Working to keep reform on track

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, managing 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.

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.”

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.

Follow Andis Robeznieks on Twitter: @MHARobeznieks