President Trump may be the top health care industry influencer this year, but the next 12 on the list are bringing innovative ideas and outside-the-box solutions to truly disrupt the way health care is delivered.

Mark Bertolini

Chairman and CEO, Aetna

In addition to the much-anticipated CVS-Aetna merger, Bertolini has long pushed for change in the industry, including greater use of consumer-facing tech.

Jeff Bezos

Chairman and CEO, Amazon

The development of an Amazon-Berkshire Hathaway-JPMorgan Chase health care initiative has continued to captivate the industry ever since its announcement, but Amazon continues to redefine the health care supply chain in other ways.

Bruce Broussard

President and CEO, Humana

Humana’s business model is banking big on partnering with others in the health care space, including Walmart, Walgreens, Kindred Healthcare and Curo Health Services.

Tim Cook

CEO, Apple

Apple has put a lot of work into electronic health care record interoperability in recent years, as well as integrating its own technology into the health care space to empower health care consumers.

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Dr. David Feinberg

President and CEO, Geisinger Health

Fienberg had put Geisinger Health on the cutting edge, pursuing partnerships with Apple Health and investing in DNA sequencing for its patients.

Dr. Marc Harrison

President and CEO, Intermountain Healthcare

Earlier this year, Harrison’s organization announced a partnership with Ascension, SSM Health, Trinity Health and the VA to create a drug company with the goal of bringing down drug prices.

Dr. Rod Hochman

President and CEO, Providence St. Joseph Health

The CEO of the third-largest health care system in the United States has been a leader in population health, putting particular emphasis on access to care for poor and community-based health reforms.

Dr. Stephen Klasko

President and CEO, Thomas Jefferson University and Jefferson Health

Klasko and his organization are rethinking the health care delivery system, seeking outside partners with innovative ideas and rewriting the curriculum used to teach medical students.

Larry Merlo

President and CEO, CVS Health

The greatly anticipated CVS-Aetna merger will undoubtedly change the way pharmacy benefits management operates.

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Larry Renfro

Vice chairman/Founder and managing partner, UnitedHealth Group/Optum Ventures

Renfro took the helm of UnitedHealth’s enterprise growth efforts earlier this year where we oversees the company’s investment in new strategic relationships and health care technology.

Anthony Tersigni

President and CEO, Ascension

Tersigni is the driving force reshaping the nation’s largest Catholic health care system, as well as a key player in a joint-venture to create a new drug company aimed at controlling costs.

Bernard Tyson

Chairman and CEO, Kaiser Permanente

A 30-year veteran of Kaiser and multiple Modern Healthcare Influencer honoree, Tyson has long been an advocate for health care reform, particularly the integration of mental health into the primary care setting.

If there’s anything that’s been a constant regarding health care over the last year, it’s change—and disruptive change, at that.

Modern Healthcare’s annual “100 Most Influential People in Healthcare” list is dominated by disruptors this year. Heading off the list is—who else?—President Donald Trump, whose efforts to pick apart the Affordable Care Act have resulted in people losing coverage, insurers losing subsidies, navigators losing funding and possibly—although the fight’s not over, and the outcome isn’t known yet—drug prices losing altitude.

Related: How broker consolidation and industry alliances are changing the industry

But the next dozen people on the list, all tied for second place and the collective title of “disruptors,” include a number people you wouldn’t expect. Outsiders are weighing in on the struggle to broaden coverage, reduce cost and even change the very way that care is delivered, and with their various outside-the-box approaches, the system appears to be in for even more shocks than it’s endured already.

So where are the rest of the top 13 from? Health systems, insurers, pharmacy, venture capital and technology companies, says the report, and some of their ideas are not just outside the box but pretty far away from it as well.

The report quotes Dr. Stephen Klasko, CEO of Jefferson Health: “Look at Amazon, Berkshire Hathaway and JPMorgan Chase. That is the ‘we’re mad as hell and not going to take it anymore’ cohort that have given up on the traditional players because all they have done is blame the other person.”

Major employers and technology companies, the report points out, are getting together to invent new coverage models and to make the health data playing field more democratic. Providers of care and insurers are attempting to put together new ways to deliver care, while health systems are not only getting actively involved in new ways to do something meaningful about high drug prices while still meeting consumers’ increasing demands for convenience and transparency.

And with tech and other titans flush with the resources and capital to invest in new technology, new staff training and outreach programs are reshaping the industry from the top down. But that doesn’t mean it isn’t a challenge to change the whole industry, especially with providers dealing with payment models at war with one another.

And there have to be incentives to convince an industry to change its ways—akin to enticing the QEII to turn on a dime. According to Klasko, “It’s hard to get someone to change when their salary doesn’t depend on it.” To that end he suggests such strategies as tying bonuses for executives to improvements to the health and well-being of their surrounding communities, instead of to bigger market shares.

“Most CEOs have focused on maintaining their cost structure and remaining profitable in the context of a model that is inefficient and not getting to better outcomes at lower costs,” healthcare consultant Rita Numerof is quoted saying in the report.

Numerof adds, “I don’t want to imply being profitable isn’t a good thing, but that side of the delivery equation is dominated by the status quo mentality that has been historically focused on bricks and mortar and heads in beds.”

And changing that focus might run to other things than hospitalization and medication, such as the actions of Danville, Pennsylvania-based Geisinger Health. Geisinger, says the report, “is trying to change that by providing fresh-food pharmacies in food deserts, which have improved diets and significantly decreased blood sugar levels. It provides free transportation for medical care as well as trips to friends’ houses, church and other social events within 50 miles to combat loneliness.”

Geisinger also offers Lyme disease screening for those living near forests and Methicillin-resistant staphylococcus aureus screening for those who live near livestock. Its CEO, Dr. David Feinberg, is quoted in the report saying, “Loneliness and isolation is as negative a health effect as heart disease or cancer. Both the medical and humanistic aspects of care are vital.”

He adds, “What really matters is your genetic code, ZIP code, behaviors and things like if you have access to good food. Kale and quinoa can be better than prescription medications.”

And speaking of prescription medications, there are also the four health care providers—Intermountain Healthcare, Ascension, SSM Health and Trinity Health—that are working with the U.S. Veterans Affairs Department “to pool their capital with 450 hospitals to create a generic-drug company.” Such a system could not just increase generic competition to avoid skyrocketing price increases, but also offer an alternative source of supplies that can be hit with shortages—like saline solution and sodium bicarbonate.

And that doesn’t even approach some of the actions being taken by such companies as Google, Apple and Fitbit, who are transforming how and where—and by whom—patient data is used.