Lots of companies say they’re trying to fix health care. Blaire Bernard is working to find ways for Iora Health, a primary care provider for adults on Medicare, to live up to that mission. As the Boston-based company’s first general counsel, Bernard navigates legal challenges that arise in promoting a health-care delivery model, where “care” teams, composed of various clinicians, work to treat the whole patient.
“Certain laws that regulate the health-care system address risks created by a payment model based on volume—the more work you do, the more you get paid even if the work is low quality. Our payment model protects against those risks, yet we are still subject to regulation under those laws,” Bernard said. Learn how Bernard seeks to strike a balance between compliance obligations and business goals.
As Iora’s first in-house attorney, what were your priorities in launching the in-house legal function?
Before joining Iora, I had worked in-house for 10 years under the leadership of three different general counsels. I knew how a high-performing legal function operates. My priority was to create the foundation to be able to grow and scale.
I began meeting with people and establishing relationships. I spent the first 60 days or so meeting in-person with people at all levels of the organization in our corporate headquarters (where I am based) and at our various practices across the country. I also met with the outside attorneys who had worked closely with Iora before I arrived. Taking the time to learn about Iora and invest in these relationships from the beginning proved invaluable to the success of the legal function.
My second priority was to get buy-in from the leadership team on what the legal function would do and how it would accomplish it. I prepared a “blueprint” for the legal function that Iora’s leadership team endorsed. This document summarized the core functions of the legal department, the top areas to focus on in the immediate future, and a plan for how the legal function would address each area. It also explained the dyad relationship I envisioned between my function and the heads of each of our functional units. With the leadership team’s support of this “blueprint,” I knew we were starting off on the right foot.
My third priority was to tackle the actual legal work. I prioritized work that required immediate attention. I established a panel of outside counsel based on subject matter expertise. I triaged certain matters to outside counsel, such as questions related to a particular state law, and kept other matters on my plate. Demonstrating early on where and how I could add value helped propel the legal function forward.
Since joining Iora in 2016, the company has doubled its number of patients, and in May 2018, Iora obtained $100 million Series E funding from investors. How has the legal and compliance function contributed to this growth?
Iora’s cofounder and CEO, Rushika Fernandopulle, paid the legal and compliance function a huge compliment recently, when he said, “[The legal/compliance] team does not get in the way of what our business teams want to do but makes sure they do it in a way that does not get Iora in trouble.”
That nicely sums up how we contribute to Iora’s successful growth. Our role is to help teams structure initiatives, such as transactional work, marketing campaigns, and employment matters, in a way that minimizes the distractions that are caused by legal, regulatory, and reputational pitfalls.
The other way we contribute is by creating resources—such as training materials, FAQs, and template agreements—that help our business partners move quickly. At a high-growth company, every minute counts. If we arm our business partners with tools and information that lessen the time it takes them to answer a question or execute on a strategy, we’re contributing to growth.
Iora is focused on a care delivery model where payment is based on the value, not the volume, of care provided. What legal challenges has this model encountered and how are you navigating them?
Certain laws that regulate the healthcare system address risks created by a payment model based on volume—the more work you do, the more you get paid even if the work is low quality. Our payment model protects against those risks, yet we are still subject to regulation under those laws. At times, this can be very frustrating.
We navigate this challenge in two ways. First, when providing guidance to [stakeholders], we constantly strive to find the right balance between compliance considerations and business objectives; second, we support opportunities to advocate for the modernization of these laws. When possible, we work with [health advocacy] groups that are trying to bring the laws into alignment with the way the healthcare system has evolved.
Our legal function is also important when we want to work with a health plan that is aligned with our care delivery model philosophically but has never put a relationship like ours in place. The health plan may have a boilerplate agreement from its legal department that it is required to use even though the contract terms speak to a different kind of payment model. When this happens, our role is to help revise the contract terms as expeditiously as possible without creating so much “red” that the other party runs for the hills. I have found that working directly with the sponsor’s in-house counsel can be a very efficient way to navigate the language that needs to be changed.
Another focus of Iora is the company’s proprietary collaborative care software platform, “Chirp.” As lead to Iora’s compliance program, how have you ensured the software follows applicable regulations and that the information you store in it remains secure?
As lead to Iora’s compliance program, I do not view my role as being the resident expert on every aspect of our operations and the regulations that apply; that is not realistic or scalable. My role is to collaborate with the people who oversee the various aspects of our operations to ensure they have the support they need to identify and resolve compliance issues. I am fortunate to work with very talented colleagues who know information technology inside and out. They are hyper-focused on making sure it [the platform] operates compliantly and securely.
On a personal level, you have been an avid marathoner. How has this hobby helped shape your legal work for Iora?
Full disclosure: I have not run a marathon in several years! I have scaled back the time I dedicate to running—even 5 miles, let alone a marathon—as other demands on my time have increased. My husband and I are full-time working parents of two daughters and it is important to our family that we spend quality time together. Sometimes this means that instead of going for a run by myself, we watch a movie or walk our dog together.
My experience balancing interests on the homefront is not unlike how I approach my legal work. Every day I am looking at the work that needs to get done and figuring out how to prioritize it. I meet regularly with my team to go over what they are focusing on, and we communicate frequently with our business partners on the status of projects and timelines for deliverables. A key skill in this role—and in my [family life]—is time and expectation management.
As you look ahead, what areas of Iora are you most excited about contributing to next?
The health-care delivery system in the U.S. is changing. It is a really exciting time to be working at a company that is helping to lead the transformation. One change that inspires me is the way in which social determinants of health are being acknowledged and addressed. I am excited to contribute to the work Iora is doing to minimize these barriers to accessing health care.
It is also an interesting time to be part of corporate America in general, in light of the attention that is being paid on workplace behavior. Iora has always focused on values and culture. I am partnering with a colleague on the talent-and-culture team to facilitate efforts that will ensure we maintain a respectful workplace. I am proud of this work and looking forward to contributing to it in the future.
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