There are profound changes taking place in the American health care market. Heather Fine, Partner, Major, Lindsey & Africa, speaks with Daniel Lantry, Vice President of Legal Affairs, North America, Sonova US Corporate Services LLC, and Earl Barnes, Executive Vice President and Chief Legal Officer, AMITA Health, about current market trends in health care and the impact of these trends on the industry. Some of the trends they discuss include the commercialization of health care, the evolving role of data in health care, health system consolidation, hybrid work models, and innovation in the financing and delivery of care. Sponsored by Major, Lindsey & Africa.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
There are profound changes taking place in the American health care market. Heather Fine, Partner, Major, Lindsey & Africa, speaks with Daniel Lantry, Vice President of Legal Affairs, North America, Sonova US Corporate Services LLC, and Earl Barnes, Executive Vice President and Chief Legal Officer, AMITA Health, about current market trends in health care and the impact of these trends on the industry. Some of the trends they discuss include the commercialization of health care, the evolving role of data in health care, health system consolidation, hybrid work models, and innovation in the financing and delivery of care. Sponsored by Major, Lindsey & Africa.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
Support for HLA comes from major Lindsay and Africa, the global leader in legal executive search for nearly 40 years. They have helped health organizations, nonprofits, fortune listed companies, and the government agencies build strong, talented, legal teams for more information, visit MLA global.com.
Speaker 2:So, so excited to be here today. Um, I'm Heather fine partner in our Chicago office of majorly Africa. And I am here with Dan Landry in Earl Barnes, and I am gonna have them introduce themselves if they don't mind. So, Dan, do you mind just taking a minute or two and telling us a little bit about yourself?
Speaker 3:Sure. Happy to, and thanks again to major Lindsay in Africa and to HLA for having us, um, we'll do our best not to disappoint<laugh>. Uh, I'm Dan Landry. I am the vice president of legal affairs for north America for son Nova, the son Nova, uh, group companies in operating in north America. So specifically we provide, uh, hearing instruments, hearing aids, um, Audi ideological care services and through a separate division, um, cochlear implants. Um, and, uh, I've been at, uh, sonno since may of this year. Uh, I've been in healthcare almost all of my legal career, starting with large law firms in Southern California and various life sciences, healthcare services and, uh, provider and health plans as well. So I've kind of, I've seen it all. So thanks so much for having me and, uh, I'm really excited to, to talk to Earl,
Speaker 4:Uh, hello, thanks so much, uh, for sponsoring and hosting this, uh, looking very forward to the, uh, the conversation. I think it should be very, very interesting. Uh, I'm uh, Earl Barnes, I'm the executive vice president and chief legal officer of Amita health. Uh, we're a healthcare system based here in Illinois, uh, with 19 hospitals, um, a number of, uh, uh, outpatient, uh, sites and centers, uh, where we provide services at behavioral health centers. Um, been with the organization for just over years now and prior to joining, uh, MEA health, uh, have served as the, the chief legal officer for a number of other, uh, healthcare systems in, uh, both, uh, Illinois and Ohio. And, uh, as I indicated, really looking forward to the, uh, the dialogue today.
Speaker 2:Excellent. Well, I am so thrilled to be moderating this podcast with two people who are just fantastic and stars in the, the legal community here and also the healthcare community general. So thank you both for taking the time. Um, so I'm gonna dive right in. Um, you know, because I know we have a, a number of things we wanna chat about, and these are gonna be broad questions, but I have no doubt we'll go in some different directions. And I think Earl, maybe we'll, we'll start with you on this question and I know Dan I'll chime in as well, but talk a little bit about the current market in your area, kind of what's happening, where are things headed? I mean, obviously you just described Anita and what you're doing. So I think we we'd love to hear your first. Yeah.
Speaker 4:Uh, well, I think, you know, I think it's a very dynamic market. I mean, Illinois is a, is a big market. Um, we we're blessed with, uh, a very large number of academic medical centers, community based, uh, health healthcare centers, um, in, and healthcare really is a bit of a hub here in this, in this part of the country, in this state in particular. Um, you know, there, there are just, there are a lot of things facing healthcare today, and I think some things are, are gonna be tied to this market and some things are gonna be more national, but, um, um, you know, when I'm describing our market, clearly, you know, I talk about the number of hospitals that are present. Uh, we have a, a very large number of federally qualified healthcare centers located here. Um, we have what I would view as a dominant payer within this market and that's blue cross blue shield. Um, I, I feel as if this market has been slow overall to adopt, uh, value based care. Um, so I think that'll become part of our, our discussion as we've moved forward. Uh, we have a, a large number of, uh, a private equity entrance, um, that have joined us over the year, um, mainly on the physician side of the house, but also on the technology side of the house. And so, you know, for people that are at not for profit healthcare systems like me, um, you know, those are opportunities, uh, for collaboration and partnership. And, you know, I think, uh, the only other component I'll mention right now in the market, that that's something that, that is going to be need to be dealt with as, as you know, time goes on is the, uh, medical malpractice environment. And, um, you know, we in here in Illinois, uh, really don't enjoy any type of, uh, uh, liability caps, uh, for medical malpractice, um, lawsuits. And so, you know, I think that if you were to talk to, uh, many of, uh, uh, my colleagues and competitors in this market, they would say, uh, that is starting to have a very real impact on dollars available to provide services, uh, within this market.
Speaker 2:Good. Good. All right, Dan, what about, what about you, you'll probably tag onto that a little bit, but also, you know, you're in a little bit of a different at least now type of environment. So, so curious your thoughts on this question.
Speaker 3:Thanks. Um, yeah, I think girl, uh, named a number of, of, uh, things from a provider side that are absolutely compelling, um, from more of the manufacturer life sciences perspective. Um, and I think we're gonna get into this a little bit, or, um, you know, I think there's just a, a general consumerization of healthcare that is, uh, driving a lot of what we're seeing here, both in terms of the development of new technologies, uh, who is actually providing the good or the service. Um, you know, Earl mentioned value based reimbursement. That's a huge driver in, in, in both the federal programs, state programs and, and private pay, uh, or I'm sorry, uh, you know, third party payers, and we're gonna continue to see that, uh, even adoption, but those who have been perhaps up slower and more reluctant to adopt, uh, value based reimbursement, um, you know, we've got some real disruptive players in the market now with, with private equity, who's, you know, been in for, for quite a long time. Uh, and, and the technology, you know, all the big tech companies, um, have substantial, uh, healthcare practices and focus areas now. So I think between that general consumerization of healthcare, the, the blurring of lines between what is a medical device and what is not a medical device, um, just in my own space, in, in hearing instruments, we've got, uh, pending regulations now that are, uh, in the review, you in comment period, uh, FDA was, uh, uh, instructed under a 2017 law to develop regulations for over the counter hearing aids. Um, you know, and the theory is that people should be able to have more control over their own healthcare and, and how that gets delivered. Um, you know, and that, that whole concept really under, uh, underpins the 21st century cures act, which made some pretty significant changes in terms of how, uh, patient information is shared, uh, information, you know, obligations by providers, not to block information, um, with, with patients or their designee, which creates issues, I think, under, under HIPAA. Um, and, and so there's just a lot going on,<laugh> in this, in this space, which makes it dynamic interesting and, and obviously extremely competitive for, for the players in, in this space. Good.
Speaker 2:Good. Okay. So you both touched on this, well, there's, I have two questions, but this consumerization, the commercialization of healthcare, right. We, we talked about this, you both have touched on it as, as something that's important, I guess, maybe what is it, how is it impacting healthcare, right. For, for those of us while you're talking to a group of healthcare, but talk a little bit more about how it is impacting, um, what you're doing in healthcare overall. And I guess maybe Dan, maybe you can start us out there and, and sure you all have to back and forth
Speaker 3:On that. Sure. I'll try to round out my thoughts a little bit more on that. So I think we've seen dramatic changes in the way the FDA operates. Um, over the last, you know, five to 10 years, I'll say, particularly with respect to medical devices and software, there's now a concept of software as a medical device. Uh, FDA, I think really struggled with how to deal with, with software in, in years past. And, um, there's been quite, uh, an accelerated focus on that. Um, so, um, so that's just one example. I think another area is, um, uh, you know, just the blurring of, of technology players and, uh, and traditional medical device players and, and how they have, uh, um, you know, they're part are, they're very much on the same spectrum of consumers that they're trying to, to provide services to, but under very different rules, right. One is specifically, uh, regulated by the FDA. Uh, another maybe, right. It depends on what they're doing and how they're, how they're trying to do it. So, um, I'll stop there early. I'm sure you have some thoughts.
Speaker 4:Well, no, and I, you know, I think, uh, you know, we could literally have a session just on this. I mean, we we've talked over the years about patient centered care and, um, you know, I think, I think so some years ago we started viewing the patient as a, in some cases as a consumer and, and if it's patient centered and the patient is a consumer, you know, how bad can you provide services to that patient and, or consumer in a way that, um, you know, is, is good for the patient, but, but also good for the, uh, health system and their healthcare providers bottom line. And, you know, I, I think, uh, as Dan has touched on technology has been, um, uh, a big mover and certainly during the pandemic, uh, being a able to access some of the technology that was already out there, but quite frankly, to be able to bring it online and provide telehealth services, um, you know, I, I think it's caused us to kind of revisit how we, we go about delivering good care. Um, you know, I think using, uh, some of the other electronic, uh, media that are available, uh, to put in homes to measure blood pressure, um, in other more basic, um, kind of, uh, uh, you know, functions, I, I think has, has been helpful in order for, uh, healthcare systems to monitor how you're doing real time versus seeing you once a month or every two months, or if you're lucky in some cases, uh, once a year, I know my doctor, uh, loves to get after me. Uh, he'd love to see me more than once a year, but he gets to see me once a year.<laugh> thankfully I'm healthy. Um, but it's, you know, I just think that it, it's a, it's a thought it's a mindset, um, that has gone into much of what we're doing these days in the marketplace is what's good for the consumer. Um, I, I don't know that we've lived to our promise just yet on that. And I think that's something that, that is continues to be deserving of, of discussion, because I think with all those market entrances that we just talked about, you know, everybody has a, a what they view as a better model for how to provide this care. And I think right now, you know, if you would ask me where we're at, you know, we're per probably in the middle in terms of our overall, um, you know, involvement into having something that's truly a model and a system for, uh, patient centric or consumer centric care. Uh, just because again, I don't think we figured it out yet. Um, I, I think that we are, are, you know, we still, you know, we say that our, our, uh, EMRs or EHRs are all interoperable and you can share data across, uh, all of them. And the answer to that is that's not really true and you can't. And so, you know, we, we need to continue to work to get there. Um, I think just in the interests of competition, many system are working to build out their own product, um, and their own service lines, but those don't necessarily work, uh, when you go to the competitor for a service. And so, um, we just, we have to continue to think about if we're, if we're truly gonna be patient centric and consumer centric, we're gonna have to think about, you know, making that better, um, and being able to provide more of that real time data to whatever caregiver you might present at as a patient
Speaker 3:Earl, I'd love to pick up on that because, you know, one of my concerns in this whole area with respect to the 21st century cures act, you know, you mentioned, uh, EHRs. I mean, that was really the basis for the information blocking, uh, rule because you, you know, the companies weren't playing, uh, very nicely with each other and really not, uh, living up to the promise of the 20 billion that was spent. Um, you know, I, I do have real concerns about consumers, um, really not understanding all the power and control they have over their own, um, information, their own records than their own decision making. So whether it be, uh, clicking the, I accept button when they upload a health app and, and basically agreeing that that developer, that help health app is gonna have unfettered access to their health information without it being protected by HIPAA. I, I doubt people understand that, um, I, you know, in terms of the notion that people are gonna be somehow better equipped to make decisions about what hearing aids they get without, you know, having the advice of a, of an audiologist, for example, maybe, uh, I, I just don't know. I, I, I think that there's a lot of areas where consumers, unfortunately, in can, um, get shortchange, uh, get manipulated, uh, simply because of, of lack of access or lack of awareness of, of, you know, all the different variables that really need to be taken into account with them making these kinds of
Speaker 4:Decisions. So, you know, it's, it's interesting because, um, you know, we all have a tendency to see things through, obviously our, our own lens. And, um, you know, for me protecting my, my health information and, and data is, is critically important and I don't want, I don't want it floating around and I really do care. Um, if you were to ask my, you know, 20 year old son about that, or my, my 17 year old daughter, uh, they would likely have a different view. And, and so it's, it's interesting as we continue to talk about what the future will hold and the model that we're going to build, you know, I just, I wonder whether those same protections that Dan, you and I are kind of pushing and need and feeling like we have to have in place, and whether, whether folks are even gonna care about that, um, as time goes on. And so I, I, I don't know the answer, but I, I do know that that whatever information is available, um, needs to be accurate. Um, it needs to, there needs to be a means for analyzing the information. I, I really don't feel like I sometimes providing people with their test data. Um, you know, a layperson has no idea how to read that information and just saying, well, I provided it to them really isn't enough. And so, you know, we've got to continue to think about, you know, if I'm giving somebody data or set of data, I'm giving them things that they can, they can transport, um, uh, that that's portable. You know, who's gonna be reading that who's gonna be helping them understand it. Who's going to be providing the type of, um, you know, I guess, foundational information that they need in order to make the next good decision about their healthcare. And I'm still, I'm still waiting for that model. And I mean, I, I obviously participate in the system that that's working to try to try and improve that overall, but it just seems to be moving at a really glacial pace, quite frankly.
Speaker 3:Yeah. It would be great if there was some sort of third party, honest broker, right. That we could all agree, like, okay, this is the storehouse of all, all, all the accurate information that's out there, a third party, who's completely disinterested in your, your dollars, um, et cetera. But<laugh>, I don't think any of us have that, that silver
Speaker 4:Bullet, not, not yet, not yet, but, you know, we're, I'm still gonna hold out hope being the optimist that I am<laugh><laugh>.
Speaker 2:I do have to say, I recently it's a couple months ago I had, everything's fine. It tests, and I literally got an email with the test result. They were, it was, and I was like, I have no idea what this is. And of course you're like, wait a minute's something wrong. Like, how do I know this is right? And I actually, then when I finally saw the doctor and person, I said, I'm so sorry, said, well, please don't send me test results without helping me understand, because it's, you know, and maybe that's just me be naive and not knowing how to read things, but I'm like, I don't think they really expect me to read these and understand them, you know? And she's like, I'm so sorry, but that, that's just how the system works. They send out the test results. I'm like, I know, but like, that's scary, you know, so anyway, and, and this, these were minor, right. I can't imagine doing it much, much larger. So, so anyway, well, again, we could talk about this, that is for sure, for a long, long period of time, let's shift a little bit in, in Earl, like think, um, maybe starting with you on, on this, because you've had some experience with it. You've served as GC of a number of, um, large health systems, you know, and there's certainly been some changes. And I, I guess kinda wondering why, why are these changes? Are we gonna continue to see this consolidation? You know, what do we see in the future as it relates to, to the healthcare, if that's, if that's the right way to refer
Speaker 4:To it? No. Well, thank you. And, you know, it's interesting cause we, we were talking about so many other things. We really didn't talk as much about, you know, kind of the trend of, uh, that we're seeing around the country of places continuing to try and get bigger and bigger and bigger. Um, and you know, certainly several of places I've worked, uh, with over for over the years, um, have, you know, certainly been in search of getting bigger and, um, some have tried to get bigger within their immediate market. Others have looked, um, external of their market and moved across state lines to, to get bigger. But, you know, again, the thinking being that the size size will matter as time goes on and, uh, size allows for some synergies that, um, might not otherwise exist. I, I, I'm still waiting for someone to prove that out. And so I'm sure, you know, there's gonna continue to be that, that analysis. I, I also think that, you know, in the case, for instance of my company, you're seeing some places that have decided did, Hey, you know, we thought that maybe size was the way to go. And we wanted to get, you know, have a, have a position in the market and be able to function as a, uh, a unified healthcare system. But I, I think that, you know, there was an announcement not too long ago that that Amita health, um, was going to, um, dissolve as an, as a management entity. And so, you know, what will remain in the market is the Ascension facilities and under Ascension Chicago and, um, the advent facilities under, under advent health, uh, Chicago. And so, you know, again, same, same type of over, you know, overall footprint, if you count the overall number, but now, you know, operating in very distinct ways, um, with, with new manage. So, you know, I, I think that, I think that where we sit today is there's still that mindset that, that, you know, you, you do need to be bigger in order to provide better services and in order to achieve this synergies, um, again, I'm not certain that that's the right thought process. Um, I think when you take it back to the patient centered, uh, viewpoint, and you're asking yourself, is this really what's, what's helping the patient and, and the consumer so to speak. Um, I, I think that there are many times that, you know, you, these systems have gotten big and they're not able to really show that they've made an impactful change in the lives of any of their patients. Uh, and so if you can show that, um, and you can't prove it out that way, you have to start to ask yourself, well, then what's the reason why you're doing these deals. And, and I always say the reason that you do the deals, can't be, you know, just to say that you're big or just to benefit, um, you know, your, your executives that work within the company. It, again, it really does have to be for the benefit of the community and the, that you're serving. But I do think as time goes on, we're gonna continue to see some of this movement because I, I think people want to, they wanna prove that they, they wanna be able to prove that this model works of getting bigger. Um, and having the, you know, these very vast systems that can gather a ton of data, measure that data and come up with, uh, you know, modified treatment protocols. And, and at the end of the day, I think the thinking really is we can help, uh, the patient, but I, you know, I think the verdict's still out on whether that's true or not. So I'm, I'm saying that for now, you'll see that continued growth. You'll see that every now and then some of the, the, um, the big affiliations that have taken place, uh, you might see some breakups there. Uh, you know, I spent many years at a law firm, uh, doing deals and I used to, you know, always know that we'd put'em together, but you, you could look 5, 6, 7 years from now. And, and, and in some cases you help take them apart again. And so, you know, we, we do offer rate in this world in cycles. Uh, some of them are deeper than others. Um, but, uh, it's, it's gonna be interesting to see what the future holds,
Speaker 3:You know, Earl with respect to size and, and whatnot. I mean, wouldn't, you agree that it, it's not just size for the sake of size, but, but size for the ability to, you know, to, to get where it matters, right. And to be able to innovate and invest in the areas that will make an incremental difference. Not only in most importantly in the lives of, of patients, but also just, you know, helping systems, uh, you know, operate more effectively. I mean, there's a lot of square footage, right. In, in acute and fairly acute you settings that, you know, those systems are, are gonna have to struggle to figure out what they're gonna do with that space, right. As value, value based care, you know, continues to advance mm-hmm<affirmative>. Um, but, you know, it seems to me that systems that are larger will be able to figure out how to be more nibble when it comes to patient scheduling and, and where best to integrate telehealth in the, you know, in the suite of services and, and ways in which they deliver care. So I, yeah, I like you I'm<laugh> I think the jury's out, but I also think that, um, I, I think I understand why organizations are trying to it larger, cuz I think if they're smart about it, they would focus on those areas where they can really move the needle and really differentiate themselves from their competitors.
Speaker 4:Yeah. I, I, I certainly agree with that. I think that, that if, if those are, if those in fact are the motives, um, you know, we just need to prove that out. And I mean, yeah. And yes, there are, are, there are some synergies that can be had from size. I, I will say though, that there, there are also some things that occur, the bigger you are. Um, you know, the, the less likely you are to be as in tune with your particular community, um, and or marketplace, and you have a tendency then to just decide that one size quite frankly, fits all across the country. And, you know, I think that, I think that medicine is, um, a little more precise than that. And so I, I think that that can, uh, lead you stray at times in terms of what you're actually providing to the, to the end consumer. Um, but you know, the trend is going to continue. I mean, and, and I think, I think the nice thing is, um, it may not just be the trend in continuing in terms of just large health systems, continuing to emerge to get larger. I mean, I think you might start to see, um, as you're trying to build out that continuum of care, uh, you might start to see some mergers of, of other care providers and, and, you know, and, and the health system will either be a part of that. They'll either lead it through, through their mergers, or they'll be a part of a much bigger, um, continuum of care that will be put in place in various communities. And we'll, and again, we'll just have to see whether we can make that work the way that it needs to work and that in a cost effective fashion. But, uh, um, there's just a lot of hard work that needs to go into that. And the, you mentioned nimble, and I love that term because I, I think that it's so critical in healthcare, particularly in this day and age. And, you know, you've seen examples of some very large systems that are just incredible and, and are able to make moves that they need to make, um, many took great advantage of the, the pandemic, quite frankly, they were there to care for their patients in a way that they needed to be cared for, but they were also there in a way that they, that they were able to make some of the market moves that they needed to make to get even larger, um, because they were able to take advantage of the fact that, you know, quite frankly, some of the smaller systems realized that they couldn't suddenly get some of the PPE that they needed, um, for their, uh, for their folks. And, uh, they, they didn't have enough cash in the bank. So to speak, to withstand some of the, uh, the downturn in, in revenue for acute care, the, in the acute care setting. And so, you know, they were, then, then you have these, these smaller systems that are suddenly looking for a larger parent that has a greater financial wherewithal to support. Um, and so, you know, again, great examples of some larger systems, really having their act together, being able to take advantage of this scenario that was presented to them. And quite frankly, doing it in a way that, that we all hope in the long run should benefit the patient.
Speaker 2:All right. So we can't have this conversation with, of course not talk about the pandemic, right. So one that we are are clearly not quite out of yet. Um, and who knows if we will be, and I guess my question around this is, you know, um, what is the pandemic recovery, but we're not, I don't know exactly we call it that look like for, for healthcare. And then I, I guess also just as remote work here to stay, I mean, I, I just, I guess I'm looking for the impact on the pandemic on healthcare, which is such a broad question. Another thing we could talk about for the rest of the afternoon, but, you know, high level and, and Dan, I guess maybe we can kind of start with you on what you're seeing and what's going on in your organization and otherwise.
Speaker 3:Sure. Well, uh, yes, I, I think we've seen a paradigm shift and I think we're never going back. Um, that's my, that's my take. Um, so just, you know, speaking for, for our, our company and, and my team, um, we, our plan at least is to come back into the office on a regular basis in January, um, using a hybrid model, a permanent hybrid based on basically two days in the office and three days out. And, um, I, I think we've taken a really thoughtful approach to it. Each of the, uh, team leaders was asked to get together with their teams and really structure what our model will be going forward, and then making sure that it is, it works for our customers, right? Our internal customers, external customers, whatever, uh, or part of the organization you have to be in, uh, and also for, for the members of the team. So my team got together, I don't know, a couple weeks ago, and we, we mapped out what we wanna do, and we're gonna, as a general rule be in the office two days a week, we all agreed that we wanted to be in the office together on, on Wednesday for our staff meeting. I have another SLT staff meeting that I'm gonna be in for on, on Mondays. So those are my two days. Um, and we talked about, well, you know, what about, you know, any of the folks on my team have, uh, for younger families and whatnot, what about leaving early or coming in late to pick up or drop off kids or whatever. Absolutely. Right. It<laugh>, um, you can work just as effectively at home after that, before that, whatever. So eight to five, nine to five, whatever that used to look like, you know, if people choose to do that and if it works well for their schedules, that's fantastic. But I really think that we're gonna have to be just recognizing that work can be done anywhere effectively, anywhere. Um, we hire good people who are, you know, self directed and smart and capable. We should let them do their work, wherever works best for them. And, and, you know, I've always thought it was crazy to spend an hour, hour plus on the freeway at night. Um, going home when, if I left, you know, an hour earlier, I could be home in, in 25 minutes. Right. And so those are the types of things. It's, we've just gotta rethink what we do and, and why we do it. And so, yes, we will continue to be consumer, you know, customer centric and focused, focused on efficiency and, and making sure that, that we are as productive as ever, if not more, but also making sure we're together. So we get to see each other and, and have that water cooler time, right. The, the opportunity to get together face to face, uh, in the office setting, I think that's really important. Our team thinks that's really, really important. And I think most people, um, given their druthers of, you know, coming in at all or not would, would, uh, would choose, you know, at least a little bit of human contact<laugh> throughout the week. So I'll stop there.
Speaker 4:Uh, well, you know, uh, the hybrid model I agree, I think is likely here to stay. Um, and, um, you know, I, I will admit, it took me a little while to be accepting of that. I'm still, I guess, a little old school in terms of wanting people in the office every day and getting a chance to see everyone. And I think also particularly with the business that we're in, I mean, at the end of the day, you know, we're providing healthcare and it is personalized service. And so it looks a little strange for, in our company for instance, to have administrators at home, um, and you know, to have the clinicians and everyone else, uh, at, at their facilities every day. So, you know, we're gonna go with the hybrid. Um, I think that, um, in the end, that's, that's the right way to go. I think it's a, it's a great satisfier, uh, for our employees. Um, I, I am, we are still struggling, I think, to figure out how to deal with the whole productivity issue. Um, and again, I think small shop easy enough to kind of know whether people are doing their work larger shop, much more difficult to know, uh, whether folks are actually doing what they need to do, um, day in and day out and having the right type of, um, you know, for us as a law department, um, client contact, uh, within the organization. And, and so we're still working on how you go about truly measuring that. Um, and, and knowing that that, that type of work is being done, but I, there's no doubt that allowing my folks to be able to work from home. Um, a good number of the days of the week, um, has been a huge satisfier. Um, I, I do feel like certainly during the pandemic, uh, that the, the more intense portions of the pandemic we were getting really, really good productivity. Uh, I still think it's going well. Although, like I said, now we do have people that are back in the office a few days a week. Um, and you know, we'll just have to wait and see long term. I think, I think at the end of the day, if anything, we've all learned that you just, you just need to stay flexible. Um, and you know, and if you, if you stay flexible and you're, you're keeping your eye on what's going on, you, you, you find ways to check in with your people to make sure that they're well, um, you, you find ways to check in with your clients to make sure that they're getting what they need. Um, you know, you can make this work so, so far so good.
Speaker 2:So I, I can't help, but be a little bit selfish here. Maybe talk about kind of how the hybrid model affects talent as well. And I don't know if either one of you have seen this, but certainly, you know, Lindsay in Africa, we have had a lot of conversations around hybrid hybrid work. You know, whether clients are offering that, what that looks like, and people have really changed their notion of what, you know, to, to both of your points, sort of what they're comfortable doing or not doing, or, or Dan, you made the great point of an hour on the highway. Like you can be, you know, how do you spend your time? And I also think, you know, the pandemic, we lost time. And so everybody's time is really valuable now, right. And we wanna figure out how to use it in the best way. And it's, it's been a really interesting conversation because 18 months ago, we never, would've been having these kinds of conversations. Right. And it's, it's just amazing to me how much it's, it's changed in all areas. And then Earl to your point also though, too, a lot of clients who'd say, well, you know, a large part of our workforce doesn't have a choice and has to be here. So how do we manage that along with those that can, are, you know, able are able to work from home. So it it's, it's, it's been interesting for sure. Um, I guess this sort of maybe a, a last kind of topic here, it's very broad. I think we've all talked about different ways that, or, well, you both have talked about, you know, how we're delivering healthcare, the model, how it's changed. I mean, are there, are there sort of any big takeaways, any big trends that you would say are out of this things that people should, should be thinking about? I mean, and maybe we've touched on all of them. I, I, I don't know. It just seems like we're in, we're shifting a little bit. Right. Um, but we're not quite where we need to be in there. It also seems like it's, it's maybe not, not all perfect yet, right. To say the least,
Speaker 3:You know, healthcare is such a big, gnarly beast, right. And it's got so many facets, the financing of it is completely bizarre. Right. And if you set up a business, you you'd never in your wildest dreams come up, you know, organize it the way healthcare is organized in terms of how it, how it's financed and, and paid for, uh, and people don't even know the cost of the things that they're buying. Right. Um, so I, I, I do think there, there will be, you know, a continued focus on innovation and disruption where, where things can be disrupted. It is not for lack of trying. I think a lot of, uh, maybe unconventional players have thrown their, had into the ring. Um, I think there was the effort, you know, a while back with some pretty big names, um, that, that said they were gonna come in and solve healthcare and they threw up their hands after a couple of months. So<laugh>, um, I, I don't know where it's all gonna go, but I, I do think there will be a continued focus on value based reimbursement on, um, uh, finding the right tool to, to provide, deliver, you know, and deliver, uh, patient care. Earl mentioned earlier, remote patient monitoring. I think there's a lot that's gonna happen on there in terms of how that gets paid for what the value of that is. Um, I think CMS is really gonna struggle with that. Um, I think pro that, you know, third party payers are gonna struggle with that as well. Um, and, and I think there's definitely a risk of abuse. Right. Um, you know, what, how, how do you appropriately pay the monitor of those activities for the value of whatever they're bringing to the table? Um, so finance of saying delivery of care, obviously I mentioned earlier, you know, um, in life sciences, there's, there's a lot going on in terms of, you know, the FDA and regulation information sharing, um, uh, you know, there will be pockets of innovation, some more than that, some faster than others, but there's a lot that's broken and there's a lot that can be, uh, you know, improved upon. So I have no idea. I mean, I'm, I'm gonna sit back and, and watch it. Well, not just sit back, I I'll be part of the part of the mess, but, uh, I'm very curious to see how things go over the next, you know, even, even five years.
Speaker 4:Yeah. Well, and, and let's face it, that's part of the excitement, uh, in terms of doing what we do. We don't, we don't completely know where we're going to end up. Uh, we, we generally have an idea of what we'd like to achieve, but we don't know where we're gonna end up. And I, I think we're gonna, we're just gonna continue to see, you know, more, more of the same, but, but more continued, um, attempts to grow, uh, amongst healthcare systems and other healthcare providers. And, and in, in some cases they'll be looking to grow, uh, together rather than, um, you know, really creating, uh, competing infrastructures. Um, I do think we're gonna see, uh, more focus on the, uh, what I call the health of the community, overall health of the community. And I think, I think you're gonna see some of that. I think you're gonna see focus on, you know, this whole concept of social determinants of health, uh, because I, I think it's very, very difficult to solve one issue without quite frankly, dealing with a myriad of issues. And, um, I, I, I, I think people have realized that. And so I think that's gonna be part of, part of the dialogue and part of the discussion as we go forward. Um, we talked about technology and I think, yes, we're gonna continue to see technology be a big, big part of, um, of, of the delivery of healthcare. Um, and you know, I think the other piece is really, you know, as we're able to gather more data and has honestly, quite frankly, as more people seem to be moving towards one particular vendor for EMRs, uh, I think it's gonna be the data piece is gonna be critical. And, and I, I think that you're going to see a big push to, to be able to analyze, um, uh, that data in ways that, that again, will hopefully tie back to improving the overall health community of, uh, the, the overall health of, uh, of your communities. So, um, that's, I mean, that's really it, but there's a lot in there and, and there's a lot of work, um, that needs to be done and there's really no one entity or individual, you know, we talked about that honest broker earlier. Um, that's helping shape all of this. I know the government that has, has, um, inserted itself and, you know, we've got a number of transformation projects that are out there. And I think, you know, they're a big player in helping shape, but, but there are also a lot of private, uh, companies that are out there that are very well capitalized, um, that are having a big, big say in what goes on. And then we also talked about the large number of not for profit healthcare systems. That's a out there that, that have their own model that they're pursuing. So, um, there's, there's just gonna be a lot of forward. Well, what, we'll just say, this there'll be a lot of activity. My hope is, is that it truly is forward movement. Uh, but there will be a lot of activity over the next five years.
Speaker 3:I suspect it won't be linear though. I think those there's gonna be some advances and there's gonna be some, uh, oh,
Speaker 4:Along the way that feels,
Speaker 2:Does this also mean a lot more need for lawyers? Like when you kept talking about the privacy piece, I just kept thinking to myself, wow. Like that's such a huge component. And does that mean that legal departments are gonna get larger because there's gonna be these bigger needs and you bring in more technology? I mean, I don't know. I, I really don't know. I'm not the expert in the field, but
Speaker 4:Right. Yeah. It gonna be interesting to see how, how that plays out. I just, I just think again, you know, it's just like with any other workforce, right, you just have to remain flexible in terms of what is needed and what's not needed. I mean, we might solve the whole privacy thing fairly quickly. Um, and then, then you might not need as much, um, on that front, but, you know, with all the other emerging technologies that are out there and we may need more people that, that understand that technology are able to, to work, uh, within the various systems to help make sure that it gets applied appropriately. So I, again, who I, I wish I had that crystal ball because it w it would've, I wish I had it 20 years ago. Would've helped me tremendously. But, uh, um, we'll just see, we'll just see where it goes. I mean, the fun, some of the fun of it is not really knowing exactly where you're gonna end up
Speaker 3:Well, and Earl, I guess I'll, I'll say, I dunno, I've been thinking about the, the blurring of, you know, tech and consumer and, and traditional healthcare, uh, companies. And, and I, I was thinking about, you know, us as healthcare lawyers, like, you know, there's a lot of non-traditional healthcare lawyers out there now, too, who are with relatively newer entrance into the healthcare space. So mm-hmm,<affirmative> just curious what, what a healthcare lawyer will even be in, in, you know, in five or 10 years. That's
Speaker 4:Right. Well, we better, we better figure that out cause we're gonna practice. So we don't wanna, we don't wanna have them get ahead of us. Right.<laugh>
Speaker 2:I have no doubt that you two will always be at the forefront. So, um, listen, this has been so fantastic. I am just super grateful again, to Dan and Earl for, for doing this with, thank you so much. You two are just fantastic general counsel here in Chicago, and so thrilled that, that we had the chance to talk with you. So thank you. This has been great. Really appreciate the time.
Speaker 3:Thank you, Heather. Thank you.
Speaker 1:Thank you for listening. If you enjoy this episode, be sure to subscribe to a H a speaking of health law, wherever you get your podcasts to learn more about ALA and the educational resources available to the health law community, visit American health law.org.