The Value-Based Healthcare is back with a brand new episode! Our guest for episode 19 is Julie Janeway, principal owner of Janeway Law, PLLC. Julie focuses on health law and discusses a variety of topics including the systemic structural barriers to healthcare access, operating her law firm during the coronavirus pandemic and more. She is also the author of the books “The REAL Skinny on Weight Loss Surgery: An Indispensable Guide to What You Can REALLY Expect!” as well as “Little Victories REAL Food Cookbook! Easy, practical, healthy foods your whole family will eat." 

Click play below to listen to the entire podcast. Scroll down to read the transcription.

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Podcast transcription: 

Jay Ackerman:
Hello, I'm Jay Ackerman, CEO of Reveleer, a software company committed to providing health plans with innovative technologies to maximize their return from quality, risk adjustment, and compliance initiatives. We're back again with yet another installment of The Value-Based Healthcare Podcast, where we engage with thought leaders and visionaries working across the healthcare ecosystem. Through our podcast, we aim to widen the visibility and voice of people working to change how healthcare is provided and the impact it has on all those who participate care delivery chain. And I'm thrilled today to be joined by Julie Janeway.

How about a little background on Julie? Julie is an attorney and national healthcare consultant with over two decades of experience as a highly trained and successful law school, health law, and business and graduate level of healthcare administration professor. Skilled in healthcare compliance, especially compliance program development and administration, risk management and patient safety, contract law, quality improvement, business formation, healthcare consulting, education training, nonprofit or development and growth, employment law and other areas. Julia is also a published author of numerous books, book chapters on white papers and articles on legal healthcare and related topics. Her passion is to bring the world closer to understanding the importance, intersectionality and necessary interdependence in healthcare, health law, and equity and equality for all in both. Welcome, Julie.

Julie Janeway:
It's great to be here. Thank you so much.

Jay:
Julie let's start off with some questions about your career journey. So first, why not let's spend a minute or two on operating in the pandemic and then we'll talk about the career. So, what have you done to keep kind of your business and your law practice running smoothly during the stay at home order?

Julie:
Actually it's been reasonably easy. Not very many people come out and say that, but it has been because we have a good tech team. Very young gen Z people who are digital natives and they have pivoted at lightspeed to this. And we got caught in a way behind them. So as long as everybody was open to sitting down and saying, okay, let's throw everything out the window, let's learn how to do it differently. What is it that we want to achieve? And how can tech do that?

And then our tech team has been fantastic about knowing software and apps and a million different ways to use things to effectuate what we need to do. Like I said, they have taught us so much. We just sit back and soak it in and say, okay, we're willing to learn. And I think that's been the experience of a lot of people in the pandemic is that where... Before we were too busy and okay, well if it ain't broke, don't fix it. We'll just keep doing it the same way. But this has been a wild opportunity to reimagine the world and reimagine healthcare. Re-imagine how we interact with it and how we get things done. And it's actually been kind of great. Working at home is great. Living on Zoom, like the rest of the world, but it is what it is.

Jay:
Yeah. It is. Anything that you've learned about yourself and your team during this period?

Julie:
Actually, we've all become much, much closer, much closer. We all miss that. Well geez, I wish we could all get together and sit and yak and have a coffee or whatever, and work through things that... We all miss that dynamic. But our dynamic online is pretty close. It is really pretty close. We've learned how not to talk over each other. And you never realized before how much, when you have a really good closely working team and people who are friends and colleagues, how much you all kind of talk at the same time. And so, we've all learned to stop doing that. I have learned, especially me being a lawyer I've always got a lot of words to share, but I've learned that it's going to be okay if this has to last this way now for another year or forever, it's going to be okay and we're going to get things done.

The only tough part is some of the tech and infrastructure like for us, I live out way out in the country, so I have satellite internet. So, there's always a delay. Everything has to go to space and back before anybody can see it or hear it. And I've learned to deal with that. But it keeps top of mind for me, how many people don't have internet, how many people are being left behind in this because they just don't have access or they don't have good access, or they don't even have a computer or even a smartphone. So that remains top of mind for me. And I've learned that internet really is a privilege and it shouldn't be, but I'm great working at home. I'm great with that so-

Jay:
Well, I think that probably strikes a chord-

Julie:
Much less dry cleaning.

Jay:
Exactly. Well, your point about internet and computers for all, probably strikes a chord for you on that equity and equality that's important to you. Maybe with that, why don't we talk about-

Julie:
Really does.

Jay:
How you got into healthcare? So talk about kind of like how that's happened and maybe give us a little insight into your career path.

Julie:
Okay. Well, I grew up with several family members, not really close members, but second level out, who worked in healthcare. I had a nephew who was born with a congenital condition and we spent a lot of time in and out of hospitals and surgeries and stuff like that with him. And it just always intrigued me quite a bit. Medicine has always intrigued me. And so I grow up and do a number of other things in my life trying to find my path. And I became a paralegal because I... My family is all in the law. Everybody expected that I was going to be a lawyer and I was kind of semi rebelling against that and figuring out whether they were right or I should find something else. For example, I was going to be an art historian. Talk about going in a different direction.

Jay:
A shift. Yeah.

Julie:
I know. It's like how dare you expect me to be a lawyer? I will do what I want. I'm going to be an art historian. Now then I shifted my way back obviously. But my second job as a paralegal, I went to work for a big, very, very well-respected law firm that had happened to have a big Health Law department. And I was a litigation paralegal working in medical malpractice defense. And we defended practitioners. We did not defend hospitals. So, it got me into that dealing with individuals and dealing with what goes on with regard to medical errors and when there really aren't medical errors. It's just we live in a situation in a world where it's all about... It's a blame-based society and the legal community is of course, blame based.

We have to find somebody to pin it on whether it's civil criminal or whatever. So, I really got to look at the other side at what healthcare professionals went through, what patients went through when there really was an error. And it just ignited a fire in me that just burned like a thousand suns. And I said, I must have more. And I began to learn about everything else in health law. And when you have a medical malpractice situation, you often have, not always thank goodness, but you often have a licensing defense situation. They often go hand in hand. So, I got into that. And then, I mean, it just got bigger and bigger and bigger. And then I got into patient safety and I got into quality. And so, my experience in healthcare now is, and through consulting all over the United States, my experience is I have kind of a deep field and broad-based knowledge of healthcare.

Nobody can ever know everything. You just can't. It's like knowing every federal law, like you... It's just impossible. But I've explored a lot of them and worked in a lot of them. Some, I dip my toe in and said, oh, thanks. But no, this is boring but necessary. So that's why lawyer specialized statements, physicians and other practitioners. So that's kind of where it got me and it's still a way to help individuals by working towards quality and value-based healthcare. And it's just, it's so important.

And as a professor and as a person who was born in Canada under a different healthcare system, not that I'm pushing that it's right or wrong or best or not, or anything else, just a different system. It gives me a different perspective and it lets look at healthcare systems around the world and look at our country and say, why can't we have some model not behind any particular model, but we need some model that allows Americans to have better access and more equitable access and continued access throughout the continuum of care to good quality value based care. It's just kind of become my raison d'etre. My reason for living and this is what really keeps me going on a daily basis.

Jay:
Well, I imagine in your role as a lawyer and a consultant, you've had kind of a great view of that care delivery chain. And so with that, let's talk about what you see as some of the industry trends that are unfolding right now and how they're beneficial to healthcare organizations and with your comments about value based care. Love to kind of like put even a finer point around that too, and kind of how you see that unfolding and the value based care continuum.

Julie:
As to trends, there's a lot of trends and you kind of put a qualifier on that and how they're kind of beneficial to health care organizations. Of course, some of these trends it's... Their determination about whether it's beneficial or not is up in the air as it's kind of a case by case basis, how they think about it. But the things that I think are beneficial right now in the industry is quality and value-based care and making sure that people are getting the care they need consistently, no matter where you go, that it is... It does have value. It does draw them because we definitely want to continue on the path of preventative care and not just reactionary. Dealing with it once everybody's sick as a dog, whether it's a cold or cancer. We definitely want to move towards that. It helps to create a very much more of a personal base patient patient-centered type of care and creates the care team and the patient as part of the care team. And I think that's very important.

Telemedicine. We've got to keep pushing the infrastructure and every person in the United States needs to have, especially elders, especially those who are socioeconomically disadvantaged. Any marginalized group may be able to, and marginalized individuals, members of marginalized groups or disenfranchised groups may be able to have easier access and less perhaps intimidating to them, whether it actually is intimidating is different, but perception is reality. So, it could be less intimidating to them and feel like they have some control. So, if somebody was giving them a big lecture about their sexual identity or whatever, like it's much easier to just hang up than it is to try and make your way out.

But hopefully those things will go away. AI, as augmented and artificial reality, are just fascinating to me. Although I have to say, I'm not a tech for Tech's sake person. I'm not a, hey let's just, because I can let's use it. It has to me really be valuable to people and valuable to care valuable to the practitioners. And it has to kind of prove itself out. But there's been a lot of AI that really has proven itself out. A lot more independent mid-levels PAs and MPs out there. We have such an unbelievable problem with our numbers of primary care. And I'd like to see them reimbursed a little more for sure, but having PAs and MPs available. So that kind of helps fill the void. I think that's very, very beneficial to all of healthcare.

And then let's see eliminating healthcare disparities and inequities. That's massive. That's just a massive thing. But now we're finally starting to see healthcare get behind this, on a large-scale level, not just some here, some there people for healthcare from blue states versus red states versus purple states. Everybody is getting behind that now. And I'm loving it. I am loving it. Breaking down silos, more communication people working together, still not embracing us legal people over here in our not necessarily say self-imposed silos, but we can talk about that later. And just culture, I think is another really, really, really big trend. And it shouldn't even be a trend, but it is still unfortunately a trend, but just culture in health care is so important to understanding the human condition, even as it applies to those who work in healthcare and to maintaining a motivated, passionate, committed workforce and saying, hey mistakes happen, but also for the improvement of the systems of healthcare. So, there's 25, consumerism, transparency. There's 25 more things I could probably talk about, but that's more than enough. I'm quite sure.

Jay:
Yeah No. That's a pretty impressive list to get us going. Well kind of departing to that for a minute. And I'm going to come back around listening to the AI point that you just made, but what do you see as the greatest challenge that you continuously encounter in healthcare law?

Julie:
Systemic structural barriers to healthcare access for sure. People wanting to... When I say people, I mean, leadership and leadership at all the levels, not just the C-suite. Leadership in all the levels, wanting to cling to the old. That I think is a major problem. People just don't, they just so don't want to embrace change. And of course, the pandemic has now forced it on people. So, they're like looking to put the brakes on anything else that they can, because just overwhelmed with change. I think we really need to do a lot of training in this country to help people really stress less about change and learn to have better coping mechanisms for change, whether it's in your own life or whether it's in the way your job is structured and operated, it doesn't matter. What else? The growing mistrust of science and medicine is really disturbing, really, really disturbing to me.

And I'm just going to limit it to healthcare science. I'm not going to get into everything else. But to me, just the growing distrust of that is... Yeah, that really bothers me. And it's, I think it's just created a massive barrier, self-imposed or not, it's created a massive barrier and probably still our insurance. Private, public strange mix of insurance. And then the patch worked throughout the states on top of that. I think that creates some barriers. Although I have to say a lot of, in defense of some payers, some payers are really working on that and that's really heartening to see. There are so many, and I'm trying to stay away from those that would be too controversial, but yeah, there's a lot of barriers still.

Jay:
So maybe you could take one or two of those and talk a little bit about what you're doing to try to help break down those barriers.

Julie:
One of the things that I'm really, really working on as is the organization that I'm general counsel for, is we're really getting out there and trying to work on... Well, two of them basically is working on quality improvement, quality improvement science, and really pushing for people who are trained in quality improvement science who are certified. Basically somebody has determined that they meet some standardized minimal competency, that these are things that are going forward properly. So for example, one of the things that I see a lot of across the country, is that you have people who are working in quality. And for those of you who can't see me, I'm doing my, the little finger by knees, funny ears.

Jay:
Air quotes.

Julie:
Bunny quotes, people who are working in quality and maybe doing so with the best of intentions, but they don't, they're not trained in quality improvement science, and there is a science to it. So, they're only getting half the job done. Like I said, they may be thinking they're doing the entire job and they may be putting corrections again bunny quotes, corrections into place, corrective systems, but those systems are then creating other problems because they don't necessarily understand the ERM, aspects of things, the legal aspects of things. And this leads me to kind of my second thing, which is the... And this is not a push for profession. It's just because of level of training. We're seeing lawyers who used to work in risk management and compliance, being replaced by people who have zero legal training and I mean on a widespread basis.

And so if you are a quality person who is doing the best of your ability, but you weren't properly trained, you may be working on corrections to systemic problems or processes, protocols, procedures, whatever, and what you put in place creates legal problems that will come out down the road because there's no risk management lawyers out there. There's very few. And those who are, are usually RMs, who've become JDs. Sometimes a PT or somebody might become a JD, but there's so few of them and they're not consulted as part of the quality and patient safety team. And it's like, look, we have the ability and the training to help you effectuate, whatever it is you need to do here to fix the problem, but let us help you do it so it doesn't create 20 other problems. Whether it's compliance or whatever the case may be. So those are some of the things that we're working on. And then working on a lot of just knocking down barriers and knocking down implicit bias issues and how that affects everything.

As a matter of fact, in September, we did a training for over a thousand healthcare lawyers who ,in the state of Michigan, who we said, look, you guys have to understand this too. And you have to help your clients and the representative of your clients to understand how this is working without their knowledge. We're not talking about people who are being explicitly biased or full on discriminatory. We're talking about implicit bias being human nature. And when it's everybody's got an affinity bias, you all think the same way. And you have confirmation of everything going on between your C-suite and everybody thinks the same way. This is how you end up not putting, deciding, not to put an urgent care in a place that is really, really needed because it's a socioeconomically depressed area and putting it in a brand-new suburb instead. And then telling the joint commission, we really don't see a lot of socioeconomically depressed or those from marginalized and disenfranchised communities. We really don't see that. Why? Because you just put all your stuff in a place where those people would never be. So, we did a lot of trainings saying lawyers, reach out and help reach out and help.

Jay:
Yeah. No important work and probably never more timely. Well, thanks for sharing kind of the hard and significant work that you're doing. I want to kind of pivot back to the point on AI. And so maybe you could share a little bit on how you see AI having a impact in this industry.

Julie:
Well, AI, let me start with the thing that we have to make sure it doesn't exist to the best of humanity's potential. And that is we have to make sure that bias doesn't exist in the coding and creation of AI. That's the first thing we have to do, and we're getting better at that, but it still does. It does exist. But when you get good AI, you've got AI that can help it's predictive AI and it can help see trends coming before humans really are aware of it because it can focus solely on that, right? Like in healthcare world, we're focusing on 30 things at the same minute, but the AI program can focus on that, that, and only that. And it can suss out those trends. It can look at who's susceptible for this and where this, when this is going to happen and blah, blah, blah.

So all those kinds of things are great. The decision support is great. Although I am a big proponent, I do a lot of speaking on this. I'm a big proponent of you can't just rely on it. There are legal issues actually of just relying on AI decision support instead of then layering your own independent experience and judgment and humanity over top of it. There are actually legal issues that can come from that. But I think it's a great tool, as long as we don't expect it to take over. And then everybody can sit at home and let your smart watch take care of your health. That should never happen. I hope it never will. It should never happen.

Humanity needs humanity, but AI is just, I mean, it's getting us leaps and bounds down the path and I think we need to embrace it and watch it and build it in where we can, which is another problem. A lot of AI doesn't enter it... We don't have interoperability with a lot of AI programs. So again, the law is always way behind the science, right? Way behind, but we're sitting there going to hang on a second. How do you get the report out of that into the medical record? That's got to happen. How do we make sure that other providers can see that? So, there's just so many amazing things though with AI that I'm just constantly floored with what people can come up with. So, it's just fun to watch and fun to dream fun to imagine.

Jay:
Well, those are great use cases to share. Let's kind of keep... Kind of to the health plan executives and with the work that you do, I'm sure you would never be short of advice. What advice might you have for a health plan executives in navigating our industry kind of during these times?

Julie:
Well, remember your humanity. Remember who you serve. Remember that if you don't have people to serve, if you are a publicly traded in any way as an insurer, remember that those people aren't going to get anything if you don't have anybody to insure. I understand the financial aspects of it all and the operation aspects of it all I really do, but we've got to support private practitioners. We've got to continue training private practitioners. We've got to find ways to make it easier for private practitioners because they're just overloaded.

I mean, I hear all the time from physicians saying, I am so sick and tired of all of the hoops and the paperwork and the code and the this and the that and the other thing. And this is the same message to government. We've got to make it easier on the practitioners and then they have to hire 25 people to figure this all out for them, but they just are overwhelmed with it. And they just want to practice medicine. So, keep looking is what I have to say. Keep looking, keep making it a value for everyone all the way around, including making the practice of medicine valuable to these people. They've spent a lot of money and a lot of time and given a lot of their life hours to this. So, let's support them with that and support the hospitals as well. So pro healthcare.

Jay:
Yeah, no. I mean, the private practice, ride is it's sadly dying, right? As a treasured destination for professionals.

Julie:
It is.

Jay:
The public, right? We're all going to pay the price if we can't turn that around.

Julie:
The mergers and acquisitions are probably the biggest area in healthcare right now in health law, but it's the acquisition of practices too. And as much as we don't want America, America as a whole, not everybody obviously, but just as a general whole people say, no, we don't really want to emulate other healthcare. Other countries systems. The funny thing is that that's, what's going to happen when hospitals own all the private practices and you will go to a hospital for everything. You will not go to a privately-owned practice and everybody's going to be an employee of a hospital and then hospitals will merge and then it'll get into bigger and bigger systems. And it will end up looking like a lot of other countries. Not that that's good. Not that that's bad. It just will. And I just think it's kind of funny that everybody's like, nah, we can't do that. Meanwhile, it's happening right now.

Jay:
Yes.

Julie:
So just be aware.

Jay:
Yeah. Last question before we kind of go to a like a quick rapid-fire round. So what recommendation or recommendations would you have for the public regarding their own empowerment and ownership of their health.

Julie:
Oh, the one that I have spent 25 years teaching, you've got to learn about the healthcare system, no place on earth, and this is not an indictment of the US population, it's just a fact. Nowhere on earth do people know less about their healthcare system and how it works than in the United States. Probably because we have the most complex healthcare system, system being just a generalized word there because it really isn't a system by academic description standards, but we have such a complex healthcare system. And here's my advice. So people are like, well, I don't want to listen. I don't want to learn because it's always got somebody's political spin on it. Here is my best advice. Go online, go to somewhere that sells used textbooks, find a community college level introduction to the American healthcare system textbook that is not older than 2014, 2015 and read it. It'll be an easy read. It'll explain it in parts and you will not get anybody's political spin on it. You will just learn what is, and it will help explain billing. It will help explain how things are organized. It will help you understand different terms. If I can get everybody in the United States to do that, it would be a different planet. We would feel like we were delivering on a different planet and we would go leaps and bounds into the future of healthcare.

Jay:
I may have to take you up on that one for myself. So, I've been leading this company for four and a half years and every day, consider myself a student of the healthcare industry. And that might be an awesome prime meat. Kind of give it a boost. Thanks for that. All right. So, let's have some fun as we go to wrap it up, you've been an awesome guest with us today. Thank you. So, first one, I have five questions. First one, what keeps you up at night?

Julie:
The fate ACA. That's what's worrying me right now and the de-legitimizing of science and medicine. That one gives me tremendous pause and then still access and equitable access and healthcare disparities, those things. Those are the three things I spend a lot of time worrying about a lot of time complaining about. Long time trying to fix.

Jay:
Yeah so, I imagine then you are pretty restless at night. So, when tossing and turning, what book might you grab from the nightstand and why are you reading it?

Julie:
Actually, it's a book called Caste by Isabel Wilkerson. It just takes me to a different world and just different problems. And it's interesting. It's historical it's all kinds of things. And my husband actually heard an interview with the author on NPR and ordered it for me. I think my husband's bought me two books in that like 19 years that we've been together. So that's what I'm reading right now. He said, "I think you will so enjoy this." So that's what I'm reading. It is just another world.

Jay:
Well, kudos to him.

Julie:
Other people's problems.

Jay:
Maybe that'll encourage them to get to the third book sooner. All right. What's the favorite app on your mobile device?

Julie:
Oh, let's see. That's a good one. Well, really my favorite app, because I have a Samsung Note so I can write on things I can write on there on my app, but my favorite is really my Samsung Notes because I can do all kinds of things, but it's not really an app. It's a function of the phone, so. Oh, okay. Well, I don't know if I can say it, but you can bleep me out if you want to, but it's my Walmart Grocery App.

They have got that figured out. I'm telling you. I can do like a 90 item grocery order in like 10 minutes because everything is saved and I just have to go bing, bing, bing, bing, bing, bing, bing pay. And they either deliver it or I go pick it up. That's the way it should be. And although there's a local grocery store that I really like, and I would rather kind of go there and get things, but their app is... It takes me two hours and I am like two hours to order groceries. I could go there and get them and be home in two hours. So, yeah, I have to say app, Walmart's app. Saves me a lot of time.

Jay:
Well, don't worry. We're not, sponsored by Amazon, so no risk of that getting bleeped. So, you're good.

Julie:
Well, I live out in the country, so Amazon doesn't get to me quickly. So yeah. That's why Walmart-

Jay:
Awesome. How do you invest in yourself?

Julie:
Well learning, I'm always learning. I'm always reading. I'm always listening to other people and just soaking up their experience, their life experience, their lived experience, their academic and every other kind of experience. I guess the investment in me is it's going to sound like I'm a complete nut cake now, but when I need to really invest in me, when I need some me time, even if it's three minutes, because I'm at home, it's usually picking up one of my two fuzzy furry cats and just sitting down and shutting my brain off for three minutes and just listening to the purring and hugging a free cat.

Jay:
Yeah well we have a couple in our house and I can tell you that that's pretty soothing.

Julie:
It is.

Jay:
What's the most creative thing that you've done, the kind of shelter in place.

Julie:
Most creative thing I've done? Ooh, that's a good one. Well, I, sow and at the beginning of the pandemic, I was making masks at the beginning I thought that was super creative, but I do creative. I've done a fair bit of writing. Mind you it's been legal writing, but nonetheless to me, it's creative. So those are my things create a lot of webinars, creative webinars things that I've been doing. And for my classes, I've done some pretty creative, interactive educational things for my classes, with a lot of simulations and bringing in healthcare professionals from around the country to work with my third year law students and doing some pretty creative simulations so that they can learn by doing, not just learn by reading. So, I guess that's really my most creative stuff.

Jay:
Awesome. All right. Well, thanks for participating in the rapid fire and kudos for being creative in changing the learning environment. I know it's challenging for students at all levels and challenging for the teachers and the educators on the other side trying to figure out how to adapt. All right, Julie. Well, thanks again for your time and your openness. You've been an awesome guest. Kudos for our Value-based Healthcare Podcast close.

Julie:
You've been an awesome host.

Jay:
Thank you. No, I've enjoyed it. I've enjoyed it a lot. So please follow Reveleer on LinkedIn. You may also follow me on Twitter @ackermanjay. Over and out. Thank you for joining us today. Listen to more episodes at reveleer.com or find us through your favorite podcast platform for episode updates, follow Reveleer on Twitter, LinkedIn or Facebook.