An annual ranking of the most influential people in health care has sharply tilted toward CEO's in recent years, a new study said, as the number of academics and advocates on the list has decreased significantly.

The analysis, published in Mayo Clinic Proceedings, looked at another publication: Modern Healthcare, and its yearly rankings of the 100 most-influential people in U.S. health care. The study by Mayo researchers noted that the widely quoted rankings have a relatively opaque selection process—making it more difficult for power players to game the rankings.

What the Mayo Proceedings study found is that the rankings have increasingly favored executives from health care organizations. Health care CEO representation in the top 100 list "…has increased from 23 percent in 2002 to 72 percent in 2018, with an apparent substantial upward inflection in this trend since 2009," the study found. "This predominance appears to be at the expense of academics, advocates, and government officials."

A sea change after passage of the ACA

Interestingly, the data seems linked to the passage of the Affordable Care Act in 2010, according to Victor Montori, a co-author of the paper. CEOs were generally ranked more highly than other groups in the Modern Healthcare lists from earlier years. But after 2010 the rankings of the other two groups identified in the study—academics/advocates and government officials—dropped steadily until the latest ranking, where those two groups stood at 10 percent. The CEO rankings rose as those of other influencers dropped.

"In the last decade or so there's been a takeover of the space of influence by chief executive officers," Montori said in an interview published by the Brainerd Dispatch. "The proportion of them increased in the last 16 years, from CEOs being about 23 percent of the list to being about 72 percent. Their influence has been steadily increasing over time, and especially since 2009."

The study also outlined the relatively lower influence of women (listed at a range of 17 percent to 28 percent of the Top 100 rankings), patients, and trade associations of health care workers. "Our findings suggest that patients and clinicians are neither defining what health care is nor deciding how it should evolve," the study said.

A Managers' Coup D'état?

A critic of corporate America, Roy Poses of the blog "Health Care Renewal," calls the study more evidence that the manager class has taken over industries such as health care. "We have frequently discussed the rise of generic managers," he writes. "Managerialism is the belief that trained managers are better leaders of health care, and every other sort of organization, than are than people familiar with the particulars of the organizations' work. Managerialism has become an ascendant value in health care over the last 30 years."

The Mayo study, while more cautious than Smith's blog, also raises concerns about too much consolidation of influence in the boardroom, rather than with those whose expertise is at the bedside.

"We found that the perceived influence over US health care of chief executives of health systems is increasing. To the extent that the ranking validly reflects influence, the sharp rise in the influence of chief executive officers at the expense of representatives of patients or health professionals may underscore the increasing industrialization of health care," the analysis said. "This trend placing health care influencers within C-suites, accountable to boards mostly comprised of other corporate leaders, may explain the rise of business language and thinking, for example [the term] 'high-value health care.'"

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CEOs have become more influential than ever in health care

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