Most Influential leaders have blazed bold reform paths

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 Nashville-based 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.”

Follow Andis Robeznieks on Twitter: @MHARobeznieks