Top 10 up-and-coming industry leaders in managed care

May 9, 2017

For the first time, Managed Healthcare Executive has identified 10 emerging healthcare industry leaders. Their backgrounds, expertise, and contributions represent four managed care sectors: pharmacy, health plans, health systems, and technology.

For the first time, Managed Healthcare Executive has selected 10 emerging healthcare industry leaders, working in the areas of pharmacy, health plans, health systems, and technology.

To get started, we identified more than 25 finalists based on nominations received and independent research. Then, our editorial advisory board reviewed the recommendations and selected 10 standouts.

To be considered, candidates had to meet the following requirements:

  • Work in the industry 15 years or fewer;
  • Lead key initiatives at their organizations or relevant organizations;
  • Take actions that lead to measurable, positive industry impacts;
  • Accomplish something new or unique in the industry; and
  • Continue to take on more advanced roles and responsibilities in their managed care career path.

With many great submissions, the decision wasn’t easy. Here’s who made the cut.

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EricBeck, DO, MPH, EMT-P, FACEPChief Executive Officer, EvolutionHealth
Dallas, Texas

BeckAt 36 years old, Beck’s career has spanned the care continuum, from moonlighting as a paramedic while putting himself through medical school, to serving as medical director for Chicago’s emergency medical services and the Chicago Fire Department, to his current role as leader of Evolution Health, which provides in-home care and care in alternative settings in 10 states, and offers telehealth services, virtual practices, and virtual medical command centers in 42 states. Major career accomplishments include leading the deployment of a technology-directed mobile integrated healthcare program for Envision, a provider of hospital physician services, and its subsidiaries, Evolution Health and American Medical Response (AMR), a provider of emergency and non-emergency ambulance transports. Beck practices clinically at the University of Chicago in the Mitchell Adult and Comer Pediatric Emergency Departments.

MHE: Why did you choose your profession?

Beck: Growing up I swam competitively and eventually became a lifeguard. This led to attending EMT school and later becoming a firefighter and paramedic. Medical directors encouraged me to continue my education, first through nursing coursework and then medical school. I have always been drawn to meaningful work through service to others. My public safety roots led me to healthcare, and more importantly to understand systems of care from the ground up. Interprofessional team-based care requires a more holistic appreciation of each team member and their potential contribution at both the patient and population levels. My experiences have helped me to understand the powerful impact of team-based care and continue to frame my work as an executive, clinical practitioner, and educator.

MHE: What has been your biggest learning experience?

Beck: Clinical integrity is paramount. The pursuit of value in healthcare requires discipline in measurement with feedback mechanisms to drive learning and improvement. What gets measured can be managed, and what gets managed can be improved upon. I have also learned that at the nexus of public safety, public health, healthcare, and managed care, lies population health-a true opportunity to align competencies across health systems, communities, and populations for the better. Measuring the right things for the right populations is where value-based care truly sits.

MHE: What change would you like to see in healthcare in the next 10 years?

Beck: Universal transparency in health and healthcare outcomes-including clinical, financial, and experiential areas. Although a lot of this data is available today, it is not readily accessible or easily understood by typical consumers and caregivers. Increasing transparency in cost, quality, and experience will continue to facilitate alignment between consumers, providers, and financiers of healthcare services with a shared goal of good health.

MHE: If you could sit down to dinner with anyone involved in healthcare, who would it be?

Beck: John Snow, who traced and tabulated fatalities during the cholera epidemic of 1854 in London to isolate the Broad Street water pump as the source of infection. As an aspiring epidemiology geek, I admire his ability to use measurement (mostly observational counting) to solve a contemporary health issue of his time.

Next: The next emerging industry leader

 

 

Mark Bini, MBAVice President, New Solutions, Express Scripts
St. Louis, Missouri

BiniBini began his healthcare career in 2008. Since then, he has steadily taken on new roles at Express Scripts, the latest being vice president of New Solutions. In this role, he leads the Express Scripts Lab-which is comprised of more than 150 researchers, decision designers, and clinical specialists. At the PBM, Bini led the development of high-tech remote monitoring solutions for patients with diabetes and asthma, as well as a solution to proactively identify and intervene when patients are at risk for opioid dependence. Presently, the company is driving a 24% decrease in the average day’s supply for at-risk patients. In addition, for Express Scripts’ diabetes remote monitoring program, 61% of patients lowered their A1c levels.

MHE: Why did you choose your profession?

Bini: My curiosity and passion for behavioral science and innovation led me to Express Scripts. I’ve been fortunate to learn and grow under some of the brightest minds in the field. This has afforded me the opportunity to help shape Express Scripts’ behavior-centric approach to innovation, developing solutions for its 85 million members.

MHE: What has been your biggest learning experience?

Bini: People have busy lives and are often consumed by in-the-moment decisions that are either pleasurable or pressing. Despite good intentions, procrastination to make healthy decisions is a common patient pain point. This has taught me that the solutions we create for patients need to fit within their life flow and require minimal to no friction. This is why we’ve focused on using behavioral science to help “activate” the good intentions people naturally have to improve their health.

MHE: What change would you like to see in healthcare in the next 10 years?

Bini: I hope to see high-tech remote monitoring solutions for chronic and complex conditions become a healthcare norm. Connected sensors, monitors, and mobile apps enable timely, cost-effective care for high-risk patients. This is an exciting space that’s already gaining momentum. For example, Express Scripts’ patients living with diabetes are using connected glucose meters and are being monitored by diabetes pharmacists who provide timely and meaningful coaching to control blood sugar levels. We’ve also seen improved medication adherence with asthmatic people through the use of inhaler sensors, smartphone apps, and monitoring from pulmonary pharmacists.

MHE: If you could sit down to dinner with anyone involved in healthcare, who would it be?

Bini: I’d love to pick Hippocrates’ brain. While considered the father of Western medicine, I think he’s the ultimate change agent and innovator. I’d be interested to understand how he advanced science and medicine while overcoming resistance from the status quo.

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Jason A. Coons, BAVice President, Care4U – CareSource
Dayton, Ohio

CoonsCoons, 35, joined the CareSource team in early 2016 to implement a community-based, member-centric model of service delivery for the plan’s 1.6 million members. Before arriving at CareSource, Coons spent nearly six years at Kettering Health Network, first as director of Process Excellence, and later as network director for Process Excellence. Assuming the initial senior leadership role in his 20s, Coons delivered nearly $6 million in hard savings while at the Kettering. A high point early in his career included sales growth of more than 300% under his direction as a first-time senior leader at TechSolve, a business management consulting company.

At CareSource, Coons leads the division for population health strategy and analytics, utilization management, a 24/7 nurse triage line, clinical business systems, care coordination and member wellness, and prevention initiatives.

MHE: Why did you choose your profession?

Coons: I’ve always wanted to be connected to something larger and find solutions. Healthcare became personal during my grandmother’s final years-I was taken aback by the inconsistency and lack of consumer experience for her and our family. That experience reignited my passion to want to mend a broken system. At my core, I am an industrial engineer. I was lucky to translate that knowledge to drive continuous improvement in hospitals. Today, I am expanding that vision to the development and promotion of Care4U, CareSource’s population health management model.

MHE: What has been your biggest learning experience?

Coons: Healthcare is an ecosystem, and to understand what pulls and pushes on it, you have to take a broader perspective. Everything is interconnected-hospitals, primary care practices, health plans, and so on. This awareness sheds light on silos within the industry, which ultimately affects patient care.

MHE: What change would you like to see in healthcare in the next 10 years?

Coons: The consumer has to be our top priority. Care4U’s change management strategy is designed to do this by giving consumers what they deserve-a focus on well-being rather than just-in-time clinical care. Via population health, we go beyond medical care management to address the whole member-looking at socioeconomic determinates and filling behavioral health gaps. This approach allows us to serve members when, where, and how they need us.

MHE: If you could sit down to dinner with anyone involved in healthcare, who would it be? 

Coons: Having worked for the Kettering Health Network in Dayton, Ohio, I’d like to sit down with its namesake, Charles Kettering. His limitless frame of mind and passion to improve the quality of life is awe-inspiring. In the early 1900s, he had the foresight to invent the first incubators for premature babies and his research on magnetism eventually led to imaging devices. He held 186 patents, many of which were life-changing.

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Michelle Histand, BA
Director of Innovation, Independence Blue Cross
Philadelphia, Pennsylvania

HistandHistand has excelled in the industry more than 12 years, most recently managing the innovation design thinking program at Independence Blue Cross. Histand built the insurer’s design thinking program-which has become a significant part of the company’s broader innovation strategy. The program set out to change the way Independence’s employees solve complex business problems, by using “design thinking” principals. The basic tenets of design thinking focus on understanding what’s most important to consumers, and then designing processes, products, or interactions that optimize those beliefs. It has become a highly sought-after program by universities, healthcare leaders, Blue Cross health plans, and others who are applying the tools Histand customized to address business challenges.

MHE: Why did you choose your profession?

Histand: I’ve always wanted to work in a field that helps people significantly. My first job at Independence was in learning and development; at that time I didn’t know much about healthcare. Over the years I’ve become passionate about access to care for everyone, particularly women. I moved into the innovation function, seeing an opportunity to think creatively in a large, traditional company. I felt that I could make a direct difference for our members and employees by helping them think about healthcare in a whole new light.

MHE: What has been your biggest learning experience?

Histand: An interesting change for me was experiencing the shift from working for a business that sells to other businesses, to working for one that sells to consumers. It’s taught me how critical the customer experience is and how using methodologies such as design thinking can refocus the business to see things from the customers’ perspective.  

MHE: What change would you like to see in healthcare in the next 10 years?

Histand: I hope health insurance will become easier for people to understand and use. I’d love to reach a point where consumers can easily find a good surgeon or schedule an annual physical, for example, and know exactly when to do it, how to do it, and how much it costs.

MHE: If you could sit down to dinner with anyone involved in healthcare, who would it be? 

Histand: Former U.S. President Barack Obama-he had an amazing vision that everyone should have access to care, and he worked to do it-despite many challenges. His hope for the future and drive to do the right thing was unwavering. I admire him immensely.

Next: The next emerging industry leader

 

Brian Kalis
Managing Director, Digital Health and Innovation, Accenture
Minneapolis, Minnesota

KalisIn 2014, at 33 years old, Kalis became the youngest managing director in the history of Accenture’s Minneapolis office. He now leads the global professional services company’s digital health business-including analytics, blockchain, cloud, and artificial intelligence. Kalis created an innovative model that fuses breakthroughs across often disparate entities (e.g., startups, providers, payers). The model helps traditional healthcare entities conduct research and development activities globally, with a bevy of outside research partners, such as a startup or research laboratory. He also advises and works with providers, payers and government entities worldwide to design strategies, build capabilities and deploy digitally-enabled models to transform healthcare delivery.

MHE: Why did you choose your profession?

Kalis: I have a passion for improving consumer services and business operations using technology. On my first project, Accenture gave me the opportunity to apply this to the healthcare industry. I immediately knew that healthcare was where I wanted to focus my work. I realized that, by leveraging technology and simplifying the complexity of healthcare, we could make a measurable and positive impact on people’s lives-which has driven me ever since.

MHE: What has been your biggest learning experience?

Kalis: Time and experience working on large-scale initiatives in the healthcare industry have helped me appreciate the importance of leadership, organizational structure, and culture. Each one carries significant weight when driving institutional change and future success. I am reminded of this daily through my collaboration with healthcare organizations on digital and consumer-focused transformations.

MHE: What change would you like to see in healthcare in the next 10 years?

Kalis: I would like to see a systemic transformation in the healthcare industry toward person-centered care. Ideally, this would be a system with a proactive focus on well-being versus reactive sick care. It would be convenient and accessible for people, who have a coordinated care team focused on value and outcomes. To accomplish this, I would like to see accelerated changes in healthcare reimbursement toward value-based payments, to help drive the structural changes-including digital health tools-required to improve consumer experience, care quality, labor productivity and, ultimately, sustainability.    

MHE: If you could sit down to dinner with anyone involved in healthcare, who would it be? 

Kalis: Atul Gawande-I have followed his work on the topic of medicine and public health for some time, and would value a discussion on how we can “heal” medicine and public health, both for the benefit of citizens and clinicians.

Next: The next emerging industry leader

 

 

Marti Lolli
Senior Vice President, Commercial Markets, Priority Health
Grand Rapids, Michigan

LolliLolli’s healthcare career began in 2008 as the consumer engaged healthcare product manager for Priority Health, a health insurance company with more than 750,000 members. Since then, she has steadily taken on new roles, including director of healthcare reform, director of Medicare product and market development, and director of product development. Lolli was instrumental in launching individual health plan products that helped Priority Health garner more than 40,000 new members, a 60% jump in membership in its second year in the marketplace. She also led the development of the insurer’s holistic plan, which covers alternative care such as acupuncture and massage services. The holistic plan helped Priority Health glean sales from a healthier demographic, while increasing overall enrollment.

MHE: Why did you choose your profession?

Lolli: I enjoy solving complex business problems, such as figuring out how to make premiums affordable for members. Another challenge is getting consumers to become engaged in their care. When this occurs, they play a more active role in their care and make more informed decisions.

MHE: What has been your biggest learning experience?

Lolli: I viewed the introduction of the Affordable Care Act as an opportunity for Priority Health and our members. I dove into understanding its ever-changing regulations, so I could simplify something that was very complex. I delivered more than 200 presentations to our employer groups and partners to help them understand its potential impact on their businesses.

MHE: What change would you like to see in healthcare in the next 10 years?

Lolli: Healthcare must become more affordable. As an industry, we need to work to flatten, if not decline, the healthcare cost trend. One way to do this is to renovate the fee-for-service model. By focusing on delivering the right care, at the right time, at the right place, we’ll be able to unwind the current delivery system mentality and eliminate waste. We also need to get pharmacy costs under control, while providing access to lifesaving medications.

Priority Health developed tools to give members the ability to shop for healthcare and research costs based on their individual health plans. Tools like these will champion change in our industry.

MHE: If you could sit down to dinner with anyone involved in healthcare, who would it be? 

Lolli: Michael Porter, because he is among the top business strategists in the country. He has also published some fascinating research on successful healthcare models. Another choice would be Clayton Christensen, a leading expert on the work in innovation. He recently shared his insights on how to reinvent healthcare to make it sustainable long-term.

Next: The next emerging industry leader

 

 

Susan Moffatt-Bruce, MD, PhD, MBA, FACS, FRCPS(C)
Cardiothoracic surgeon
Chief Quality and Patient Safety Officer
The Ohio State University Wexner Medical Center
Columbus, Ohio

Moffatt-BruceMoffatt-Bruce, who began her career in healthcare as a staff surgeon at St. Paul’s Hospital in Vancouver, British Columbia, in 2004, has held many posts within Ohio State’s Wexner Medical Center and its College of Medicine for the past 10 years At Wexner, an academic health center with seven hospitals, she introduced and implemented a systematic approach incorporating customized safety tools aimed at generating permanent culture change around patient safety. She also secured a grant of nearly $4 million from the AHRQ Patient Safety Learning Laboratories, to establish and support her concept of Institute for the Designs of Environments Aligned for Patient Safety (IDEA4PS). It seeks to use systems approaches to bring together multidisciplinary teams to generate new ways of thinking regarding the design of feedback to the environment of care in alignment with systems dynamics.

MHE: Why did you choose your profession?

Moffatt-Bruce: I was inspired by many of my mentors, particularly Wilbert Keon, MD, a cardiac surgeon at Ottawa Heart Institute, Canadian senator, and an astute healthcare leader. He performed the first pediatric heart transplant in Canada, and he envisioned and built the business of specialized heart care.

MHE: What has been your biggest learning experience?

Moffatt-Bruce: As healthcare providers and leaders, we can learn and even borrow from other industries. While patient care is complicated and sometimes unpredictable, lessons learned from industries ranging from aviation, nuclear power, and retail impact patients’ safety and outcomes. In addition, I have learned that healthcare is truly a service industry and the patient and their family must remain the customer.

MHE: What change would you like to see in healthcare in the next 10 years?

Moffatt-Bruce: I’d like to see more women physicians in healthcare leadership roles. It’s my impression that physicians are impactful as senior healthcare leaders included in the C-suite, and that women have a tremendous ability to weigh priorities, optimize resources, and effectively multi-task. The proverbial healthcare executive glass ceiling must be broken.

MHE: If you could sit down to dinner with anyone involved in healthcare, who would it be?

Moffatt-Bruce: Elizabeth Blackwell, MD, the first woman to receive a medical degree from an American medical school. After working in European clinics, she came to New York City-where she was repeatedly refused work in hospitals and clinics. Therefore, in 1854, she opened her own dispensary in a small house.

Next: The next emerging industry leader

 

 

Justin Ryan, PhD
Research Scientist, Phoenix Children’s Cardiac 3D Print Lab Phoenix Children's Hospital
Phoenix, Arizona

RyandAt 28 years old, Ryan has been working in the industry for only five years, but he’s made a big impact. He played a pivotal role in establishing the Cardiac 3D Print Lab at Phoenix Children’s Hospital, one of the nation’s first clinical-based 3D print laboratories. He collaborated with more than 24 institutions to expand the laboratory’s reach and impact, and helped secure more than $850,000 in grants and philanthropic monies to help fund the laboratory’s development and ongoing operations. Ryan has also helped perform more than 75 virtual surgeries (a process with collaborations in seven countries). For this, Ryan works with surgeons following 3D reconstructions and enables them to do a “surgery before the surgery.” This translates to him computationally resecting tissue, implanting devices, and transplanting organs, all prior to an actual surgery. Through this virtual process, he enables surgeons to plan and even practice complex interventions.

MHE: Why did you choose your profession?

Ryan: After receiving a bachelor’s degree in digital art and animation (think Pixar type animations), I pursued an engineering degree because I wanted my animations to produce entertainment and-if successful like any strong Pixar or Disney animation-a level of introspection. Through engineering, I was able to apply my art-making techniques (3D modeling, 3D printing, mold-making, etc.) for a greater purpose-healthcare.

MHE: What has been your biggest learning experience?

Ryan: When our interdisciplinary team started 3D printing over five years ago, few non-academic hospitals were doing it. On a tight budget, we created a working 3D laboratory that now houses three printers and has nearly 30 students. The entire process taught me that the old adage, “squeaky wheel gets the grease,” is indeed true. Our laboratory wouldn’t be possible without stakeholders constantly showing decision makers about in-house developments that are both innovative and revolutionary.

MHE: What change would you like to see in healthcare in the next 10 years?

Ryan: I would like to see stronger partnerships between medical image software and novel 3D hardware companies. A great disparity between the two critical platforms exists. Utility of novel 3D technologies (virtual reality, augmented reality, holography, and 3D printing) relies on developing useful applications across many healthcare disciplines. And of course, I’d like to see insurance companies reimburse novel 3D technologies. The added benefits of improved surgical outcomes and reduced time metrics, both relating to reduced longitudinal costs, are enticing.

MHE: If you could sit down to dinner with anyone involved in healthcare, who would it be?

Ryan: I would choose to sit down with Elon Musk, who isn’t yet significantly linked to medicine. The innovation, rapid production, and zeal for sciences that he has engendered in the greater public are astounding. Utilizing his experience and enthusiasm for healthcare could yield incredible opportunities.

Next: The next emerging industry leader

 

Justin Schneider, PharmD
Vice President of Operations, Sinai Health System
Chicago, Illinois

 

Schneider

After receiving his Doctor of Pharmacy degree from the University of Iowa in 2004, Schneider began his career as a pharmacist for CVS. He then joined Sinai Health System, a private, not-for-profit organization comprised of seven member organizations, as the assistant director of pharmacy and was quickly promoted to director of pharmacy and then system director of pharmacy before becoming vice president of operations in 2014. At Sinai, Schneider has revamped the performance expectations for his division, resulting in a more engaged and higher achieving staff; implemented new technologies to streamline operations and drive improvements in quality, safety, and outcomes; transformed the pharmacy practice model from a distribution focus to a patient-centric model; and standardized the system’s approach to supply chain and laboratory services across all of its hospitals and clinics. He also established two residency programs, two primary stroke centers, as well as numerous training programs with several colleges and universities.

 

MHE: Why did you choose your profession?

Schneider: A strong understanding and interest in science initially led me to pursue a career as a community pharmacist. I then transitioned to a pharmacy leadership position in the hospital setting. There, I quickly realized I am motivated by the collaborative nature of the hospital environment and the opportunities to affect change at a high level. Today, as an operations executive, the work is dynamic and fast-paced and the nonstop focus on problem-solving has a tangible impact on the quality of patients’ lives.

MHE: What has been your biggest learning experience?

Schneider: Working in a health system which treats primarily underserved patients has shown me that social determinants of health are as important as the clinical care we provide in improving patient lives. Limitations due to economic, social, and environmental circumstances impact patients’ daily choices. These factors are directly related to morbidity, mortality, and life expectancy. If we expect to achieve better outcomes for patients and their communities, we must be mindful of the underlying burden many patients face and tailor interventions and care plans accordingly.

MHE: What change would you like to see in healthcare in the next 10 years?

Schneider: I would like to see Medicare change its policy to recognize pharmacists with “provider” status. Pharmacists are licensed and trained to provide services for which they are not currently reimbursed under Medicare, such as managing chronic diseases, wellness testing, complex medication management, and administering immunizations. As the most accessible healthcare professional-and sometimes the only healthcare professional in some communities-there is an opportunity to make a significant impact on this gap in access to care.

MHE: If you could sit down to dinner with anyone involved in healthcare, who would it be?

Schneider: Jonas Salk, because what he did would be nearly unimaginable today. He tested his polio vaccine on himself and family members first, and he did not patent the vaccine that nearly eradicated polio worldwide. I would love to know why and how he made the decision to put himself and his family at such great risk while walking away from what would have been a significant fortune.

Next: The next emerging industry leader

 

Nirav Vakharia, MD
Primary care physicianAssociate Chief Quality Officer
Vice chair of Population Health
Cleveland Clinic
Cleveland, Ohio

VakhariaBefore entering medicine, Vakharia worked as a middle school math and science teacher in Washington, D.C. He joined Cleveland Clinic as a primary care doctor in 2012. Within four years, he rose to become associate chief quality officer for the health system, vice chair of population health for the Medicine Institute, and quality chair of the Cleveland Clinic Medicare Accountable Care Organization. Vakharia leads initiatives to improve transitions of care and improve performance in risk contracts. Under his tenure, readmissions have continued to decrease, and the clinic’s ACO has enjoyed excellent quality and patient experience scores. In its first year (2015), it generated $34 million in shared savings.

MHE: Why did you choose your profession?

Vakharia: In college, I studied engineering, and afterward became a middle school teacher. I loved the analytical thinking of engineering, but also the caregiving and humanism of teaching. Only as an administrator and physician did I find a career that required both in order to be successful. It’s immensely gratifying to apply these dual interests to improve the health of our healthcare system and patients.

MHE: What has been your biggest learning experience?

Vakharia: Stories-whether they are from patients about a particular treatment option or about issues within our healthcare system-often wield greater power than data. We must honor these stories in order to promote change among patients or caregivers. The majority of clinical decisions don’t yet have evidence behind them, nor do we have solid evidence to suggest what steps healthcare systems should take to be successful. Looking at the data, as well as appreciating stories from others, increases our chances of success in the exam room and board room.

MHE: What change would you like to see in healthcare in the next 10 years?

Vakharia: Pushing healthcare providers to take ownership of patients’ health, and not just their healthcare, is a great thing. However, only a small portion of patients’ overall health is impacted by healthcare, with the rest being due to genetics, social factors, food policy, housing policy, environmental policies, etc. To be successful at population health, we must align all the tools at our disposal-healthcare providers, health insurers, housing agencies, public health departments, nonprofits, community-based organizations, environmental protection agencies, etc. This could be achieved via smarter policy and funding mechanisms that incentivize cooperation among these entities. Government at all levels must be engaged to have a widespread and lasting impact.

MHE: If you could sit down to dinner with anyone involved in healthcare, who would it be? 

Vakharia: The new HHS Secretary Tom Price or CMS Administrator Seema Verma, to better understand their plans for U.S. healthcare. Just knowing what to expect over the next few years would help a lot of us sleep better at night!

Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.