 10, as might be ex­pected, in­clude Pres­i­dent Barack Obama and mem­bers of his ad­min­is­tra­tion in high-pro­file po­si­tions. Af­ter fin­ish­ing first the past two years, the pres­i­dent fin­ished third on the 2011 list, ahead of CMS Ad­min­is­tra­tor Dr. Don­ald Ber­wick (who has made the list ev­ery year since it started in 2002) in the No. 4 spot, and HHS Sec­re­tary Kath­leen Se­be­lius at No. 5.

Dr. Farzad Mostashari, na­tional co­or­di­na­tor for health in­for­ma­tion tech­nol­ogy, fin­ished at No. 9. Dr. Carolyn Clancy, who Pres­i­dent Ge­orge W. Bush named di­rec­tor of HHS’ Agency for Health­care Re­search and Qual­ity in 2003 and Obama reap­pointed in 2009, fin­ished at No. 11.

Round­ing out the top tier are pres­i­den­tial can­di­date and for­mer U.S. Speaker of the House Newt Gin­grich, founder of the Cen­ter for Health Trans­for­ma­tion, at No. 6; Dr. John Wennberg, di­rec­tor of the Dart­mouth In­sti­tute for Health Pol­icy and Clin­i­cal Prac­tice, who led the field from aca­demic medicine and came in at No. 7; John­son & John­son CEO Wil­liam Weldon, the high­est pri­vate-in­dus­try sec­tor fin­isher, at No. 8; and Therese “Terri” Vaughan, CEO of the Na­tional As­so­ci­a­tion of In­surance Com­mis­sion­ers, at No. 10.

Although Gin­grich’s and Wennberg’s of­fices did not re­spond to re­quests for com­ment and Weldon’s and Clancy’s de­clined, both Ryan and Shum­lin of­fered their views on the cur­rent state of the na­tion’s health­care sys­tem.

“The pri­mary driver of our na­tional debt is our health­care pro­gram,” Ryan said. “There’s no one magic bul­let—like pass this and it’s fixed—but, save the health­care sys­tem and you’re sav­ing the coun­try from its debt cri­sis.”

Ryan added that health­care in­fla­tion has made health­care pro­grams un­sus­tain­able, so his goal is to make them sus­tain­able long term, “make them meet their mis­sion,” and main­tain a world-class sys­tem based on “in­no­va­tion and ex­cel­lence.”

Shum­lin, a Demo­crat, said Wash­ing­ton has be­come “par­a­lyzed by par­ti­san bick­er­ing,” and ex­plained that a sin­gle-payer sys­tem would elim­i­nate waste, ad­min­is­tra­tive over­head and in­surance com­pany prof­its, and he wants to have it im­ple­mented in Ver­mont by 2014.

“If you took as an ex­am­ple, all the Tea Par­typro­posed cuts to our fed­eral bud­get and you im­ple­mented them, and you took all rev­enue Democrats have pro­posed rais­ing from the wealthy and you put them to­gether,” Shum­lin said, “you would still have the same fed­eral spend­ing chal­lenges, the same growth in bud­gets and the same tril­lions of dol­lars of debt you have right now in three years.”

Both men fa­vor a sys­tem that steers away from em­ployer-based in­surance so the cov­er­age fol­lows the in­di­vid­ual and is not linked to the per­son’s job. For Shum­lin, this is a way to

“en­sure that health­care is a right and not a priv­i­lege.” For Ryan, it means in­sti­tut­ing a sys­tem where in­di­vid­u­als get a re­fund­able tax credit for health­care costs and “providers com­pete against each other based on value—price, qual­ity and out­comes—for their busi­ness.”

For all their dif­fer­ences, both men can sound alike at times.

“We spend more money per per­son than any other in­dus­tri­al­ized coun­try,” Ryan said. “We don’t spend in­tel­li­gently either.”

Ryan added that the govern­ment should put its money “where it’s needed the most,” and that’s help­ing the poor and the most sick. He also said he has al­ways be­lieved in state-based risk pools for pa­tients with pre-ex­ist­ing con­di­tions. “Health­care should be viewed as an as­set and driver of eco­nomic growth—rather than a drag on the econ­omy,” he said.

Shum­lin, who wants to do away with “this crazy fee-for-ser­vice sys­tem,” ac­knowl­edged the con­cerns peo­ple have about a state-run health­care pro­gram. “I think those who dis­trust govern­ment in health­care have ev­ery rea­son to do so,” he said. “Govern­ment has got­ten this wrong ev­ery sin­gle time.”

Ryan’s pro­posal to cut $730 bil­lion in Med­i­caid spend­ing over 10 years by turn­ing it into a block grant pro­gram was the sub­ject of heated de­bate at this year’s Amer­i­can Med­i­cal As­so­ci­a­tion House of Del­e­gates meet­ing. His plan to cut some $390 bil­lion in Medi­care spend­ing (com­pared with the pres­i­dent’s bud­get), was also crit­i­cized by an un­likely source: the free mar­ket­pro­mot­ing Lib­er­tar­ian Party.

“Repub­li­can Paul Ryan’s plan to ‘pri­va­tize’ Medi­care is just re­ar­rang­ing the deck chairs on the Ti­tanic,” reads a June 3 state­ment from party Chair­man Mark Hin­kle. “If Con­gress­man Ryan is so wor­ried about the cost of Medi­care, maybe he should not have voted for the huge Repub­li­can Medi­care ex­pan­sion in 2003.”

Oth­ers on the list from the fed­eral govern­ment in­clude Sur­geon Gen­eral Dr. Regina Ben­jamin, at No. 26; Aneesh Cho­pra, U.S. chief tech­nol­ogy of­fi­cer, No. 39; Eric Holder, U.S. at­tor­ney gen­eral, No. 55; Dr. Thomas Frieden, di­rec­tor of the Cen­ters for Disease Con­trol and Preven­tion, No. 70; Dr. Mar­garet Ham­burg, Food and Drug Ad­min­is­tra­tion com­mis­sioner, No. 73; Richard Fe­in­stein, di­rec­tor of the Fed­eral Trade Com­mis­sion’s Bureau of Com­pe­ti­tion, No. 74; Eric Shin­seki, Vet­er­ans Af­fairs sec­re­tary, No. 84; Richard Fos­ter, the CMS’ chief ac­tu­ary, No. 87; Dr. Howard Koh, HHS as­sis­tant sec­re­tary for health, No. 92; Daniel Levin­son, HHS’ in­spec­tor gen­eral, No. 94; and Dr. Richard Gil­fil­lan, act­ing di­rec­tor of the new CMS’ Cen­ter for Medi­care & Med­i­caid In­no­va­tion, No. 97.

Other Repub­li­can politi­cians on the list are Speaker of the House John Boehner of Ohio, No. 21; Sen. Chuck Grass­ley of Iowa, who’s been on the list ev­ery year since its in­cep­tion, No. 47; and Florida Gov. Rick Scott, No. 49.

Nurses wield their in­flu­ence

Rose Ann DeMoro, ex­ec­u­tive di­rec­tor of the AFL-CIO-af­fil­i­ated Na­tional Nurses United la­bor union, who also has ap­peared on the list all 10 years, is not a fan of Ryan—but her dis­agree­ment comes from the other end of the po­lit­i­cal spec­trum com­pared with the Lib­er­tar­i­ans.

“The mar­ket isn’t magic and it doesn’t trickle down. There’s a role for govern­ment—I just wish the peo­ple in govern­ment would play it,” DeMoro said. “The Paul Ryans of the world ac­tu­ally don’t want a so­ci­ety. They want in­di­vid­u­als and cor­po­ra­tions to make un­godly amounts of money. There is no so­ci­ety—only in­di­vid­u­als and what in­di­vid­u­als can do on their own.”

The pol­i­tics of pri­vacy

Her ire, how­ever, is not re­served for con­ser­va­tive Repub­li­cans alone. DeMoro is also up­set with Congress and Obama for not push­ing for a sin­gle-payer, “Medi­care for All” plan when they had the chance.

DeMoro pre­dicted that most po­lit­i­cal health­care-re­lated change will be at the lo­cal level and said go­ing to Wash­ing­ton is “a waste of time.” She told of a nurse lob­by­ing in the na­tion’s cap­i­tal who was told that nurses need to “lower their ex­pec­ta­tions.” Ac­cord­ing to DeMoro, the nurse replied: “Do you want us to say that to you when we prep you for surgery?”

DeMoro said nurses are los­ing their jobs as hos­pi­tals close or they are of­ten sup­port­ing spouses, grown chil­dren and even par­ents who have lost their jobs. She pre­dicted the sit­u­a­tion will drive po­lit­i­cal change. “He­roes aren’t made, they’re cor­nered, and nurses are feel­ing cor­nered—and be­lieve me, they’re hero ma­te­rial,” DeMoro said. “Peo­ple are an­gry. We’re go­ing to tap that anger and run with that anger.”

Dr. Deborah Peel, an Austin, Texas-based psy­chi­a­trist and founder and chair­woman of the Pa­tient Pri­vacy Rights Foun­da­tion, af­ter mak­ing the list from 2007 to 2009—in­clud­ing the No. 4 spot in 2007—found her­self knocked off the 2010 rank­ing. So she was sur­prised to learn she made it back this year—espe­cially af­ter spend­ing much of the past year work­ing be­hind the scenes on the Health Pri­vacy Sum­mit her or­ga­ni­za­tion sponsored in June.

“I was the con­vener,” said Peel, who holds the No. 52 spot. “I just said ‘hello’ and ‘goodbye.’ ”

Peel joked that her low pro­file may have helped in­crease her in­flu­ence, but she also said there is almost univer­sal sup­port for the pri­vacy pro­tec­tions her or­ga­ni­za­tion is push­ing to have in­cluded in the na­tion’s de­vel­op­ing health IT net­work, say­ing that both sides of the aisle in Congress agree with her. But she said the Obama ad­min­is­tra­tion and the Bush ad­min­is­tra­tion have sought to use health IT to cre­ate un­blocked “win­dows into the most in­ti­mate in­for­ma­tion about a per­son’s mind, body, fi­nances and fam­ily re­la­tions.”

To em­pha­size the im­por­tance of pa­tient pri­vacy, Peel cited an HHS study that es­ti­mated 586,000 Amer­i­cans did not seek can­cer treat­ment be­cause of pri­vacy con­cerns and 2 mil­lion did not seek treat­ment for men­tal ill­ness.

“The Amer­i­can peo­ple are very united on this; the prob­lem is not a po­lit­i­cal prob­lem,” she said. “From the minute we came to Wash­ing­ton, we

The pol­icy of in­surance

had some heavy sup­port from both some con­ser­va­tive right-wing groups and the ACLU (Amer­i­can Civil Lib­er­ties Union), so we ac­tu­ally had a coali­tion that was bi­par­ti­san—or transpar­ti­san.”

Therese “Terri” Vaughan, who leads the Kansas City, Mo.-based Na­tional As­so­ci­a­tion of In­surance Com­mis­sion­ers group, said her group has also man­aged to avoid the par­ti­san paral­y­sis plagu­ing Wash­ing­ton.

“It’s a group of tech­ni­cal ex­perts on in­surance, and we know how in­surance works and the pri­mary ob­jec­tive is pro­tect­ing the con­sumers,” Vaughan said, adding that “the NAIC is just a con­duit or mech­a­nism for putting to­gether the best think­ing at the state level.”

The Pa­tient Pro­tec­tion and Af­ford­able Care Act men­tions the NAIC muli­ple times and calls on the HHS sec­re­tary to con­sult with the or­ga­ni­za­tion when de­vel­op­ing rel­e­vant in­sur­ancere­lated stan­dards, rules and def­i­ni­tions. “Mem­bers of Congress rec­og­nized that we weren’t on one side or the other of this is­sue, though in­di­vid­ual mem­bers might be,” Vaughan said. “Our job is to make this work ef­fec­tively for con­sumers.”

Other in­surance ex­ec­u­tives also made this year’s rank­ing: Stephen Hem­s­ley, pres­i­dent and CEO of Unit­edHealth Group, who holds No. 22; Pa­tri­cia Hem­ing­way Hall, pres­i­dent and CEO of Health Care Ser­vice Corp., No. 35; An­gela Braly, chair­woman, pres­i­dent and CEO of Wel­lPoint, No. 40; Karen Ig­nagni, pres­i­dent and CEO of America’s Health In­surance Plans, No. 57; Ge­orge Halvor­son, chair­man and CEO of Kaiser Per­ma­nente, No. 60; Michael McCal­lis­ter, chair­man and CEO of Hu­mana, No. 67; and Scott Serota, pres­i­dent and CEO of the Blue Cross and Blue Shield As­so­ci­a­tion, No. 90.

Ig­nagni, an­other honoree who has made the most in­flu­en­tial list all 10 years, said pay­er­provider part­ner­ships in med­i­cal homes and ac­count­able care or­ga­ni­za­tions are bring­ing about re­forms that Wash­ing­ton has been un­able to ac­com­plish. “We know that fee for ser­vice doesn’t en­cour­age safety or in­cen­tivize cost con­tain­ment,” she said. “Health plans and providers have come to­gether to move the nee­dle.”

Mau­reen Bisog­nano, who suc­ceeded Ber­wick as pres­i­dent and CEO of the In­sti­tute for Health­care Im­prove­ment and comes in at No. 37, said the health­care sys­tem’s woes cre­ate “the most press­ing time for in­no­va­tion,” adding that the cur­rent mod­els aren’t work­ing. “Although the di­vi­sion has the po­ten­tial to hold us back, I am heart­ened by lo­cal and re­gional im­prove­ments.”

Ber­wick has taken the IHI’s “Triple Aim” strat­egy of im­prov­ing pop­u­la­tion health, im­prov­ing the health­care ex­pe­ri­ence and lower- ing costs per capita with him to the CMS, but Bisog­nano said the two of them don’t dis­cuss that. “We don’t talk about work for a num­ber of dif­fer­ent rea­sons,” she said. “I ad­mire his vi­sion and com­mit­ment to im­prove care. I think the direc­tion he’s tak­ing CMS—espe­cially with the Cen­ter for In­no­va­tion—is help­ful be­cause it’s cre­at­ing the for­ward think­ing that we need.”

Deal­ing with un­cer­tainty

Dr. Gary Ka­plan, chair­man and CEO of the Vir­ginia Ma­son Hos­pi­tal & Med­i­cal Cen­ter, Seat­tle, said health­care is an ex­tremely com­plex in­dus­try and his con­cern is that the fed­eral govern­ment may wind up tin­ker­ing with iso­lated changes not con­nected to a cen­tral vi­sion.

“There is cer­tainly a lot of ac­tiv­ity in Wash­ing­ton and still a fair amount of un­cer­tainty,” said Ka­plan, No. 33 on this year’s rank­ing. “But the train is mov­ing down the track in re­gards to re­form and the hos­pi­tal and health sys­tem ex­ec­u­tives have an im­por­tant role to play.”

He said Vir­ginia Ma­son has had suc­cess adopt­ing man­u­fac­tur­ing prin­ci­ples to health­care and work­ing with area em­ploy­ers on em­ployee prob­lems that add up in terms of cost and lost pro­duc­tiv­ity. “I think the re­form law di­a­logue has been a cat­a­lyst, but we’ve known for some time that health­care needs to be bet­ter in terms of qual­ity and safety—and it needs to cost less.”

Chris Van Gorder, pres­i­dent and CEO of Scripps Health and No. 18 on this year’s rank­ing, re­it­er­ated that govern­ment is the largest payer most providers have. He said the un­cer­tainty over what this payer will do next is lead­ing many or­ga­ni­za­tions to in­no­vate and re­design—and that’s a pos­i­tive de­vel­op­ment. “When ev­ery­one else thinks the sky is fall­ing, I’m run­ning around the coun­try say­ing, ‘I’ve never been more bullish on health­care,’” Van Gorder said.

Ru­lon Stacey, pres­i­dent and CEO of Poudre Val­ley Health Sys­tem in Fort Collins, Colo., and chair­man of the Amer­i­can Col­lege of Health­care Ex­ec­u­tives, said providers need to iden­tify what they can do to re­duce costs and im­prove qual­ity—and then do it be­fore waiting to be told.

“I think we spend too much time wor­ry­ing about what the govern­ment is go­ing to do,” said Stacey, a first-timer to the list who holds the No. 88 spot. “We’re go­ing to wish Congress well while we drive vari­a­tion out of our or­ga­ni­za­tion. It’s one thing I can change and will change.”

Stacey ex­plained how, if an or­ga­ni­za­tion per­forms a pro­ce­dure 10 dif­fer­ent ways, “by def­i­ni­tion, nine are in­fe­rior. When you iden­tify best prac­tices, you drive peo­ple to do the things the right way,” he said. “I don’t need Congress’ per­mis­sion to do that.”

Teri Fon­tenot, pres­i­dent and CEO of Woman’s Hos­pi­tal in Ba­ton Rouge, La., and chair-elect of the Amer­i­can Hos­pi­tal As­so­ci­a­tion, said per­for­mance re­port­ing is prompt­ing hos­pi­tals to im­prove faster than any govern­ment pro­gram she’s ever seen. “I’m a firm be­liever in trans­parency and dis­clo­sure, and that can have more im­pact on per­for­mance im­prove­ment than any pay­ments or penal­ties,” said Fon­tenot, No. 79 on the list and also a first-timer.

She added that the AHA looks to the govern­ment for fund­ing and sta­bil­ity, and she said it still looks at the pas­sage of the Af­ford­able Care Act as a pos­i­tive move. “I know that it’s still pretty con­tro­ver­sial, even among our mem­bers,” she said. “The Amer­i­can Hos­pi­tal As­so­ci­a­tion re­ally views it as the first step in get­ting peo­ple af­ford­able care.”

Dr. Robert Wah, No. 12 on the list, is the na­tion’s for­mer deputy na­tional co­or­di­na­tor for health IT and the new board chair­man of the Amer­i­can Med­i­cal As­so­ci­a­tion—an­other or­ga­ni­za­tion that was bashed for sup­port­ing the re­form law. He said the AMA wants the govern­ment to fix the Medi­care pay­ment for­mula, re­form mal­prac­tice li­a­bil­ity and change an­titrust laws to al­low more physi­cian col­lab­o­ra­tion.

“As a prac­tic­ing physi­cian, what I see is a time of great op­por­tu­nity. I al­ways see change as op­por­tu­nity, and I never like to miss an op­por­tu­nity,” said Wah, also chief med­i­cal of­fi­cer for IT com­pany Com­puter Sciences Corp. “It’s quite an ex­cit­ing time.”


“The pri­mary driver of our na­tional debt is our health­care pro­gram,” says House Bud­get Com­mit­tee Chair­man Paul Ryan.

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