Not playing by the rules

There's an exception to every rule, and we made a big one when we chose Chief Justice of the United States John Roberts as the most influential person in healthcare for 2012. Roberts wasn't nominated by our readers in the spring, nor did he make our ballot of 300 readers voted on through mid-June. But he undoubtedly became the most influential person in the industry June 28, when the U.S. Supreme Court released a series of six opinions that upheld most of the key provisions of the Patient Protection and Affordable Care Act.

Roberts cast the deciding vote in the 5-4 decision upholding the reform law's individual health insurance mandate. In doing so, Roberts gave the go-ahead for other key provisions of the law such as the employer insurance mandate, the accountable care organization program and all the new business and underwriting rules for health insurance companies.

Taken together, the law's provisions reach into every corner of the $2.7 trillion healthcare industry and, absent being repealed by Congress and the next president, will change the lives of patients, providers, payers and suppliers forever. That's influence, and that's why we broke with tradition and named Roberts No. 1 on this year's ranking of the 100 Most Influential People in Healthcare.

As for determining the other 99 powerbrokers on the list, here's how we did it. We announced the call for nominations in the March 12 print edition of the magazine, on our website and in all of our daily e-newsletters. The nominating period continued through April 20, with 21,678 nominations submitted. The top 300 candidates, based on those nominations, made up the final ballot for this recognition program, our 11th annual. Readers then voted for the five candidates on the ballot of 300 who they believed were the most influential in the industry. Some 220,330 votes were cast during the voting period from May 7 through June 15. Reader votes counted toward 50% of the outcome; the senior editors of Modern Healthcare determined the other 50%.

Of note on this year's ranking are the executives whose companies likely will be most directly affected by Roberts' influence. Mark Bertolini from Aetna, George Halvorson from Kaiser, Stephen Hemsley from UnitedHealth, Angela Braly from WellPoint, Michael McCallister from Humana and Patricia Hemingway Hall from Health Care Service Corp. represented half of the first 12 slots on this year's ranking. How the executives are reacting to the reform law from a business perspective earned them their spots on our list.

For example, Bertolini engineered Aetna's proposed $5.7 billion acquisition of Coventry Health Care, a leading Medicaid managed-care operator. But even before that, Aetna jumped into the accountable care organization business with the creation of a designated business unit called Aetna Aligned Care Solutions, which partners with individual hospitals, health systems and medical practices to create private-sector ACOs. Its business partners include such leading organizations as Aurora Health Care, Inova Health System, Banner Health and the Carilion Clinic. McCallister, meanwhile, has Humana snatching up physician practices across the country through a subsidiary called Concentra, an operator of urgent- and occupational-care clinics that Human bought in 2010. And Halvorson has Kaiser on the cutting edge of information technology, giving its clinicians and patients the latest electronic apps and platforms to share personal medical information.

What those insurance company executives as well as the other leaders on our list have in common is a certain fearlessness. Rather than play it safe and hope the storm passes, they're embracing the changes in the industry. They're grabbing the clouds, reshaping them and making it rain for their organizations, patients and constituencies.

David Burda, editor of Modern Healthcare