Most In­flu­en­tial lead­ers

Have blazed bold re­form paths

Modern Healthcare - - 100 MOST INFLUENTIAL PEOPLE IN HEALTHCARE - By An­dis Robeznieks

The man who may have to keep his veto pen handy to block con­gres­sional Repub­li­can ef­forts to re­peal or roll back the Pa­tient Pro­tec­tion and Af­ford­able Care Act took the top spot in Mod­ern Health­care’s 100 Most In­flu­en­tial Peo­ple in Health­care.

Pres­i­dent Barack Obama, who pushed through the law that has dra­mat­i­cally re­shaped U.S. health­care, re­ceived more than twice as many votes as any­one else on this year’s 100 Most In­flu­en­tial bal­lot, and his name ap­peared on al­most 25% of the more than 31,000 bal­lots cast. If the Repub­li­cans win con­trol of the Se­nate in Novem­ber, he will likely be busy in 2015 stop­ping GOP bills to re­peal ACA man­dates, taxes and other key fea­tures of the law. Hos­pi­tals, physi­cian groups, in­sur­ers and other health­care stake­hold­ers, which have spent enor­mous amounts of time, money and ef­fort in mak­ing changes based on the law, will be closely watch­ing the out­comes of th­ese ACA bat­tles.

Un­cer­tainty about the po­lit­i­cal sta­tus of health­care re­form will re­main con­stant for two more years, pre­dicted Chip Kahn, CEO of the Fed­er­a­tion of Amer­i­can Hos­pi­tals. But if it con­tin­ues to be im­ple­mented and pre­vi­ously unin­sured Amer­i­cans con­tinue to re­ceive cov­er­age, “there will be no turn­ing back” af­ter 2016, he said. “We have to get through this elec­tion,” said Kahn, No. 46 on this year’s in­flu­en­tial list and one of only six peo­ple to make the rank­ing all 13 years of its ex­is­tence. “This is ei­ther the last elec­tion or the sec­ond-to-last elec­tion that will be about Oba­macare.”

Un­cer­tainty com­bined with op­por­tu­nity has led to some un­likely part­ner­ships as gov­ern­ment, providers and in­sur­ers all try to pro­mote their vi­sion of health­care trans­for­ma­tion. So it’s no sur­prise that th­ese stake­hold­ers are all well rep­re­sented in the top 10 of this year’s an­nual 100 Most In­flu­en­tial ros­ter.

Fed­eral of­fi­cials rank­ing close be­hind Obama, who also topped the list in 2009 and 2010, are new HHS Sec­re­tary Sylvia Mathews Bur­well at No. 3 and CMS Ad­min­is­tra­tor Marilyn Taven­ner at No. 5. From the pri­vate sec­tor, at No. 2 is Bernard Tyson, CEO of Kaiser Per­ma­nente, the huge in­te­grated de­liv­ery sys­tem. Tyson praised the job be­ing done by Obama and Taven­ner.

“With Pres­i­dent Obama, I re­spect the fact that he truly be­lieves that health­care of the high­est qual­ity should be ac­ces­si­ble to ev­ery sin­gle Amer­i­can,” Tyson said. “Marilyn Taven­ner is just a thor­ough and thought­ful and very bal­anced leader that I en­joy work­ing with.”

A for­mer nurse, Taven­ner re­ceived praise from two other RNs on the 100 Most In­flu­en­tial list, Marla We­ston, CEO of the Amer­i­can Nurses As­so­ci­a­tion, No. 45; and Sis­ter Carol Kee­han, CEO of the Catholic Health As­so­ci­a­tion, No. 34. It’s We­ston’s first time on the list and the ninth time for Kee­han. Having Taven­ner in such a key po­si­tion, We­ston said, “re­in­forces to nurses the im­por­tance of the nurses’ per­spec­tive. There is a re­newed sense of fire and in­no­va­tion that wasn’t there a decade ago.”

Other lead­ers of large provider or­ga­ni­za­tions in the Top 10 in­cluded R. Mil­ton John­son, No. 6, CEO of Nashville­based HCA, the na­tion’s largest for-profit hos­pi­tal chain, and An­thony Ter­signi, No. 9, CEO of St. Louis-based As­cen­sion, the largest pri­vate not-for-profit hos­pi­tal chain. Rep­re­sen­ta­tives from the in­sur­ance side in­clude Stephen Hem­s­ley, CEO of Min­netonka, Minn.-based Unit­edHealth Group, No. 4, and Mark Ber­tolini, CEO of Hartford, Conn.-based Aetna, at No. 8.

“The Af­ford­able Care Act has cre­ated pres­sure for in­no­va­tion,” said Dr. Robert Wachter, No. 83, chief of hos­pi­tal medicine at UCSF Med­i­cal Cen­ter in San Fran­cisco and a noted pa­tient-safety ad­vo­cate. “I’m see­ing much more payer-physi­cian co­or­di­na­tion and it’s in an en­vi­ron­ment that is much less com­bat­ive and much more col­lab­o­ra­tive.”

Kevin Lofton, CEO of En­gle­wood, Colo.-based Catholic Health Ini­tia­tives, has seen the trend first­hand as his 93-hos­pi­tal sys­tem moves ag­gres­sively into the Medi­care Ad­van­tage and com­mer­cial in­sur­ance busi­ness. “We think some com­pe­ti­tion will help ev­ery­one and im­prove care by of­fer­ing peo­ple more op­tions about where their cov­er­age may come from,” said Lofton, who placed No. 11 while mak­ing his 11th ap­pear­ance on the an­nual rank­ings.

Round­ing out the Top 10 were John Castel­lani, CEO of the Phar­ma­ceu­ti­cal Re­search and Man­u­fac­tur­ers of Amer­ica, No. 7, and Kent Thiry, CEO of Den­ver-based DaVita Health­Care Part­ners, No. 10.

DaVita, the sec­ond-largest provider of kid­ney dial­y­sis in the U.S., is in­te­grat­ing into its op­er­a­tions with Health­Care Part­ners, a large mul­tispe­cialty med­i­cal group it ac­quired in 2012. DaVita will be test­ing a new Medi­care ac­count­able-care ar­range­ment for pa­tients with end-stage re­nal dis­ease called ESRD Seam­less Care Or­ga­ni­za­tions, or ESCOs.

“The re­nal com­mu­nity is per­fectly po­si­tioned to de­liver on the prom­ise of in­te­grated-care man­age­ment as we care for a frag­ile, ill pop­u­la­tion who also suf­fer from other co­mor­bidi­ties—di­a­betes, heart dis­ease and more,” Thiry said. “We are well-po­si­tioned to be suc­cess­ful be­cause we see th­ese pa­tients three times a week in our cen­ters for three to four hours each day.”

The new col­lab­o­ra­tions between providers and in­sur­ers are im­por­tant, Kee­han said. But she’s par­tic­u­larly ex­cited about health­care re­form’s ex­panded ac­cess to care. “We made sig­nif­i­cant gains in get­ting peo­ple who weren’t in­sured, in­sured—and we made the big­gest gains among peo­ple who needed it the most,” she said.

Other elected of­fi­cials who made this year’s Most In­flu­en­tial list are Se­nate Ma­jor­ity Leader Harry Reid (D-Nev.), No. 29; House Speaker John Boehner (R-Ohio), No. 30; Gov. Terry McAuliffe (D-Va.), No. 33; Se­nate Fi­nance Com­mit­tee Chair­man Ron Wy­den (D-Ore.), No. 63; and Gov. John Kitzhaber (D-Ore.), No. 80.

Chet Speed, the Amer­i­can Med­i­cal Group As­so­ci­a­tion vice pres­i­dent for public pol­icy, praised the job Wy­den has been do­ing since tak­ing over as Fi­nance Com­mit­tee chair­man af­ter the res­ig­na­tion of Sen. Max Bau­cus (D-Mont.). “I think Wy­den is a very thor­ough health pol­icy thinker, and he has a very good staff,” Speed said. “He’s fo­cus­ing on the right things.”

Health­care stake­hold­ers are closely watch­ing the fate of ACA-au­tho­rized Med­i­caid ex­pan­sion in the 24 states that haven’t yet ap­proved the ex­pan­sion to adults with in­comes up to 138% of the fed­eral poverty level.

Kahn said all eyes are on McAuliffe in Vir­ginia and Repub­li­can Gov. Mike Pence of In­di­ana to see whether Med­i­caid ex­pan­sion will ad­vance in more con­ser­va­tive states. McAuliffe cam­paigned hard on Med­i­caid ex­pan­sion but so far has been blocked by Vir­ginia’s Repub­li­can law­mak­ers.

“A lot of peo­ple look to Vir­ginia as a piv­otal pur­ple state,” Kahn said. “Gov. Pence is go­ing back and forth with CMS and that could be a bell­wether if he suc­ceeds” with his pro­posed con­ser­va­tive-ori­ented ex­pan­sion pro­posal stress­ing con­sumer fi­nan­cial re­spon­si­bil­ity.

Dou­glas Hawthorne, CEO of 17-hos­pi­tal Texas Health Re­sources, placed No. 96 on the Most In­flu­en­tial list. It’s the ninth time for the long­time leader of that sys­tem, who has an­nounced he will re­tire at the end of the year. He said the fight for Med­i­caid ex­pan­sion in Texas is not over, de­spite the strong op­po­si­tion of Repub­li­can lead­ers in his state. “Health­care or­ga­ni­za­tions in the state have banded to­gether with com­mu­nity lead­er­ship to say we need to ad­vo­cate for ex­panded Med­i­caid at the ear­li­est op­por­tu­nity,” he said.

CHI’s Lofton said he has been in­flu­enced by lead­ers such as Dr. Glenn Steele Jr., No. 48 on the list and long­time CEO of Danville, Pa.-based Geisinger Health Sys­tem, who is re­tir­ing in 2015. “I think he’s demon­strated that a health­care sys­tem like Geisinger can be a model we all can fol­low by fo­cus­ing on to­tal co­or­di­na­tion for the pa­tient and on the value equa­tion for those pay­ing the bills,” he said.

Lofton, a past AHA board chair, also praised the CHA’s Kee­han and Richard Umb­den­stock, CEO of the Amer­i­can Hos­pi­tal As­so­ci­a­tion, No. 26 on this year’s list. He said Kee­han and Umb­den­stock showed brave lead­er­ship in sup­port­ing the ACA even when that sup­port was far from unan­i­mous in their or­ga­ni­za­tions. “I was able to see up close and per­sonal the for­ti­tude and re­solve those two peo­ple have,” he said. “They took the greater good into ac­count.”

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PRES­I­DENT BARACK OBAMA

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