One of the more notable first-timers on the list is Peter Orszag, director of the White House Office of Management and Budget, who debuts at No. 9. The former director of the nonpartisan Congressional Budget Office has made his stamp on the direction healthcare reform should take. In particular, he has advocated for an independent review council to advise the president on Medicare reimbursement decisions, despite the CBO's recent calculations that such a council would deliver only modest savings over the next decade.
The point of the proposal was never to generate savings over the next decade, Orszag insisted recently on his blog. “Instead, the goal is to provide a mechanism for improving quality of care for beneficiaries and reducing costs over the long term. In other words, in the terminology of our belt-and-suspenders approach to a fiscally responsible health reform, the (Medicare council) is a game-changer, not a scoreable offset.”
George Halvorson, chairman and CEO of Kaiser Permanente based in Oakland, Calif., who leaped from No. 78 in 2008 to No. 12 this year, is hoping that Congress will include more provisions on prevention in the final reform package.
“Much of the legislation is built around financial issues, not on better care,” says Halvorson, an outspoken critic of the current healthcare delivery system and author of the book Health Care Will Not Reform Itself, which was released in June.
Halvorson believes that universal coverage could be achieved “by requiring everyone to buy coverage, every carrier to sell coverage,” and by allowing low-income families to get their premiums subsidized. “This way, people don't wait until they're pregnant or have cancer before they join the risk pool.”
As for Obama's tack on reform, “he hasn't come back with a final plan yet. It's still a work in progress,” Halvorson says, adding that Obama has taken the position of having Congress do the first cut on the plan before he steps in. “Once he has all of the pieces on table, he'll sit down and figure out how this whole thing fits together and that has yet to happen.”
Like Halvorson, Steve Burd, president and CEO of Safeway stores based in Pleasanton, Calif., who ranks No. 17 as a first-timer on the list, believes that making Americans healthier is the key to lowering healthcare costs.
Dismayed by annual double-digit increases in its healthcare bill, which had amounted to $1 billion annually, Safeway, a self-insured employer, in 2005 “decided to design a plan where personal responsibility was the core,” says Burd, an early supporter of healthcare reform who has been CEO since 1993. Safeway is one of the largest supermarket chains with more than 1,700 stores in the U.S. and Canada, some 190,000 employees and more than $44 billion in revenue in 2008, according to the company.
Using automobile insurance as the inspiration, Safeway built upon a provision in the Health Insurance Portability and Accountability Act of 1996 that permits employers to differentiate premiums based on behaviors.
“There's a piece of this called Healthy Measures, which measures cholesterol, blood pressure, tobacco use and body mass index,” Burd says. Employees pay a higher premium based on whether they smoke, have a high BMI or blood pressure count, although Safeway offers smoking-cessation and other prevention programs to encourage better health.
As a reward for quitting smoking, Safeway “will write a check for any elevated premiums they've experienced,” Burd says. Similar deals exist for lowering BMI numbers and cholesterol levels, he says.
Considering that a smoker easily costs an employer $1,400 a year in annual medical expenses, based on Safeway's estimates, “If you can give them free cessation training, it can save you money on annual healthcare costs” just by eliminating these types of healthcare risk factors, Burd says.
So far, it has paid off: “Over the last four years, we've held our healthcare costs flat. During that same time period, costs have increased by 38% for the rest of the country,” Burd says.
Burd, chairman of a coalition of large employers that endorses a mix of market-based reforms and universal coverage to improve healthcare, says his plan to bend the cost curve has already made an impact on Capitol Hill. As an example, there's a provision in the Senate HELP Committee bill “to allow employers more flexibility to do wellness programs and differentiate premiums,” he says.
Meanwhile, John Tooker, executive vice president and CEO of the American College of Physicians, has his own wish list for reforming the healthcare system: improving the way primary care is structured and how it's reimbursed for the services it provides. Tooker is another first-timer on this year's list, coming in at No. 86.
“For example, there is currently no reimbursement for care coordination of chronically ill patients or preventive services in primary care, and we've been advocating for that to be included” in reform legislation, Tooker says.
Tooker attributed his selection to the growing recognition of the importance of primary care, and the role that the ACP has played in healthcare access, delivery, workforce and payment reform.
“The ACP, American Academy of Family Physicians, American Academy of Pediatrics and the American Osteopathic Association have worked together and with other key stakeholders over the past year to boost primary care,” Tooker says. The group, which represents internists and subspecialties of internal medicine, has taken an active role in promoting health IT, comparative-effectiveness research and the development of patient-centered medical homes.