Health Care Meets Legal Meets Tech

In Crista Harwood’s worldview, nothing can ever be perfect.

“I like analyzing and improving complex systems to make people and machines work more optimally,” she says. “It’s a constant challenge because there’s almost always a way to make something better and more efficient.”

This attitude has taken Harwood far in her career—from a position as an industrial engineer at General Motors and Ford, to returning to school for her MBA and JD, and finally to the complex intersection of health care, law, and technology as senior vice president, general counsel, and chief administrative officer at Passport Health Communications.

One of her first tasks upon joining Passport in 2010 was to organize the process for requesting and producing contracts. She approached it like an engineer: “I drew a flow chart of how the process should work, and Salesforce used my design to help configure it for us. It has streamlined and automated the process, enabled our sales team to create their own contracts, and helped us track important data points.”

Harwood most enjoys seeing Passport’s products improving how health care is delivered. For example, Passport’s “Payment Navigator” helps hospitals conduct financial analyses on uninsured patients so they can be financially triaged—i.e., channeled into the most appropriate path for payment (Medicare, Medicaid, charity, up-front collection, or an installment plan). The program’s ultimate goal is to reduce uncompensated care, which totaled $85 billion nationwide in 2013 (the most recent year for which data is available), 60 percent of which was incurred by hospitals.

Another problem Passport Health and the Affordable Care Act (ACA) are tackling is the fragmented system in which health-care procedures are currently billed. The ACA calls for “bundling” payments, meaning that hospitals, doctors, and other providers are paid a flat rate for each “episode of care.” For example, instead of a procedure like knee surgery generating multiple claims from multiple providers, the entire team would be compensated via one “bundled” payment. If follow-up treatment is required or there are complications, the payment total would be adjusted. All of this requires documenting and tracking procedures and patient outcomes, something Passport is already doing.

“This has created a great opportunity for us,” Harwood explains, “because we are already collecting the data required to make this possible. Our repositories indicate where patients go for each stage of care, how they fare, and who pays their bills. Once providers start sharing this data, everyone can benefit, and payments will be streamlined.”

Passport’s legal and IT departments work extremely closely to safeguard this information. “We have a very robust security program—we stay one step ahead of anyone who might try to access our network,” Harwood says. “All patient data is encrypted and is not viewable from outside the system. Experian, which acquired Passport Health in 2013, also has industry-leading fraud-protection programs in place. In fact, much of the coding behind the use of multiple choice questions to confirm your identity was developed by Experian, and the data used resides in the company’s massive data banks. We’ve been able to add some of the same sophisticated security tools to our patient portals.”

Experian’s acquisition has brought many significant benefits to Passport, but Harwood admits it has also required some adjustments. “We were a small, entrepreneurial, tech-oriented health-care company, where people came up with new ideas and ran with them,” she says. “Now, new products have to be vetted, from a legal and regulatory standpoint, and go through a full marketing review. In the end, it does help for everyone to be looped in, but we don’t want to stifle creativity and innovation or we risk losing our competitive advantage. So, we need to find a balance.”

One way in which Passport is trying to achieve this balance is by having its lawyers spend more time with the development teams, so they can help brainstorm and nurture ideas earlier in the process and identify any potential legal issues before a project gets too far down the track. Of the ten attorneys in the legal department, however, Harwood is the only one with technical training.

“I would love to see more attorneys with technical backgrounds,” she says. “It truly is a great combination. It gives me credibility when I’m talking about new technologies and when I’m discussing security concerns.”

As for lawyers who don’t have a technology education, Harwood advises them to not get discouraged and to embrace their room for growth. “The best way is to have intellectual curiosity, to jump in and ask a lot of questions,” she says. “Instead, some choose to sit on the sidelines and not learn about the technologies behind their company’s products and services. To truly support a business, you need to understand what it does.”