Health-care visionary

In the early 1980s, the hospital director of the 350-bed Penn State Hershey Medical Center was looking for his next challenge. He applied to be the administrator of Fairfax Hospital, then about double the size of Penn State’s hospital, a natural next step for a health-care executive.

After a yearlong interview process, Knox Singleton instead was chosen to lead the entire hospital system, which at that time owned three hospitals. The CEO of Fairfax Hospital Association was planning to retire and wanted to groom the young executive to take his place.

Singleton had been assistant director and director at Hershey and previously worked for the English National Health Service at Guy’s Hospital in London.  But he hadn’t led anything comparable to the Fairfax association, which at the time had hundreds of millions of dollars in revenue and thousands of employees. “At the age of 35, that was unexpected and a somewhat daunting development,” he recalls.

“But I never did get that administrator’s job at Fairfax,” he jokes in his office at the headquarters of the Inova Health System, the successor to Fairfax Hospital Association that he has now led for 31 years.

Despite the ambitious role he was given in his 30s, Singleton expected to stay at Inova for only three to five years before looking for the next step in his
career.

Northern Virginia in the 1980s was not the economic powerhouse it is today. 

Fairfax County, with a population of around 700,000, was mostly a bedroom community of Washington, D.C. Today, the county has 1.1 million residents and is the home of eight Fortune 500 companies and 125 firms on the Inc. 5000 list.

“I had no real insight that this edge city was going to grow up underneath our feet here, and the whole community was just going to explode and boom as it has over the last 25 years,” says Singleton.

Inova’s transformation has followed the explosive growth of Fairfax and Northern Virginia. Today the nonprofit health system has 16,000 employees and five hospitals with 1,700 licensed beds.

“If you said, ‘I’m going to leave when the growth slows down or the innovation stops’… there was no place to get off the bus. It was rolling at high speed going to lots of interesting places,” says Singleton.

Inova now offers a wide range of health-care specialty centers, outpatient facilities, primary and specialty physician practices and the internationally recognized Inova Heart and Vascular Institute, Inova Translational Medicine Institute, Inova Neuroscience Institute and Inova Children’s Hospital.

“Northern Virginia has been blessed to have had a handful of leaders and visionaries who transformed the region from a government bedroom community to an internationally recognized economic powerhouse — Knox Singleton is one of them,” says Sean Connaughton, the president of the Virginia Hospital and Healthcare Association, who first worked with Singleton after being elected chairman of the Prince William County Board of Supervisors in 1999. “Knox has built Inova into a top-notch health-care, academic and research center while never losing sight of the fact that the health system’s primary role is to serve its patients.”

Instead of easing his way into retirement, Singleton, 67, is continuing to make his mark on Inova and the community. He is the catalyst behind the Inova Center for Personalized Health — an envisioned campus for researchers, clinicians, educators and patients — designed around the growing field of personalized medicine. It is a plan that, according to health-care and economic development officials, already is attracting attention around the world and could help diversify a regional economy still heavily dependent on federal spending.

“He has the willingness to have a bold vision for the Center for Personalized Health and the willingness to get behind it, to drive it and to take risk,” says Todd Stottlemyer, the center’s CEO. “Because when you get out in the area of genomic science, we’re on the cutting edge of medicine and the cutting edge of clinical research and care. That hasn’t deterred him in any way from articulating a big vision for the health system and for the Center for Personalized Health.”

For his leadership during Inova’s transformative growth and his ambitious plans for the Inova Center for Personalized Health, Virginia Business has named Singleton its 2015 Virginia Business Person of the Year.

A growing field
Under Singleton’s guidance, Inova expects to build an academic, research and clinical campus focused on the growing field of personalized medicine, which aims to predict, prevent and treat disease based on an individual’s genetic makeup. The medical field already has garnered attention from the White House, which in January unveiled its $215 million Precision Medicine Initiative to fund research.

Singleton’s dream is to make Inova a leader in the field, and he has personal reasons for that goal. His mother died of lymphoma, and 15 years ago he was diagnosed with the same disease. “My bet is that some of my four kids will have lymphoma,” says Singleton. “I found mine at stage four, where the survival rates are 35 percent. If my son gets lymphoma, he should discover it at phase one, where it’s 90 percent curable.”

Inova already has invested in this field in a number of ways, establishing the Inova Translational Medicine Institute and hiring Dr. John Niederhuber, the former director of the National Cancer Institute, to lead it. Inova also hired Dr. Donald “Skip” Trump, the former head of the Roswell Park Cancer Institute in Buffalo, N.Y., to lead its Inova Dwight and Martha Schar Cancer Institute. The institute focuses on pharmacogenomics, which uses therapies based on patients’ genomes and the genetic characteristics of tumors being treated. In addition, Inova had explored  the development of a medical school and other education programs related to personalized medicine.

Then Exxon Mobil Corp. announced in 2012 it would vacate its 117-acre campus in Fairfax, moving 2,100 jobs to its Houston headquarters. Singleton saw the property — located across the street from Inova Fairfax Hospital — as the linchpin that could make Inova a leader in personalized medicine. Inova took ownership of the property Oct. 1 for a reported $180 million. The health system will spend the next six to nine months working on a master plan for the entire campus. 

In early October, a large framed aerial photograph of the future site of the Inova Center for Personalized Health was propped up against the wall on the floor of Singleton’s office. The photo shows, in the center of a densely wooded area, the existing 1.3 million square feet of office space that Inova has begun to retrofit.

So far, Inova leaders are envisioning a village that includes clinical care, research, hotel and even residential facilities. Singleton says Virginia universities from around the state likely will have a presence. A big component of the plan is attracting new businesses to the campus, which sits in a region that already has a high concentration of technology workers and companies.

“What the Center for Personalized Health provided was really an opportunity to bring all of [these initiatives into personalized health] into physical proximity and create the opportunity to synergize across these different boundaries,” says Singleton. “And then create a companion site for businesses. Really the opportunity that was not in the works before we [acquired the property] was the vision of bringing businesses, who were going to be active in the analytics or the genomics or the personalized medicine field, into direct proximity with the research and delivery components.”

That could mean university and Inova researchers working with an IT company to develop a tool to identify mothers at risk for complicated pregnancies or with a drug company to develop a test determining optimal doses of blood thinners for patients based on their genetics. “What our focus is on is translational research, which takes established basic science results and translates them into patient care,” says Singleton. 

Jerry Gordon, president and CEO of the Fairfax County Economic Development Authority, says the former Exxon Mobil campus is the key to establishing Inova as a leader in personalized medicine. “A lot of communities around the world have designated this as one of their future growth industries,” says Gordon. “But you have to have something that makes you attractive and something that makes you special. This whole campus is that special thing that makes Fairfax County distinctive.”

He says the future of translational medicine is dependent on the ability to store and analyze big volumes of data. “We have that capacity here in Northern Virginia,” says Gordon, who started in his position the same year Singleton began leading Inova. “We have the workforce to help accelerate this research.”

Already, the campus has received interest from research organizations and a wide variety of  life-science, pharmaceutical and technology companies from around the world, says Stottlemyer, who was CEO of IT company Acentia LLC before returning to Inova to lead the project. Stottlemyer previously had been an executive vice president at the health system.
“I think this is the most exciting opportunity for Northern Virginia since I’ve been in the area [for more than 30 years],” he says, “because it has the opportunity to combine the significant advancements that are being made in scientific discovery around medicine with some of the core strengths being made in Northern Virginia around information technology and data analytics, as well as connecting to some of the outstanding universities from around the state.”

Inova’s push into personalized medicine is promising because the center is near Washington and it is hiring top researchers, says Edward Abrahams, president of the Personalized Medicine Coalition, an education and advocacy group. “[With personalized medicine], we hope we can know in advance what is likely to work and what doesn’t, and in cancer that is obviously very, very important. There are statistics that say that 75 percent of cancer drugs don’t work well. That’s not very good, and they’re toxic.”

Abrahams hopes that Inova is able to demonstrate the benefits of personalized medicine by “conducting the research and bringing that research to clinical care on the ground where it can, and we hope will, demonstrate the effectiveness of personalized medicine and its ability to produce better outcomes for patients and lower overall costs for systems like Inova.”
Other health organizations around the country, such as the Mayo Clinic, also are investing in personalized medicine. Yet, Inova is unique because it’s a community hospital system rather than an academic research center, says Abrahams.  “[Inova’s] efforts to expand its influence punch above its weight in being on the frontier of modern medicine,” he says.

Singleton says fundraising for the center has gone well. The cancer center alone received a $50 million donation from homebuilder Dwight Schar and his wife, Martha, earlier this year. Singleton says the overall project has received other multimillion donations.

Inova is buoyed by strong financials. The health system ended 2014 with $2.7 billion in operating revenue, up from $2.5 billion in 2013. Its operating income was up 65 percent last year to $217.7 million. The health system had $4 billion in unrestricted cash and investments, putting it in a prime position to invest in capital expansion.

Stottlemyer credits Singleton’s vision as being the catalyst behind the center. “Knox is a big visionary and audacious leader,” he says. “And he’s challenged all of us in such a positive way to build something that is truly game changing for the health of our community and also broadly for the economic development related benefits to our community, too.”

Responding to change
During his more than three decades at Inova, Singleton has been able to stay ahead of health trends and identify impending changes, says John Toups, the former chairman of the Inova Health System board of trustees, who served on the board for more than 20 years.  Singleton also has been able to respond to change by hiring good people who can run Inova’s day-to-day operations, the former board member says. “He’s got good, good people in those major slots, so that does allow him time to think of the future and what changes are coming and how Inova can react to them.”

The biggest change that Singleton has encountered is the Affordable Care Act. “The ACA has been the most transformational piece of legislation during my 35, 40 years in health care,” says Singleton. “The ACA is incentivizing payers to actually manage care, take risks and manage utilization and the costs of care. It also fundamentally is moving the locus of decision-making and funding of health care out of employers and onto individuals.”

One innovative response to the ACA was a partnership Inova formed with health  insurer Aetna. The joint venture was one of the first of its kind in the country. It offers a health plan, Innovation Health, to employers and to individuals through health exchanges created by the ACA.  Membership has grown quickly to more than 172,000. Thirty-eight thousand people have purchased the plan on federal exchanges.

Singleton also has strived to keep a personal connection with employees, patients and other stakeholders despite Inova’s rapid growth. For years, he wrote folksy letters to them, mixing personal anecdotes with company news.

“People could really resonate with the illustrations of a lot of these organizational issues in a personal context,” says Singleton. “Everybody can relate to when you talk about your kids or other parts of your family or your pets.”

Today, on the advice of some of Inova’s millennial employees, the letters have morphed into a blog, “Opportunity Knox,” on which Singleton posts short videos.  

For all the change he’s overseen at Inova, Singleton still refers to his decision to open a program for AIDS patients in the early 1990s as his proudest achievement.

Back then, AIDS was sparking public fear. While a growing number of patients were diagnosed with the incurable disease, little was known about its transmission.

“At the time, it was not a cool thing to do because there was so much fear,” says Singleton. “We organizationally stood up and did what there was a pressing need for. It was neither an economically nor socially advantageous step, but it was the right thing to do.”

To this day, Inova treats the largest numbers of HIV-positive patients in the Washington, D.C., area.

That desire to help people drives Singleton at work and outside the office, say those who work with him. Singleton helped found the Community Coalition for Haiti (CCH), a Vienna-based organization that provides health care, education and community development services in Haiti. The organization was founded by two churches, including Vienna Presbyterian Church where Singleton is a member, 25 years ago.

Singleton still travels to Haiti on missions. He was the president of the organization for several years and still is a member of its board.

“He really wants to help those poor people in Haiti who are less fortunate than we are and who have very, very challenging lives,” says Wood Parker, who serves on the CCH board. “He’s got a heart for helping people, and it is that heart and that desire to help people that [are shown in] his work in CCH for years.”

Singleton also is on the board of the Global Good Fund, which identifies and invests in young social business entrepreneurs around the world.

His associates believe Singleton’s desire to help people is the motivation for his push into personalized health.

“This is about much more than economic development, much more than science and medicine,” says Stottlemyer. “I think a fundamental value and belief of his is he has an opportunity to drive an effort that can really change the human condition and lives of our friends and family members because of its ability to better predict, prevent and treat disease.”