Shared influence

Not surprisingly, the leaders of healthcare's megahospital systems were once again well-represented on Modern Healthcare's annual ranking of 100 Most Influential People in Healthcare. But others, coming from systems with more modest numbers in their hospital count, found new ways to grow their influence without necessarily expanding their footprint.

Both Dr. John Noseworthy, president and CEO of the Rochester, Minn.-based Mayo Clinic Health System, and Dr. Delos “Toby” Cosgrove, president and CEO of the Cleveland Clinic Health System, lead organizations that take pride in being physician-led systems that only use employed physicians. And they say their organizations are not players in the merger-and-acquisition game.

“We've stayed away from mergers and acquisitions,” Noseworthy says of the 23-hospital Mayo system. “Mayo doesn't see how that would help us provide better care.”

Instead, Mayo has embarked on a “subscription model” to share order sets, research breakthroughs and second opinions. So far, the organization is doing this at about 20 sites. Noseworthy expects that number to grow by 50% to 100% over the next few years. The fee is “proprietary,” he says, and based on the subscriber's size and expected use of materials.

Noseworthy, who ranks No. 15 on this year's roster of the Most Influential, says Mayo has approached “groups that we respect” for participation. And Mayo has been approached by organizations “at risk for being bought out” and looking for a competitive edge in their markets, he says.

Cleveland Clinic has entered into or is developing a number of clinical affiliations with other organizations. These include a population-management alignment being negotiated with the eight-hospital, Toledo, Ohio-based ProMedica system; a cardiology and research affiliation with nine-hospital MedStar Health, Columbia, Md.; and cardiology and oncology affiliations with two-hospital Cadence Health, Winfield, Ill.

In these relationships, Cosgrove, ranked No. 16, says Cleveland Clinic monitors quality metrics and takes responsibility for results. The affiliation that garnered the most attention, however, is the strategic alliance the organization entered into with for-profit Community Health Systems, a 132-hospital publicly traded system, to improve cardiovascular services, advance telemedicine and reduce supply costs.

“It's not that we bought them or they bought us,” Cosgrove says. “I liken it to we're 'going steady.' They won't date another not-for-profit, and we won't date other for-profits.”

Community has announced merger plans with Health Management Associates, Naples, Fla.

Dignity Health, a 37-hospital not-for-profit based in San Francisco, in recent years expanded its potential for growth by changing its name from Catholic Healthcare West and dropping its formal connection to the Roman Catholic Church. “Our values have not changed, our mission has not changed, but we did change our name,” says Lloyd Dean, president and CEO of Dignity, who is No. 34 on this year's ranking. “We are using our voice to strengthen coordination of care in our community. We are one spoke on the wheel.”

Kaiser Permanente includes the 32-hospital Kaiser Foundation Hospitals system, more than 600 outpatient facilities and its long-running health plan. But Chairman George Halvorson says the most influential number in the Kaiser organization is “one”—as in one electronic health-record system accessible at every Kaiser location. “If you have all the pieces, but not the data—you basically have a set of unconnected care sites,” says Halvorson, who is retiring at the end of this year and has made the Most Influential list for 11 consecutive years. “We decided a decade ago to be entirely paperless and to connect every single thing we did so it could electronically flow from place to place.”

While, already a pioneer in the use of health IT, Kaiser began its implementation of a unified system in 2003 and announced that it had completed the task in March 2010.Halvorson says the quality outcomes produced by Kaiser's $4 billion investment in software, analytics and infrastructure have proven how meeting federal meaningful-use criteria for health information technology can have benefits.“I think one of the reasons people are comfortable going down this path is because they saw us make use of the data,” Halvorson says, adding that a combination of data analytics and a culture of continuous quality improvement has led to higher cancer survival rates, lower incidences of bed sores and reductions in other adverse events.Halvorson, who is No. 9 on this year's roster, has already turned over his CEO title to Bernard Tyson (who was formerly president and chief operating officer), and will relinquish his chairmanship later this year. But Halvorson said he is not retiring, he's “repotting,” and he has already expanded his influence outside of healthcare. Last month, he presided over his first meeting as chairman of the First 5 California commission, which looks at developing community-based early childhood programs, primarily education-related. “Those years are absolutely critical,” Halvorson says. “If you do the right things in those years, they have a much a greater chance at success in life.”

Follow Andis Robeznieks on Twitter: @MHARobeznieks