Attorney Neil Sullivan, a former deputy state insurance commissioner, has left Meadowlands Hospital Medical Center and joined the law firm of McElroy, Deutsch, Mulvaney & Carpenter, where he plans to continue helping to drive the health care system in a new direction: striving to keep people healthy while also getting control over rising health…
Sullivan, who ranks 13th on the 2014 NJBIZ Power 50 Healthcare list, was a key player in New Jersey’s implementation of the Affordable Care Act. He joined the state Department of Banking and Insurance in 2010, the year Congress passed the ACA, and by the time he left DOBI for Meadowlands in March 2014, thousands of previously uninsured New Jerseyans had gotten covered under the ACA, either through subsidized health plans purchased on HealthCare.gov or through the Medicaid expansion.
A new survey estimates that since 2013, New Jersey’s uninsured rate has plunged 46 percent, to 11.5 percent.
At McElroy Deutsch, Sullivan will help clients forge new models of health care delivery that seek to create financial incentives to deliver better quality health care more efficiently.
“We’re really at a time in history when we’re starting to see a convergence between the health care delivery system and the health care financing system,” said Sullivan, who joined the Morristown law firm last Monday.
Prior to joining DOBI in 2010, he spent more than a decade at Horizon Blue Cross Blue Shield of New Jersey and, before that, nearly 20 years at Prudential Financial.
He said he began his health insurance career under the “fee-for-service” model that many experts argue deserves much of the blame for the runaway cost of American health care.
Under fee-for-service, “For the health care providers, their best economic interest is trying to get paid as much per transaction as they could and perform as many transactions as they could,” Sullivan said. “And on the payer side it was paying as little as possible per transaction and denying transactions through utilization management. But what was missed was: How do we keep people healthy?”
Sullivan said that, today, providers and payers are coming together to figure out how to achieve better population health while also saving money.
“Because that is where we all have a mutual interest: How do we keep people healthy? That is going to make the best public policy, the healthiest population and most economic sense,” he said.
For health care lawyers, the emerging new payment and care models — accountable care organizations; hospital-owned health plans; multiple employer, self-insured health plans; and the like — all require legal guidance to spell out the responsibilities of all the parties.
“There is a lot of experimenting that is going on out there, a lot of trying different things out, a lot of pilots,” Sullivan said. And the parties involved “want to know that what they are doing is in conformance with all of the legal requirements. That is what I’ve been engaged in, and that is what I’m interested in and excited to bring to the clients of McElroy and Deutsch. They have a broad spectrum of clients with interests in all aspects of that health care financing and delivery spectrum. I’m looking forward to jumping right in.”
Sullivan was named general counsel of Meadowlands in March 2014 and, in May, former state Insurance Commissioner Thomas Considine came on board as chief executive of Meadowlands. Considine stepped down as Meadowlands CEO last month, amid reports that he had not been given the leadership latitude he had expected when he was recruited to head the for-profit Secaucus hospital.
Sullivan said he had been drawn to Meadowlands by “the opportunity to again work with Tom Considine. I have a lot of respect and admiration for him; he is a guy who can get things done.”
Considine has said that, since stepping down as Meadowlands CEO in August, he has been a consultant to Meadowlands and to other business and insurance clients.
He said Sullivan’s new position “is a great thing for McElroy Deutsch. I think Neil is the best health care lawyer in the state. He is a recognized leader in the country on Obamacare implementation and it really moves the firm’s health care practice to another level. ”
James Robertson, who heads the health law practice at McElroy Deutsch, said: “We couldn’t be more pleased that Neil has chosen to come here. His expertise is perfect for our practice group, given all that is going on in health care industry right now.”
Robertson said there is tremendous activity in health care around experimentation with new ways to deliver and pay for care.
“There is a seismic shift away from fee-for-service reimbursement and toward what we call a patient population management model,” he said. “So you are seeing different types of arrangements now, where the providers are managing patient populations to keep them healthy and keep them out of the hospital.”
For example, in accountable care organizations, or ACOs, hospital and physician practices receive incentive payments for reaching best-practice benchmarks on how patient care is delivered, and how much the health of the population improves.
Robertson said the goal of the new models is “a healthier population being cared for at lower costs. And if this all works, hopefully the patients and the citizens and the employers of New Jersey will experience lower premiums.”
Sullivan said New Jersey is moving forward “in the way health care and financing are coordinated — in a way that works to everybody’s best advantage. There are a lot of misaligned incentives in the system as it is now.”
He said if there is a common thread in the different health models underway, “it is really about realigning incentives. What makes the most sense is not to pay for transactions but pay to keep people healthy; that is what all of these (changes) are aiming toward.”
Robertson said McElroy Deutsch advises New Jersey hospitals, which have been merging with one another and acquiring physicians’ practices to better position themselves for the new health care environment. And the firm advises physician practices as they merge into larger groups or join hospital systems.
The result has been a steady growth in the firm’s health care practice.
About 15 of the firm’s 300 lawyers are dedicated to the health care practice, while another 15 or so devote considerable time to health care. Robertson said health care increasingly draws on firm-wide expertise; for example, the firm’s employment lawyers do a lot of work for health care clients.
“More and more of our lawyers are collaborating with our health care practice: they are bringing clients to us and we are bringing clients to them,” Robertson said. “There is organic growth going on every day in our firm in the health care sector.”
ALSO ON NJBIZ: