Work­ing to keep re­form on track

A chang­ing in­dus­try poses chal­lenges for health­care lead­ers across all sec­tors

Modern Healthcare - - LATE NEWS - By Andis Robeznieks

Now re­ally, who else could it be? Is there any­one else in health­care man­ag­ing a $941 bil­lion bud­get and tasked with mov­ing the mas­sive Pa­tient Pro­tec­tion and Af­ford­able Care Act from pa­per to re­al­ity?

In her fis­cal 2012 bud­get state­ment, HHS Sec­re­tary Kath­leen Se­be­lius sum­ma­rized her agency’s mis­sion: Strength­en­ing health­care; ad­vanc­ing sci­en­tific knowl­edge and in­no­va­tion; ad­vanc­ing the health, safety and well-be­ing of the Amer­i­can peo­ple; and do­ing so ef­fi­ciently, trans­par­ently and with ac­count­abil­ity.

That’s some to-do list. Whether or not one agrees with the goals or the meth­ods, manag- ing the trans­for­ma­tion of the na­tion’s health­care sys­tem from one that re­wards vol­ume to one that re­wards value is a Her­culean task— re­quir­ing a steady hand with bold imag­i­na­tion and at­ten­tion to the small­est de­tails. And, in many ways, the work has just be­gun. HHS’ sec­re­tary has been in charge of ex­pand­ing health­care cov­er­age, cer­ti­fy­ing elec­tronic health records, pro­mot­ing flu shots and re­spond­ing to dis­as­ters. Be­cause of her han­dling of im­me­di­ate con­cerns and im­ple­men­ta­tion of pro­grams whose ef­fects will be felt for years to come, Mod­ern Health­care read­ers and edi­tors named Se­be­lius the most in­flu­en­tial per­son in health­care for 2013.

Se­be­lius is the third HHS sec­re­tary and only

the sec­ond woman to top the Mod­ern Health­care Most In­flu­en­tial rank­ings. (Sis­ter Carol Kee­han, CEO of the Catholic Health As­so­ci­a­tion, topped the list in 2007. She is ranked No. 10 this year.) Fif­teen peo­ple were named to the list for the first time this year and seven have made it ev­ery year since the rank­ings were first pub­lished in 2002—when then-HHS Sec­re­tary Tommy Thomp­son topped the list. In all, there were 75 men and 25 women on the Most In­flu­en­tial ros­ter for 2013. They rep­re­sent the full spec­trum of the health­care in­dus­try, in­clud­ing providers, sup­pli­ers, in­sur­ers, ad­vo­cates, politi­cians as well as reg­u­la­tors.

A moral case and a busi­ness case

Lloyd Dean, pres­i­dent and CEO of San Fran­cisco-based Dig­nity Health, cited Se­be­lius among those he per­son­ally finds most in­flu­en­tial. In not­ing how Se­be­lius has steered the na­tion to­ward a sys­tem that ex­pands ac­cess and re­wards value over vol­ume, Dean said Se­be­lius has “built the moral case, the busi­ness case and the so­ci­etal case for health­care for all.”

“Even with all the pol­i­tics that have been pre­sented in Wash­ing­ton, she con­tin­ues to fight the fight, con­tin­ues to lis­ten to providers, pay­ers and con­sumers, and has not lost the faith in the im­por­tance of health­care for all,” says Dean, who placed No. 34 in the Most In­flu­en­tial rank­ings.

While health­care re­form may be bet­ter known now as Oba­macare, Dean said the ef­forts of Se­be­lius will gain more ap­pre­ci­a­tion as the years pass. “In my opin­ion, she’s one of the silent heroes,” Dean says. “Her lead­er­ship, when we look back at this in a decade from now, will be rec­og­nized. And she will be rec­og­nized as some­one whose courage and stead­fast­ness were re­spon­si­ble for mak­ing progress in serv­ing this na­tion with af­ford­able, qual­ity health­care.”

Se­be­lius is a for­mer in­sur­ance com­mis­sioner of Kansas and a for­mer gover­nor of the state. Her fa­ther, John Gil­li­gan, served as gover­nor of Ohio from 1971 to 1975. In 2002, Se­be­lius be­came the first daugh­ter of a gover­nor to be­come a gover­nor her­self when she was elected in 2002 to be­come the chief ex­ec­u­tive of Kansas. She was re-elected four years later but left that of­fice in 2009 when Pres­i­dent Barack Obama picked her as his choice for HHS Sec­re­tary. (Obama, who has topped the Most In­flu­en­tial list twice, ranks No. 3 this year.)

Her lead­er­ship and in­flu­ence also re­ceived praise from Dr. David Blu­men­thal, the national co­or­di­na­tor for health in­for­ma­tion tech­nol­ogy from 2009 to 2011, who says he is a great ad­mirer of Se­be­lius.

“She’s do­ing a great job un­der dif­fi­cult cir­cum­stances in im­ple­ment­ing the Af­ford­able Care Act,” says Blu­men­thal, now pres­i­dent of the Com­mon­wealth Fund and No. 93 on this year’s rank­ing. “I think she’s a steady hand at the wheel un­der enor­mous pres­sure. No one has ex­pe­ri­enced as much fe­ro­cious op­po­si­tion to im­ple­ment a law as she and the cur­rent ad­min­is­tra­tion are fac­ing.”

Help­ing hands

Of course, Se­be­lius is not do­ing it all on her own. Other mem­bers of HHS’ team on the Most In­flu­en­tial list in­clude Mar­i­lyn Taven­ner, CMS ad­min­is­tra­tor, No. 5; Blu­men­thal’s suc­ces­sor as national co­or­di­na­tor and for­mer deputy, Dr. Farzad Mostashari, who is No. 27 in the rank­ings and who an­nounced his in­ten­tion to leave of­fice this year; Dr. Thomas Frieden, di­rec­tor of the Cen­ters for Dis­ease Con­trol and Preven­tion, No. 43; Dr. Mar­garet Ham­burg, di­rec­tor of the Food and Drug Ad­min­is­tra­tion, No. 45; Daniel Levin­son, HHS’ in­spec­tor gen­eral, No. 68; and Dr. Fran­cis Collins, di­rec­tor of the National In­sti­tutes of Health, No. 73.

Taven­ner, a for­mer nurse and hos­pi­tal CEO with the na­tion’s big­gest hos­pi­tal sys­tem, HCA, is the first Se­nate-ap­proved CMS ad­min­is­tra­tor in six years af­ter be­ing con­firmed in May. She had been serv­ing as act­ing ad­min­is­tra­tor since Dr. Don­ald Ber­wick left the CMS in De­cem­ber 2011 with­out ever hav­ing his con­fir­ma­tion voted on by the Se­nate. She is tasked with im­ple­ment­ing such pro­grams as the health in­sur­ance ex­changes and sev­eral pay­ment-re­form pilot projects.

Taven­ner told Mod­ern Health­care this month about the role of hos­pi­tals and hos­pi­tal boards in help­ing ed­u­cate the pub­lic about in­sur­ance ex­changes. “Each hos­pi­tal in a com­mu­nity has a spe­cial role,” Taven­ner said. “First of all, they have a rea­son to help peo­ple get in­sured. Ob­vi­ously, th­ese are the in­di­vid­u­als they see in the emer­gency depart­ment and who are ad­mit­ted.”

Taven­ner cited pos­i­tive re­sults in CMS pro­grams seek­ing to re­duce hos­pi­tal ad­mis­sions. She cred­ited the ac­tive en­gage­ment of hos­pi­tals and physi­cians “in chang­ing the de­liv­ery sys­tem to one that’s more ac­count­able for qual­ity and out­comes.”

Blu­men­thal hired Mostashari as his deputy in 2009, and he said the job de­scrip­tion of the national co­or­di­na­tor’s post has changed im­mensely since he left it in April 2011.

“He’s had a tougher job than I had—cer­tainly very dif­fer­ent,” Blu­men­thal says of Mostashari, adding that part of the work they did to­gether was to “make a lot of bets” on what would work. “Our job was to get a pro­gram up and run­ning,” he said. “It was heavy on pol­icy and launch, and not so much of the heavy grind of im­ple­men­ta­tion.”

Blu­men­thal said what Mostashari is do­ing re­quires at­ten­tion to de­tail and “a lot of teach­ing” about “what’s pos­si­ble, what’s nec­es­sary, and how to get from one place to the next.”

Other reg­u­la­tors who ranked this year among the most in­flu­en­tial in­clude Richard Fe­in­stein, who re­cently stepped down as di­rec­tor of the U.S Fed­eral Trade Com­mis­sion’s Bureau of Com­pe­ti­tion, No. 64; and Eric Shin­seki, sec­re­tary of the Vet­er­ans Af­fairs Depart­ment, No. 91.

#1 Kath­leen Se­be­lius HHS sec­re­tary

Source: Mod­ern Health­care re­port­ing

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