Double-digit cost increases, labor shortages and rising malpractice insurance rates make the challenges particularly daunting for those at the top.
It would follow, then, that the largest insurer in town often finds itself at the center of the storm and the subject of the closest scrutiny.
For Ken Melani, president and CEO of Highmark Inc., which operates among the largest Blue Cross/Blue Shield plans in the country, the challenge is among the toughest of the tough.
While hospitals and doctors face difficult challenges when it comes to delivering care while keeping costs in check, health insurance companies are frequently the lightning rod when it comes to criticism for rising premium payments.
Melani combines experience in both the clinical and the business sides of the health care delivery system. A physician by training and former executive vice president of strategic business development for Highmark, Melani took the helm of the insurer last year. He has also served as president of Keystone Health Plan West Inc., the Highmark HMO plan.
He joined Highmark in 1989 as corporate medical director after developing a multi-specialty group medical practice and serving as CEO and chairman of West Penn Cares Inc.
A testament to Melani's skill in resolving thorny issues is his role in striking a contract with the University of Pittsburgh Medical Center that kept UPMC's providers in the Highmark network and available to its 2 million members. The negotiations also paved the way for converting the former St. Francis Medical Center into a new Children's Hospital.
Since taking the top post at Highmark, Melani has taken the lead to develop a new strategic plan for Highmark and has stumped the region to raise awareness of health care cost and financing issues. How to reach: Highmark Inc., www.highmark.com