The trends and news behind this year's list

As President Barack Obama heads into the homestretch of his two terms in office, he once again tops Modern Healthcare's ranking of the 100 Most Influential People in Healthcare—the third time he's won the honor. And that's not surprising given his name—courtesy of his most vitriolic opponents—will be forever attached to the most significant expansion of health insurance coverage since the creation of Medicare and Medicaid in 1965.

Enduring influence is also the central theme for many of the other names atop this year's ranking, Modern Healthcare's 15th annual. Coming in at No. 2 and No. 3 this year are CEOs of two of the nation's largest healthcare systems.

Bernard Tyson, at No. 2, leads Kaiser Permanente, the giant integrated system with operations in nine states, predominantly in the West. Kaiser itself will be expanding its influence in healthcare delivery with the opening of its first medical school, expected by fall 2019.

Anthony Tersigni, making his 12th appearance on the list at No. 3, is the longtime leader of the nation's largest Catholic system, operating nearly 150 hospitals in 24 states. He's also looking to expand the system's reach abroad with the announcement this month that it will form Ascension Holdings International, a division that will work collaboratively with other investors and provider partners. It continues Ascension's interest in overseas opportunities, following the opening of Health City Cayman Islands in 2014, a joint venture with India's Narayana Health.

For-profit systems continue to play a major role influencing the delivery of U.S. healthcare. That's why R. Milton Johnson, CEO of for-profit behemoth HCA, is ranked No. 6 this year.

The nation's payers—both public and private—are also well represented at the top. HHS Secretary Sylvia Mathews Burwell comes in at No. 5 along with acting CMS Administrator Andy Slavitt, No. 10. Nothing says influence like overseeing a complex national health policy apparatus that disburses hundreds of billions of federal dollars annually and regulates a $1.7 trillion industry.

Both have played lead roles in the long-term drive to fundamentally change the way healthcare services are delivered, steering away from the longstanding payment for volume and moving head-on into a variety of programs designed to reward providers for the quality and value of care.

In remarks last year to a national quality conference, Slavitt explained his motivation for leaving the private sector to come work for the CMS. “What drew me to Washington is that the healthcare agenda today is moving out of the 'talking about it' stage into the 'changing-it' and 'getting-it-done' stage. … I've spent too many years and too many meetings talking about the stubborn uninsured rate and talking about the broken fee-for-service system.”

Among private insurers, leaders are also looking for fundamental changes. Among them is the push for consolidation. Four of the Big Five publicly traded insurers are currently attempting to complete mega-mergers—but have been met with legal challenges from the Justice Department over concerns about market concentration.

Aetna, led by Mark Bertolini, No. 4, on this year's list, is trying to merge with Humana in a $37 billion deal. Meanwhile, Anthem, led by Joseph Swedish, No. 12, has agreed to merge with Cigna Corp., headed by David Cordani, No. 57, in a $53 billion deal. Final rulings in the challenges to the transactions aren't expected until early next year. This is Swedish's 11th time on the list, which includes his tenure as CEO of Trinity Health before taking the helm at Anthem.

Also cracking this year's top 10 is Stephen Hemsley, CEO of UnitedHealth Group, the nation's largest private insurer. He holds the No. 7 spot. UnitedHealth was the first insurer to announce it was pulling out of the Obamacare exchanges in most of its markets, citing deep and growing losses from the plans, which have drawn a larger proportion of older and sicker enrollees than expected. Aetna and Humana also have announced will be significantly downsizing their participation in the exchanges.

Marilyn Tavenner, as CEO of America's Health Insurance Plans, the primary lobbying group for the private insurance sector, is a leading voice in promoting the interests of the insurers—even though United and Aetna are no longer members of AHIP. Tavenner is No. 9 on this year's roster and it's her fifth time on the list, which includes her nearly two-year stint as CMS administrator.

She cites healthcare affordability as a key part of her mission as head of AHIP. “We still haven't solved that problem, as you well know. There's just a lot more that needs to be done to sustain it,” Tavenner said. “Some of that will involve pharma, some will involve hospitals, and some of it will involve us.”

Even as the nation's largest insurers face challenges in the courts and in making the exchanges a profitable enterprise, there's a prominent voice on this year's list who would like to put the private insurers out of business altogether.

Vermont Sen. Bernie Sanders, who led an insurgency against frontrunner Hillary Clinton in the battle for the Democratic nomination for the presidency, can be credited with single-handedly drawing the issue of single-payer universal healthcare back into the mainstream debate.

“Healthcare is absolutely a human right, whether you are rich, whether you are poor or whether you're in the middle class,” Sanders said on the campaign trail. “There is no healthcare system in the world that comes close to being as wasteful and bureaucratic as ours,” he said, making a case for cost savings through adoption of single-payer. Depending on who ends up winning the White House and control of Congress in November, it's an idea that could continue to resonate.

Other elected officials on the ranking include two freshman governors—Democrat John Bel Edwards of Louisiana, at No. 35, and Republican Matt Bevin of Kentucky, No. 89, both of whom made their state's Medicaid program a major issue during their campaigns.

Provider lobbying and advocacy groups are also well represented on this year's roster of the 100 Most Influential. Highest on the list is Rick Pollack, who was named CEO of American Hospital Association in 2015. He holds the No. 8 spot, marking his fourth time on list and reflecting his service in other executive positions at the AHA before taking the helm. He's followed by Chip Kahn, longtime CEO of the Federation of American Hospitals, at the No. 21 spot. Others include Pam Cipriano, president of the American Nurses Association at No. 24, and Dr. Andrew Gurman, president of the American Medical Association.

The federation's Kahn is one of only five people to be on the rankings all 15 years. The other perennials are Trevor Fetter, CEO of Tenet Healthcare Corp., at No. 14; Wayne Smith, CEO of Community Health Systems, No. 23; RoseAnn DeMoro, executive director of National Nurses United, No. 46; and Drew Altman, CEO of the Kaiser Family Foundation, No. 81.

What's the secret of long-term influence? AHIP's Tavenner said she doesn't have a magic answer to that question, but joked that, “Maybe it's just because I've been around a long time and know a lot of people.”