The health care industry is the worst managed in America. It wastes near $765 billion a year due to inefficiencies, mistakes, duplicative and unnecessary services and fraud, according to the Institute of Medicine. That’s nearly a third of total health care spending. But the game is changing, and not just because of the health care law. Anxiety over the national debt is putting pressure on how much Medicare pays hospitals, while fed up employers, who pay the bulk of health care premiums, are negotiating tougher contracts with providers. Scripps Health CEO Chris Van Gorder rescued troubled Scripps from near insolvency a dozen years ago as its new CEO. Now, he’s put Scripps in the middle of a cultural transformation aimed at saving hundreds of millions of dollars a year according to a recent report at Kaiser Health News.