50 of the Most Powerful People in Healthcare
The U.S. healthcare system is heading into one of its most monumental years in decades, as the Patient Protection and Affordable Care Act will go into near-full motion.
Many sectors in the healthcare industry have played major roles in shaping the system we have today: hospitals, health systems, physicians, nurses, health insurance companies, scientists, researchers, politicians, advocacy groups, lobbyists, journalists, Wall Streeters and more.
As we head into 2014, here are 50 of the most powerful people who have shaped policy, thoughts, operations and management in healthcare. Note: People are listed in alphabetical order.
Joel Allison. Mr. Allison serves as CEO of Baylor Scott & White Health in Dallas. This past year, he oversaw the merger of Baylor Health Care System and Scott & White Healthcare, creating Baylor Scott & White. The new organization, which is the largest nonprofit health system in Texas, includes 43 hospitals, more than 6,000 physicians, 34,000 employees, the Scott & White Health Plan and about $8.3 billion in combined assets. Mr. Allison has been with Baylor since 1993, when he was the system's senior executive vice president and COO, before becoming Baylor's president and CEO in 2000. He also has a national presence, serving on the Healthcare Leadership Council and The Joint Commission board of commissioners.
Mark Bertolini. As chairman, president and CEO of Hartford, Conn.-based Aetna, Mr. Bertolini oversees a health insurer with more than $35.5 billion in revenue, according to 2012 figures. Earlier this year, Aetna closed on its deal to acquire Coventry Health Care, a prominent health insurer for Medicare Advantage and Medicaid managed care plans. The transaction was valued at $7.3 billion, including $5.7 billion in cash and stock. Mr. Bertolini has been with Hartford, Conn.-based Aetna since 2003, joining as head of the company's specialty products. Prior to joining Aetna, he held executive positions at Cigna, NYLCare Health Plans and SelectCare.
Leah Binder. Since 2008, Ms. Binder has served as CEO of The Leapfrog Group, a nonprofit organization that focuses on the safety, quality and affordability of healthcare. Leapfrog is most known for its annual Leapfrog Hospital Survey, which compares the safety, quality and efficiency of all hospitals across the country. Under Ms. Binder's leadership, Leapfrog launched the Hospital Safety Score, a system that assigns a letter grade to every hospital based on how safe that institution is for patients. Before Leapfrog, she spent eight years as vice president of Franklin Community Health Network in Farmington, Maine. She also was a senior policy adviser for former New York City Mayor Rudy Giuliani.
Deborah Bowen. Ms. Bowen is president and CEO of the American College of Healthcare Executives, the preeminent professional society for hospital and health system leaders. Currently, ACHE is home to more than 40,000 healthcare executives, offering credentials and board certification in healthcare management. Ms. Bowen joined ACHE's staff in 1992 as director of government relations and was promoted to vice president of the administration division. She temporarily left ACHE in 2000, becoming deputy executive director of the Society of Actuaries. She then served as ACHE's executive vice president and COO before taking over as CEO in May 2013, taking over for Tom Dolan.
Steven Brill. Mr. Brill — a journalist, lawyer and founder of both CourtTV and American Lawyer — made waves after writing one of the most extensive exposés on the U.S. health system. The report, "Bitter Pill: Why Medical Bills Are Killing Us," appeared in the March 4, 2013, issue of TIME. The 24,000-plus word article took up the entire feature section of the magazine, the first time in the history of TIME that has happened. The article specifically pointed a magnifying glass at hospitals, explaining that patients are in the "ultimate seller's market" because prices at hospitals are neither transparent "nor do they seem to be based on anything objective." Mr. Brill's report partly prompted CMS to release troves of data on inpatient and outpatient hospital charges in May. Following the article's publication, many any other states, like North Carolina and Arizona, also passed legislation requiring hospitals to post chargemaster prices.
Bruce Broussard. Effective January 2013, Mr. Broussard became president and CEO of health insurer Humana, based in Louisville, Ky., replacing Mike McCallister. In 2012, Humana posted more than $39.1 billion in revenue and net profit of $1.2 billion. Over the past few years, Humana has become more involved with hospital-payer negotiations centered on care coordination and accountable care for its Medicare Advantage population. The insurer has also been active within the PPACA insurance marketplaces, although it expects enrollment will lag due to problems associated with the exchange website. Mr. Broussard joined Humana as president in December 2011 after serving as CEO of McKesson Specialty/U.S. Oncology.
Bill Carpenter. Mr. Carpenter is chairman and CEO of LifePoint Hospitals in Brentwood, Tenn. The for-profit hospital system owns and operates roughly 60 hospitals, mostly small community providers, in 20 states. In 2012, LifePoint posted $151.9 million of profit on more than $3 billion of revenue. The company grew significantly throughout 2013, acquiring several new hospitals and building upon Duke LifePoint Healthcare, its joint venture with Durham, N.C.-based Duke University Health System. Mr. Carpenter was a founding employee of LifePoint in 1999 and previously served as the company's executive vice president, senior vice president and general counsel. He also is a trustee and past board chair of the Federation of American Hospitals, the primary lobbying group for investor-owned hospitals.
Christine Cassel, MD. In 2013, the National Quality Forum appointed Dr. Cassel as its new president and CEO. The NQF, which receives funding from the government, private sources and foundations, aims to improve the quality of U.S. healthcare through the creation of standards, education and publicly measured and reported performance. Dr. Cassel, a leader in the fields of geriatric medicine, internal medicine, medical ethics and quality of care, served several other roles before joining the NQF. She is one of 20 scientists serving on President Barack Obama's Council of Advisors on Science and Technology. Dr. Cassel previously served as dean of the Oregon Health and Science University School of Medicine in Portland and as the chief of general internal medicine at the University of Chicago.
Mark Chassin, MD. Dr. Chassin, a board-certified internist, has served as president and CEO of The Joint Commission since 2008. The Joint Commission, a nonprofit organization, accredits and certifies more than 20,000 U.S. healthcare organizations and programs. Dr. Chassin has established several new initiatives during his tenure, including the Joint Commission Center for Transforming Healthcare. The center works with leading hospitals and health systems to address problems surrounding healthcare-associated infections, wrong-site surgeries and other critical safety and quality lapses. Previously, Dr. Chassin was a healthcare mainstay in New York: He was the founding chairman of the health policy department at Mount Sinai School of Medicine in New York City, and he also served as the commissioner of the state department of health.
Benjamin Chu, MD. Nationally and regionally, Dr. Chu has become a prominent voice among hospital and health system advocates. He serves as executive vice president of Kaiser Foundation Hospitals and Kaiser Health Plan in Oakland and regional president of Kaiser Permanente Southern California and Hawaii. Overall, Dr. Chu oversees the operations of 14 Kaiser hospitals and 168 medical offices. In addition, he is the current chairman of the American Hospital Association, the top elected position for the largest hospital lobbying group in the country. Previously, Dr. Chu served as president of New York City Health and Hospitals Corp., one of the largest public hospital systems in the country.
Francis Collins, MD, PhD. The National Institutes of Health has had to deal with dwindling funding due to sequestration and other budget cuts. But as the 16th director of NIH, Dr. Collins has found ways to keep NIH as one of the most prominent biomedical research institutions in the world. Routinely working 90-hour weeks, he has led pioneering work in genomics — he discovered disease genes, sequenced the full human genome and oversaw the international Human Genome Project. Dr. Collins was the director of the National Human Genome Research Institute at NIH for 15 years. In 2007, he received the Presidential Medal of Freedom, and President George W. Bush said Dr. Collins was "the man who led the federal [human genome] project to full and thrilling success."
David Cordani. For the past four years, Mr. Cordani has led Bloomfield, Conn.-based health insurer Cigna as president and CEO. In 2012, Cigna posted more than $29.1 billion in total revenue and acquired HealthSpring in a $3.8 billion deal. Cigna has been one of the most proactive commercial health insurers in the accountable care organization space. Cigna calls its ACOs "collaborative accountable care" initiatives. As of November 2013, it had 75 CAC initiatives in 26 states with a variety of providers, and Cigna's stated goal is to have 100 CACs covering 1 million people in 2014. Mr. Cordani has been with Cigna for more than 25 years, holding other executive positions within the company's distribution, marketing, clinical management, underwriting, finance and operations divisions.
Delos "Toby" Cosgrove, MD. Cleveland Clinic is one of the country's most iconic academic medical centers, and Dr. Cosgrove has led the $6.2 billion nonprofit organization as president and CEO for the past decade. Dr. Cosgrove, an award-winning cardiac surgeon and former surgeon in the U.S. Air Force, oversees a system that has become influential both locally and abroad: The main campus in downtown Cleveland has more than 1,400 beds, and the system has more than 4,400 beds overall. Cleveland Clinic operates eight community hospitals, a children's hospital, Cleveland Clinic Florida and two international sites — one in Toronto, Canada, and another in Abu Dhabi, United Arab Emirates. Earlier this year, Cleveland Clinic formed a strategic partnership with Franklin, Tenn.-based Community Health Systems, one of the largest for-profit hospital operators in the country. The collaboration will lead to the sharing of best practices between the two organizations, and they are also exploring hospital joint ventures together.
RoseAnn DeMoro. Ms. DeMoro serves as executive director of National Nurses United, one of the largest, most progressive healthcare labor unions in the country. NNU represents approximately 185,000 registered nurses. Under Ms. DeMoro's leadership, NNU has spearheaded several campaigns, notably to improve the job environment for nurses, create secure retirement for healthcare workers and promote a single-payer system. Earlier this year, on author and talk show host Tavis Smiley's "Vision for a New America: A Future Without Poverty" tour, Ms. DeMoro promoted the union's goals for a single-payer system and a Robin Hood tax, which would levy a fee on Wall Street transactions to fund public causes, like healthcare.
Karen DeSalvo, MD. In late December 2013, HHS announced Dr. DeSalvo, a general internal medicine and geriatrics physician, is the National Coordinator for Health IT at the ONC — making her the foremost authority on all health IT issues. She replaced Jacob Reider, MD, CMO of the ONC who acted as national coordinator for two months following the departure of Farzad Mostashari, MD. Dr. DeSalvo served as health commissioner of New Orleans and senior health policy advisor to New Orleans Mayor Mitch Landrieu. She has spearheaded efforts to modernize the New Orleans healthcare system, including leading health IT-focused projects to augment the city's neighborhood-based medical homes and to improve access to care for underserved populations following Hurricane Katrina. Dr. DeSalvo also oversaw the construction of the city's newest hospital, which will feature a fully integrated health IT network.
Judy Faulkner. In 1979, Ms. Faulkner founded Epic, one of the largest technology and electronic health record companies in the U.S. and worldwide. She currently serves as CEO of the private Epic, which posted $1.5 billion in revenue in 2012, up roughly 25 percent from 2011, according to Forbes. Epic's near-omnipresence within hospitals and health systems has risen drastically since Oakland, Calif.-based Kaiser Permanente adopted the EHR in 2003. Forbes estimates almost half of U.S. patients have their medical information in an Epic EHR system. In a rare interview with Forbes in May, Ms. Faulker, a computer programmer by background, said she began working in the EHR and data management system sector to create a patient-centric product. "One of the things that made Epic strong when I wrote the original code was that it never occurred to me to do anything other than put the patient at the center," she said.
Trevor Fetter. Mr. Fetter, president and CEO of Tenet Healthcare Corp., an investor-owned hospital company in Dallas, was behind one of the biggest moves in healthcare in 2013. Tenet agreed to buy Vanguard Health Systems, a Nashville, Tenn.-based hospital chain, for $1.8 billion in cash and assumed $2.5 billion of Vanguard's debt. The transaction vastly grew Tenet's portfolio, and now Tenet operates 77 hospitals, more than 170 freestanding outpatient centers and business solutions firm Conifer Health Solutions. In fiscal year 2012, Tenet posted $141 million of profit on more than $9.1 billion of net revenue, and the company's revenues are expected to rise significantly when factoring in the newly acquired Vanguard hospitals. Mr. Fetter has been president of Tenet since 2002 and added the CEO title in 2003. He joined Tenet in 1995 and served as CFO from 1996 to 1999.
Tom Frieden, MD. In June 2009, Dr. Frieden became director of the Centers for Disease Control and Prevention. Dr. Frieden's physician specialties include internal medicine, infectious disease, public health and epidemiology. He joined the CDC in 1990 and worked at the agency until 2002, when he became commissioner of the New York City Health Department. Dr. Frieden has several notable accomplishments during his time at the CDC and the NYC Health Department. When he started as CDC director, Dr. Frieden handled the 2009 H1N1 flu virus pandemic. He also created Vital Signs, a CDC periodical discussing the most critical health problems confronting the U.S. today. During his tenure, New York City also became the first U.S. city to ban trans fats from restaurants. Also in New York, he oversaw the largest community electronic health record project in the country, which eventually became the model to expand EHR use nationwide.
Atul Gawande, MD. A "Renaissance Man" of sorts, Dr. Gawande is a surgeon at Brigham and Women's Hospital in Boston, a staff writer for the New Yorker magazine, an author and a public health researcher. He also is a professor of surgery at Harvard Medical School in Boston and a professor of health policy and management at the Harvard School of Public Health. Two of Dr. Gawande's most influential pieces include a 2009 New Yorker essay, "The Cost Conundrum," that described why healthcare costs have inflated so much and his book The Checklist Manifesto: How to Get Things Right, which explains how simple checklists can dramatically make patient care safer. Dr. Gawande, who still actively writes and teaches, has received many accolades, including recognition as a MacArthur fellow and a Hastings Center fellow. (Photo credit: Tony Rinaldo)
Richard Gilfillan, MD. For almost three years, Dr. Gilfillan served as the first director of the Center for Medicare and Medicaid Innovation, which was created under the PPACA to test "innovative payment and service delivery models to reduce program expenditures" while enhancing quality of care. In 2013, he stepped down and was later named president and CEO of Livonia, Mich.-based CHE Trinity Health, one of the largest Catholic health systems in the U.S. CHE Trinity Health was formed through a merger of Trinity Health and Catholic Health East. The combined entity owns 80 hospitals across 20 states and has more than $13 billion in annual operating revenue. Dr. Gilfillan, a family medicine physician, previously spent time as CEO of Geisinger Health Plan, the insurance arm of Danville, Pa.-based Geisinger Health System, and held other executive roles within commercial insurers.
Gary Gottlieb, MD. Since 2010, Dr. Gottlieb has been president and CEO of Partners HealthCare System in Boston, one of the largest and most influential systems in the country. At the core of Partners is Massachusetts General Hospital and Brigham and Women's Hospital, two leading academic medical centers. Partners has expanded its reach significantly under Dr. Gottlieb's tenure, and the system includes six other community hospitals and is in the process of acquiring several more. In FY 2012, Partners reported operating income of $191 million on $9 billion of revenue, and its total assets are valued at $12.6 billion. Previously, Dr. Gottlieb was president of Brigham and Women's and Brigham and Women's Faulkner Hospital. He is board-certified in psychiatry and geriatric psychiatry.
Glenn Hackbarth, JD. Mr. Hackbarth chairs one of the most discreetly powerful U.S. government healthcare agencies — the Medicare Payment Advisory Commission. Established under the Balanced Budget Act of 1997, MedPAC advises Congress on all issues affecting the Medicare program, including provider reimbursements, new payment delivery models and quality of care. In 2013, MedPAC suggested all Medicare accountable care organizations should take on more financial risk and that Congress should cut reimbursement rates to hospitals for procedures that can be performed in lower-cost clinic settings. Mr. Hackbarth, a lawyer, has served as MedPAC's chair since 2001. He previously founded and was CEO of Harvard Vanguard Medical Associates, a multispecialty group practice in Boston and an affiliate of Atrius Health in Newton, Mass. From 1986 to 1988, Mr. Hackbarth was the deputy administrator at CMS, then known as the Health Care Financing Administration.
Margaret Hamburg, MD. Dr. Hamburg, an internist, became the 21st commissioner of the Food and Drug Administration in 2009. The FDA, part of HHS, is responsible for protecting and advancing public health by assuring the safety and efficiency of drugs, medical devices, the country's food supply and other medical innovations. In 2013, the FDA joined much of the world by declaring trans fats as no longer safe, essentially banning their use from the food supply. Dr. Hamburg, a graduate of Harvard Medical School, previously was the senior scientist at the Nuclear Threat Initiative, a nonprofit organization with a goal to ultimately prevent the spread of nuclear, biological and chemical weapons. Dr. Hamburg also served as assistant secretary for policy and evaluation within HHS.
Stephen Hemsley. Since 2006, Mr. Hemsley has served as president and CEO of UnitedHealth Group in Minnetonka, Minn., the largest health insurer in the U.S. in terms of both revenue and membership. In 2012, UnitedHealth Group posted $5.5 billion of profit after pulling in $110.6 billion of revenue. The health insurer has several prominent subsidiaries, including UnitedHealthcare and Optum, and in October 2012, it dipped its toes further into international waters by acquiring a 90 percent stake in Amil Participações, the largest hospital and healthcare company in Brazil. Mr. Hemsley joined UnitedHealth Group in 1997 as senior executive vice president and later became the company's COO and president. He is one of the highest-paid healthcare executives in the U.S., earning more than $38 million over the past three years.
Ardis Dee Hoven, MD. Dr. Hoven became the 168th president of the American Medical Association in June 2013. She has been an AMA board of trustee member since 2005 and served as board chair for 2010-11. Board-certified in internal medicine and infectious disease, Dr. Hoven's reputation in the medical field spans far and wide. She previously served as president of the Kentucky Medical Association. When Dr. Hoven was inaugurated as AMA president, she said: "The one constant in the field of medicine is change. Some is positive: My medical school class had only five women out of approximately 75 graduates, and now nearly fifty percent of medical school students are women. Other changes present greater challenges. My message to physicians is that by joining together, we have the power to not just be witnesses to change but to shape the future of our healthcare system."
Karen Ignagni. Ms. Ignagni is president and CEO of America's Health Insurance Plans, one of the largest healthcare lobbying firms in the U.S. AHIP was created in 2003 through a merger between the American Association of Health Plans and the Health Insurance Association of America. She is consistently ranked by publications and law firms as one of the most influential healthcare lobbyists on Capitol Hill. Ms. Ignagni and AHIP have been at the forefront of the PPACA debate, saying most recently that consumers received cancellation notices from their health insurers, due to PPACA requirements that must cover certain benefits, "beyond what many people choose to purchase today." Previously, Ms. Ignagni was president of AAHP and director of the AFL-CIO's department of employee benefits. She also spent time within the government as a staff member on the Senate Labor and Human Resources Committee and HHS.
Milton Johnson. Effective Jan. 1, 2014, Mr. Johnson leads the largest for-profit hospital company in the U.S. — Hospital Corporation of America in Nashville, Tenn. — as president and CEO. He succeeds Richard Bracken, who retired from his CEO role but will remain with HCA as board chair in 2014. HCA owns and operates more than 160 hospitals and 114 ambulatory surgery centers in 20 U.S. states and London. It rakes in more revenue than any other investor-owned hospital chain — in 2012, net income totaled more than $1.6 billion in profit on $33 billion of revenue. HCA also dominates market capitalization among the for-profits at more than $20 billion. Previously, Mr. Johnson served as HCA's president and CFO. He joined HCA in 1982 as tax manager in the research and planning division.
Chip Kahn. Mr. Kahn serves as president and CEO of the Federation of American Hospitals, a role he has held since 2001. FAH represents more than 1,100 investor-owned, for-profit hospitals and health systems, which make up approximately 20 percent of all community hospitals. Mr. Kahn's political and lobbying background is extensive. Before joining FAH, he led the Health Insurance Association of America, which has since merged with AAHP to form AHIP. While there, Mr. Kahn launched the insurance industry's "Harry and Louise" campaign in 1993 and 1994, which ultimately derailed President Bill Clinton's healthcare reform plans. He also influenced how the PPACA would affect hospital reimbursements. Mr. Kahn's Republican-leaning political experience began in the 1970s, when he managed the House campaigns for former Speaker Newt Gingrich.
Darrell Kirch, MD. A psychiatrist and neuroscientist, Dr. Kirch is president and CEO of the Association of American Medical Colleges, the top advocacy group representing the country's 141 medical schools and 400 major teaching hospitals, academic medical centers and health systems. The AAMC has lobbied vigorously against sequestration and cuts to graduate medical education. The group has also highlighted solutions to physician shortages. Dr. Kirch assumed his position in 2006 and previously was dean of the Penn State College of Medicine and CEO of Penn State Milton S. Hershey (Pa.) Medical Center. At the AAMC's 2013 annual meeting, Dr. Kirsh said medical schools and teaching hospitals must be the vanguards of change during healthcare reform: "We are in a unique position to show leadership in academic medicine. This is a moment of truth our nation desperately needs us to seize."
John Kitzhaber, MD. Gov. Kitzhaber serves as governor of Oregon, his third term in the office after serving from 1995 to 2003. Central to Gov. Kitzhaber's platform is healthcare public policy. Before seeking office, he was an emergency medicine physician in Oregon for 15 years. When Gov. Kitzhaber was part of the state legislature, he was critical to the establishment of the Oregon Health Plan, which is the state's Medicaid program for low-income residents. Gov. Kitzhaber has since taken Oregon's healthcare reform even further. CMS granted the state a waiver, signing a five-year, $1.9 billion agreement to transform Oregon's Medicaid program through new coordinated care organizations. CCOs are considered to be a model for accountable care structures, as they coordinate the physical, mental and dental care for all of the state's 600,000 Medicaid patients. In 2003, Gov. Kitzhaber established the Center for Evidence-Based Policy at the Oregon Health & Science University in Portland, where he graduated medical school.
Daniel Levinson, JD. As the senior official within the HHS Office of Inspector General, Mr. Levinson oversees all audits, investigations, compliance initiatives and other projects related to combating fraud and abuse in Medicare, Medicaid and other HHS programs. He has served as inspector general since 2004, and he also serves on the Government Accountability and Transparency Board. Over the past few years, the OIG has released several major reports. For example, in 2013, the OIG found that high hospital charges lead to excessive Medicare outlier payments to hospitals. The OIG has also scrutinized the critical access hospital program, saying Medicare could save hundreds of millions of dollars annually if CAHs followed all requirements. In addition, the agency has ramped up Medicare and Medicaid compliance reviews at virtually every provider across the country. Prior to his work at the OIG, Mr. Levinson was deputy general counsel of the Office of Personnel Management.
Kevin Lofton. Since 2003, Mr. Lofton has led 87-hospital Catholic Health Initiatives, based in Englewood, Colo. CHI has annual operating revenue of more than $12 billion and nearly 86,000 employees. CHI continues to grow — it acquired St. Luke's Episcopal Health System in Houston in the middle of 2013 — and the system also issued $1.7 billion in taxable and tax-exempt bonds to fund market expansion, IT infrastructure, insurance products, clinically integrated networks and ACOs. Prior to CHI, Mr. Lofton served as CEO of the University of Alabama Hospital in Birmingham and CEO of Howard University Hospital in Washington, D.C. He also was the American Hospital Association board of directors chair in 2007.
James Madara, MD. Dr. Madara, a pathologist and expert on cell biology and gastrointestinal disease, was named executive vice president and CEO of the American Medical Association in 2011. The AMA is one of the most influential physician lobbying groups in America, posting $274 million of revenue in 2012. Since Dr. Madara took the helm, the AMA has advanced several issues to the forefront, including a permanent fix to the sustainable growth rate, which determines Medicare reimbursements to physicians, medical liability reform, delays in ICD-10 and developing quality metrics for federal programs. Before leading the AMA, Dr. Madara was CEO of the University of Chicago Medical Center. He has received several national and international awards for his studies and research, including a MERIT Award from the National Institute of General Medical Sciences.
John Noseworthy, MD. Mayo Clinic in Rochester, Minn., is a pioneering U.S. institution for medical discoveries, and it has been touted for its healthcare model centered on an integrated physician group practice. Dr. Noseworthy, a renowned neurologist, has served as president and CEO of Mayo Clinic since 2009 after serving as chair of its department of neurology. During Dr. Noseworthy's tenure, Mayo has greatly expanded its reach and developed new models of efficient care. The $8.8 billion organization has more than 61,000 physicians, scientists, residents and other personnel. It has two major clinic campuses outside of Minnesota, one in Arizona and another in Florida. In 2013, Dr. Noseworthy, who received his medical training in Canada, also launched Mayo's "Destination Medical Center" initiative, which he says will secure Mayo's and Minnesota's status as a global medical hub: "Ten years from now, there will emerge just a few medical centers with the reputation for healthcare excellence and patient-focused outcomes that will attract patients from all over the world. Mayo Clinic intends to be one of them."
President Barack Obama. President Obama, the 44th and current President of the United States, has etched his name into the history books, enacting the most sweeping healthcare reform since the inception of Medicare and Medicaid in 1965. In 2010, President Obama signed the Patient Protection and Affordable Care Act into law, and many of its major provisions have already taken form. These include ACOs, value-based purchasing, bundled payments, readmissions reductions and several changes to the health insurance industry, such as no more cancellations due to pre-existing conditions and the mandate to buy coverage starting in 2014. The PPACA has endured some hiccups as well: The Supreme Court ruled in 2012 that states could not be required to expand Medicaid, and rollout of the federal health insurance exchanges via HealthCare.gov has been rocky at best. President Obama's healthcare law may look different in the future through tweaks, changes and executive orders, but the PPACA has set the stage for a transformational shift from volume- to value-based care.
Neal Patterson. In the health system EHR space, Epic garners much of the attention, but Mr. Patterson, chairman and CEO of Cerner in North Kansas City, Mo., has quietly become one of the most influential people in the health IT arena. Mr. Patterson co-founded Cerner in 1979, and now it is the largest independent health IT company in the world, posting more than $2.5 billion of revenue in 2012. Cerner's EHR and IT solutions are deployed at more than 2,700 hospitals and offices of 45,000 physician nationwide. Cerner especially took off in 2009, following the enactment of the American Recovery and Reinvestment Act, which heavily emphasized investment in health IT through the HITECH Act. In 2012, Forbes featured Mr. Patterson, who also owns a major league soccer team, on its cover as one of the healthcare law's "billionaire" beneficiaries.
Edith Ramirez, JD. Ms. Ramirez was sworn in as commissioner of the Federal Trade Commission in April 2010, a term that lasts until 2015. In 2013, President Obama designated her as the FTC's chairwoman. A Harvard Law School graduate, Ms. Ramirez is one of the most powerful regulatory figures when it comes to healthcare industry consolidation, which has reached record highs over the past few years. Under her watch, several major health system transactions have been challenged, including the highly followed case of Phoebe Putney Health System in Albany, Ga., which reached the Supreme Court. She also testified before the House Committee on the Judiciary in November 2013, explicitly stating the "healthcare and technology sectors" will be the primary targets of the FTC's antitrust enforcement.
Larry Robbins. Mr. Robbins is the founder of Glenview Capital Management, a $10.9 billion hedge fund based in New York City. Viewed by some as an activist investor and described by Mr. Robbins in interviews as a "suggestivist," Glenview has become a silent force, investing in some of the largest healthcare firms in the country. Mr. Robbins owns significant stakes in several for-profit hospital chains — HCA, LifePoint, Tenet, CHS and Health Management Associates — as well as other massive healthcare companies like Walgreens, McKesson, Humana and Cigna. His name rose to the surface swiftly in 2013 due to his involvement with Health Management. The Naples, Fla.-based hospital operator had been struggling financially, and Mr. Robbins and Glenview began a campaign to "revitalize HMA." Ultimately, Mr. Robbins won, as Health Management installed a new board of directors per his suggestion, removed several top Health Management officials and agreed to a merger with CHS.
Jeffrey Romoff. As president and CEO of UPMC in Pittsburgh, Mr. Romoff is the point man for the $10 billion integrated health system, which includes more than 20 hospitals, a health plan, advisory services and a preeminent academic medical center based in the heart of the Steel City. Mr. Romoff and UPMC have been in the headlines extensively over the past few years, especially in 2013. In March, Pittsburgh Mayor Luke Ravenstahl announced the city would mount a formal challenge to revoke the tax-exempt status of UPMC, arguing the organization does not meet the requirements of an "institution of purely public charity." UPMC has fought the city's claims, saying the challenge is distorting the state's test of defining a tax-exempt entity. Mr. Romoff's career began at the University of Pittsburgh in 1973. In 1992, he was named president of UPMC, and he added the title of CEO in 2006.
Paul Rothman, MD. Dr. Rothman, a rheumatologist and molecular immunologist, was named CEO of Baltimore-based Johns Hopkins Medicine in 2012. He oversees a $6.5 billion academic medical center and health system that has garnered acclaim for its clinical advances both nationally and internationally. Johns Hopkins Medicine includes The John Hopkins Hospital, the only hospital to have been ranked first overall in the nation for 21 straight years by U.S. News & World Report, as well as The Johns Hopkins University School of Medicine. Dr. Rothman came to Johns Hopkins Medicine from the Carver College of Medicine at the University of Iowa in Iowa City, where he served as dean. His research on cytokines, which are immune system molecules, has changed how medical scientists study the development of blood cells, and he has received several national awards for his work.
Kathleen Sebelius. Ms. Sebelius serves as the 21st secretary of the Department of Health and Human Services, a role she has held since President Obama took office in 2009. As HHS secretary, Ms. Sebelius is responsible for the full implementation of the PPACA. Provisions include the recruitment and training of more primary care providers, support of EHRs and a focus on prevention and wellness. Ms. Sebelius has also worked closely with Attorney General Eric Holder and the Department of Justice to crack down on Medicare and Medicaid fraud, and a record $4.2 billion in healthcare funds were recovered in the government's 2012 fiscal year. Most recently, Ms. Sebelius has been responsible for the health law's online insurance marketplaces on HealthCare.gov. Testifying before the House Energy and Commerce Committee, Ms. Sebelius apologized for the site's botched rollout and acknowledged use of the site has been "miserably frustrating" for people trying to purchase coverage, although federal officials have plans in place to fix it. Before joining HHS, she was governor of Kansas from 2003 to 2008, and she was the insurance commissioner of Kansas from 1995 to 2003.
Scott Serota. The Blue Cross and Blue Shield Association, a conglomerate of 37 independent BCBS companies, covers almost one in three Americans. Roughly 96 percent of all U.S. hospitals contract with BCBSA companies. The association also has a presence in more than 170 countries and territories around the world. Mr. Serota has served as the organization's president and CEO since 2000 after previously working as BCBSA's COO and executive vice president for system development. Before joining the Blues system, Mr. Serota was president and CEO of Rush Prudential Health Plans. He also is a founding member of the National Business Group on Health's Institute on Healthcare Costs and Solutions and serves on board councils of several prominent healthcare associations.
Peter Shumlin. Gov. Shumlin is the 81st and current governor of Vermont, a title he has held since 2010. He has made a big impression in healthcare, despite the small size of Vermont. In 2011, he signed legislation that would create a single-payer system, providing universal healthcare coverage to all state residents by 2017. Green Mountain Care is the state-funded organization that would administer the system. Essentially, GMC would pay hospitals and other healthcare providers 105 percent of Medicare rates, while the system itself would be funded through public financing and taxes. The project in Vermont is viewed in some circles as an incubator to see if single-payer could work on a broader level within the U.S. In a Washington Post interview with Ezra Klein in 2011, Gov. Shumlin said: "Single payer means something different to everyone. The way I define it is that healthcare is a right and not a privilege. It follows the individual and not the employer. And it's publicly financed."
Bruce Siegel, MD. Dr. Siegel, board-certified in preventive medicine, has become a leading figure for safety-net hospitals and health systems. He serves as president and CEO of America's Essential Hospitals, formerly the National Association of Public Hospitals and Health Systems, which includes more than 200 organizations that serve the most vulnerable populations in the U.S. Dr. Siegel has led two AEH members as president and CEO: Tampa (Fla.) General Hospital and the New York City Health and Hospitals Corp. He also was the New Jersey health commissioner and director of the Center for Health Care Quality at the George Washington University School of Public Health and Health Services in Washington, D.C. Dr. Siegel's work on healthcare quality and equity has been featured at the Robert Wood Johnson Foundation and The Commonwealth Fund.
Wayne Smith. Mr. Smith serves as chairman, president and CEO of Community Health Systems, a for-profit hospital chain based in Franklin, Tenn., that owns, operates or leases 135 nonurban hospitals across 29 states. CHS is primed to operate more than 200 hospitals, pending its acquisition of Health Management Associates. The average hospital within CHS, post-merger, will have about 150 beds, and CHS will gain a huge foothold in several markets in which it currently doesn't have a big presence, particularly Florida, Mississippi and Oklahoma. In fiscal year 2012, CHS and Health Management had a combined $18.9 billion in revenue. Mr. Smith has also spearheaded other big projects at CHS over the past several years, including a clinical quality alliance with Cleveland Clinic. Before joining CHS in 1997, Mr. Smith was with Humana for 23 years, where he was president and COO.
Joseph Swedish. In March 2013, Mr. Swedish made the ultimate jump from provider to payer. He became CEO of Indianapolis-based WellPoint, the second-largest health insurer in the country and an independent licensee of the Blue Cross and Blue Shield Association. Mr. Swedish came to WellPoint from Livonia, Mich.-based Trinity Health amidst the health system's merger with Newtown Square, Pa.-based Catholic Health East. He joined WellPoint as it underwent massive changes, stemming from the departure of former CEO Angela Braly due to shareholder disapproval. Mr. Swedish currently oversees a health insurer that posted $2.7 billion of profit on more than $60.7 billion of revenue, and he has actively pushed the company to offer health plans on the new health insurance marketplaces. Mr. Swedish has also held senior leadership roles with Centura Health in Denver and two different Florida divisions within HCA.
Marilyn Tavenner. In the spring of 2013, Congress did something it hadn't done in seven years — it confirmed a CMS administrator. Ms. Tavenner was the acting administrator for more than a year before being confirmed, succeeding Donald Berwick, MD, who resigned from CMS in December 2011. As administrator, Ms. Tavenner manages the $820 billion agency, which also is the largest payer in the country, and oversees the implementation of several PPACA reforms. Every year, CMS updates prospective reimbursement schedules for providers. For the 2014 federal fiscal year, hospitals, ASCs and other providers received marginal increases in Medicare reimbursements. CMS also unveiled its new two-midnight rule, which essentially tells providers that inpatient admissions are considered reasonable and necessary as long as they span at least two midnights. Prior to her current role, Ms. Tavenner served other roles with CMS and Virginia's health administration. She also spent 25 years as a nurse with HCA hospitals, as well as a hospital and division CEO.
Anthony Tersigni, EdD. Dr. Tersigni serves as president and CEO of Ascension, based in St. Louis. Within the $16 billion Ascension is Ascension Health, the nation's largest Catholic and nonprofit health system with roughly 100 hospitals across 21 states. Dr. Tersigni also oversees Ascension Health Care Network, a joint venture with Oak Hill Capital Partners that is the first for-profit Catholic health system, and Ascension Ventures, a strategic healthcare venture fund. Dr. Tersigni is considered the first president and CEO of Ascension, which reorganized January 2012 and formed all of its current subsidiaries. Previously, he served as president and CEO of Ascension Health since 2004, and he also was Ascension Health's executive vice president and COO. Before talking on corporate responsibilities within Ascension, Dr. Tersigni was president and CEO of Detroit-based St. John Providence Health System, Ascension's largest integrated network.
Bernard Tyson. Mr. Tyson took over as chairman and CEO of Kaiser Permanente in Oakland, Calif., in 2013 after George Halvorson announced his retirement. As CEO, he is the strategic leader of a 38-hospital system and health insurer that covers 9.1 million people and has more than $50 billion in annual operating revenue. Mr. Tyson has been with Kaiser for almost 30 years. He served as president and COO for more than two years before attaining his current role. Mr. Tyson has also been an individual hospital administrator, a division president overseeing Kaiser's California business and an executive vice president on the health plan and hospital operations side. He recently spoke with the New York Times about how he manages Kaiser, saying leaders are at their best when they "understand differences in personalities and how people process information."
Richard Umbdenstock. For the past seven years, Mr. Umbdenstock has served as president and CEO of the American Hospital Association, the largest hospital lobbying group in the country with more than 5,000 hospital and healthcare organization members. When he took the reins, he knew massive change and reform were forthcoming. AHA supported healthcare reform going into 2010, as the PPACA expanded coverage to tens of millions of uninsured Americans, providing financial and societal benefits to hospitals and patients alike. However, since the law went into effect, Mr. Umbdenstock and AHA have dealt with several curveballs, including sequestration, the Supreme Court decision on Medicaid, the continued cuts of disproportionate share hospital payments and other reimbursement issues. At the beginning of 2013, Mr. Umbdenstock and AHA outlined roughly a dozen priorities for the industry, including the acceleration of payment and delivery reforms, the elimination of preventable infections, the advancement of health IT, price and quality transparency and emphasis on population health. Before joining AHA, Mr. Umbdenstock served as president and CEO of Providence Health & Services in Renton, Wash.
© Copyright ASC COMMUNICATIONS 2012. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.