« March 2015 Issue

Donor Profile: A Conversation with Dean Richlin, Partner, Foley Hoag

With more than 30 years of experience, including five years as the First Assistant Attorney General for the Commonwealth of Massachusetts, Dean Richlin is an accomplished attorney with an expertise in health care and health system regulation. As a partner at Foley Hoag, he has successfully represented Fortune 500 companies, as well leading companies and institutions in the fields of life sciences, health care and education. In addition to his professional accomplishments in the field of health care, he serves as board chair for the Commonwealth Care Alliance, an innovative Massachusetts-based care delivery system for individuals with complex health needs. Richlin has been a generous supporter of Community Catalyst.

We sat down with Richlin to talk about a range of health care topics - from how the Harvard Pilgrim Health Care receivership contributed to health reform in Massachusetts to his thoughts on the implications of the upcoming U.S. Supreme Court case, King v. Burwell, which could significantly undercut the Affordable Care Act. Richlin also shared some thoughts with us about why he believes it’s important to support Community Catalyst and its work to keep the consumer at the center of the health system.

What do you find most challenging about the health care industry for consumers right now?

(Access to) information and understanding how the system works - because it is not intuitive for the consumer. And this is where Community Catalyst is so important. Health care is not focused around the interests and needs of the consumer. It’s either focused around the provider or more likely around the source of payment to the provider. That is so obscure and inaccessible for consumers to understand. I hope there are trends occurring now that will change that.

You’ve been a generous donor to Community Catalyst. What would you tell someone who is thinking about making a gift to the organization?

Community Catalyst is an essential player ensuring the consumer’s voice is heard and the only way you get a consumer-orientated health care system is if the consumer voice is heard. If you don’t support Community Catalyst, that is not going to happen. We are on the threshold of health care transformation, but to make it happen we have to keep our (consumer advocacy) organizations strong.

Here in Massachusetts, you were working in Office of the Attorney General when  Harvard Pilgrim Health Care (one of the largest insurers in Massachusetts) went through financial difficulties. What were some of the most significant lessons you drew from that experience? 

Although it was quite some time ago, it was a formative moment for the Massachusetts health care industry. It was my first opportunity to have a close-up look at health care financing and how the money affected decisions.

When the receivership of Harvard Pilgrim began and the Attorney General took over the insurer, consumers were quite concerned because they didn’t know what that meant. Hospitals and doctors were wondering if they would ever get paid for services given to Harvard Pilgrim patients. We had to get an order from the court and it gave us the power to compel doctors to give care if needed…and we know of no instance of any consumer who was denied care. It was – and I played just a very small part - a stunning success of public policy and of a soft government intervention that protected consumers and allowed the system time to look for other solutions.

It brought [consumers] to the front of the equation and caused the system to start asking itself where the consumers were in the decision making? Because of organizations like Health Care for All, the board of directors of Harvard Pilgrim was reconstituted and consumer seats were added. It showed that the institutions were quite fragile and the system everyone was lauding as best in the world had some significant deficiencies. From that, and of course it took many years, we got payment and cost reform and universal insurance.

Many readers of our newsletter are familiar with Commonwealth Care Alliance and its innovative approach to integrated care. What parts of their model do you feel should be replicated as part of health system transformation?

What is key about our model is it starts with the consumer. There are ways to make a difference to the well-being of the individual that then benefits their health status. Helping an individual walk and socially engaging someone, these are the things doctors sometimes ask about but don’t have the means to facilitate. And of course the integrated model has the beauty of not having to worry about where the money is coming from or if the service fits a reimbursable category. The question isn’t how do we categorize it and how do we pay for it, instead it’s about meeting the need. When that washes through the American health care system the war will be won.

Turning to the federal landscape, I am guessing you might be following the U.S. Supreme Court case, King v. Burwell. Can you give us some thoughts on significance/implications of this case?

The importance of the case can’t be understated. First, it will have a dramatic impact on the reach of the Affordable Care Act if the argument of the plaintiffs is accepted. It is worrisome—given the very purpose of the law, which is to extend coverage as far as possible.

Secondly, this is a case of statutory interpretation. The argument of the case’s proponents is that Congress intended to provide tax credits only to state Marketplaces. But if a state determined it couldn’t set up its own Marketplace and asked the federal government to come in, it would be foregoing the tax credits that are available on the state Marketplace. Given the very purpose of the law (to extend coverage broadly), on that fact alone, the interpretation that the proponents of this case offer should be questioned and challenged. Typically, in the usual statutory interpretation case, great deference is given to the legislature.

The other risk of this case is that it will damage the reputation of the Supreme Court for being a fair arbiter of important issues of the day. If the tax credits end for over three dozen states, it’s unclear what would happen. I’m a strong believer in the law of unintended consequences…and sometimes the politics operate in ways that we don’t initially expect. Having said that, my wish is that the Supreme Court rejects this challenge as I think they should and as I think the law requires.

Lucy Dagneau, Communications Manager
Tory Stephens, Assistant Director of Development