Imagine a smart health care world where X-rays and scans are co-read by intelligent machines as well as human technicians for greater accuracy, where hospital rooms are equipped with “Alexa” devices to answer patients’ questions or summon nurses, where patients from pregnant mothers to heart attack survivors are monitored remotely and require fewer office visits, where surgeons operate using a robotic arm while watching a magnified monitor, where doctors and hospitals can be paid almost instantaneously with little patient effort.
All those scenarios and more are in various stages of use or development in the U.S. health care industry. Now, imagine the in-house lawyers needed to make it all work.
General counsel Loretta Cecil doesn’t have to imagine it. She knows one of the hottest in-house counsel tickets right now lies at the intersection of technology, health care and the law.
“That’s the story of my life. I’m seeing it every day,” quipped Cecil, executive vice president and GC of Change Healthcare. The Nashville, Tennessee-based company, previously called Emdeon, operates the largest financial and administration information exchange in the U.S. for health care providers, payers and patients.
And Cecil is always looking for talent. Indeed, the explosive growth in technology within the health care industry in the past few years has most general counsel continually recruiting. Cecil has about 100 lawyers in her department now, but says she is steadily hiring two or three new attorneys a month. “We’ll probably top out around 120,” she says.
But she has competition. As more major companies—like Amazon.com Inc., Apple Inc., International Business Machines Corp., Walmart Inc. and even United Parcel Service—move into the health care space, the demand for health tech attorneys rises. Nancy Reiner, a managing director at legal placement firm Major, Lindsey & Africa, notes that the health care industry is the largest employer in the United States, and there is always fierce competition for the top attorneys.
“Everybody under the sun is getting involved in health care now,” Reiner said. “So we’re seeing a big increase in searches for health care attorneys. And I’ve not had a search for a health care attorney yet where they did not also want some technology experience.”
HOW IT’S CHANGING
Long gone are those simple days when a patient visited a doctor’s office, received treatment, paid the $10 or $20 fee and walked out. Today, at the very least, a patient provides identification and proof of insurance, signs a privacy statement, and approves the release of information into the payer system. The provider—doctor, hospital or pharmacy—sends the patient information through a billing system, such as Cecil’s Change Healthcare, which transforms the data into a coded format and sends it in batches along to the third-party payer, such as Medicare or an insurance company.
And every one of those steps is regulated. Corporate legal recruiter Michael Evers says health care companies “have a large appetite” for regulatory attorneys, especially those with privacy and cybersecurity experience.
“Two industries most sensitive to data breaches are financial and health care,” Evers said. “That’s the most valuable and private information there is.” His Chicago firm, Evers Legal Search, recruits for companies throughout the country and also offers experienced in-house counsel to companies on an adjunct basis.
Reiner says the U.S. Food and Drug Administration is becoming more involved with health care startups, so “now health care lawyers are being hired in that startup area at an earlier stage.” Regulatory lawyers, especially those with experience dealing with the FDA, are in high demand, “and we are seeing multiple suitors for the same attorney,” she said.
Cecil says she seeks a mix of talent for her legal department, including those with regulatory or insurance company backgrounds. But she also looks for lawyers from non-health care, highly regulated industries that have experienced technological changes.
“A phenomenal hire for me has financial industry tech experience or communications tech experience, and not necessarily health care,” the GC said. “Those industries have seen it and done it, and they can troubleshoot what we are going to be doing in health care.”
Cecil herself has been in health care information technology for 14 years, after working 17 years in-house for AT&T as the communications industry underwent deregulation and high tech changes.
Cynthia MacLean also has made a successful career combining health care and tech for the past 20 years. As general counsel of GE Healthcare Group’s commercial activity in the U.S. and Canada, MacLean said she expects all her lawyers to be data-fluent.
“Back in the day,” she said, “if you knew how to do licensing, that was sufficient. But not now. Now you need to know more about how technology is brought to market, and it’s not by licensing, as well as about data security and privacy. It’s highly technical.”
MacLean began her career at a law firm, but after eight years moved in-house as senior counsel with Philips Medical Systems. From there she moved into General Electric Co.’s digital health care group and eventually became general counsel of that unit for three years before moving into her current GC job two years ago. “There has always been a steady demand for lawyers who understand technology in health care,” she said.
Christopher Mensoian, assistant general counsel at Wolters Kluwer Health, also knows the value of a tech background. In 2009, Mensoian moved in-house, leaving his transactional practice in a law firm to indulge his fascination with health care and technology law.
After working a succession of three health care software companies—Daedalus Software, athenahealth and Orion Health—he joined Wolters Kluwer three years ago. His company provides information through texts and software for professionals and students in medicine, nursing, pharmacy and allied health sectors. It also publishes Health Law Daily, an online legal newsletter.
Mensoian said, “Given the increasing prevalence of artificial intelligence, analytics and reporting, health care technology apps, and the health information exchange standard, lawyers need proficiency in this new technology.”
He predicts: “Health care tech is only going to keep growing.”
The U.S. has one of the largest and most complex health care systems in the world, accounting for about 20 percent of this country’s gross domestic product, according to figures from the international Organisation for Economic Co-operation and Development. And it’s still growing. U.S. Bureau of Labor Statistics data show the industry will continue to drive the nation’s employment increases through 2026 by adding around 4 million new jobs, accounting for about a third of the country’s total job growth. And lawyers will be a vital part of it.
Dale Van Demark, a partner in the health advisory practice at McDermott Will & Emery in Washington, D.C., sees a “blending of health care, technology and the biosciences.” Van Demark said, “We’re seeing technology companies, traditionally information tech companies that perhaps have a business or consumer market, beginning to explore health care and life sciences in a variety of ways.”
He draws an analogy to how information technology has disrupted some other industries, but adds that health care and life sciences “are more complicated than other segments of the economy due to the extreme amount of regulation and the third-party payer system. “In other words, providers can’t eliminate the “middleman” in health care as easily as Amazon has eliminated retailers.
“Talking about information technology within the health care sector holds a remarkably diverse set of implications,” Van Demark said. “We’ll be seeing the effects of it for a long time.”
He says any general counsel of a health care company looking for a lawyer, or of a tech company wanting to get into health care, will need to hire “someone who really understands health care, and who can deploy technology in a way that is financially sustainable.”
He explains it is easy on paper to make the health care industry a lot more efficient, but savvy health tech lawyers know better: “What people find in reality is that the reason those aren’t being done is the regulatory structure prohibits it.”
Cecil, Change Healthcare’s GC, tends to agree, saying her legal team and her company are on a journey to make health care more efficient. Part of that is implementing new technology. “In order for us to be successful we’ll need not only consumers and stakeholders, like providers and hospitals and payers, but also the regulators,” she said.
“Technology is always ahead of the regulation,” Cecil noted. “And so within the legal community we have to partner with our regulators and legislators to make sure we are not slowing down implementation with over-regulation.”
A previous version incorrectly listed Christopher Mensoian's former companies as Daedalus Inc. and Athena Health Care Systems. They are Daedalus Software and athenahealth.
Sue Reisinger, a senior reporter at ALM since 2004, covers general counsel and white collar crime. She is based in Florida. Contact her at email@example.com.