Harry Nelson

Why I Wrote the Book: Towards a Personal Mission

Think bigger

My last blog post covered how and why I wrote the book. But I also wanted to share some thoughts on the bigger topic of why a book in the first place and about the evolution of my sense of personal mission. Over the past few years, I’ve gotten a lot of funny feedback from other lawyers about my speaking, writing, and other entrepreneurial activities. Most of it is positive. But not all of it.

In the last couple weeks, the latest version of this has been comments like, “Congratulations! So are you done with lawyering?” It turns out many lawyers don’t relate to the energy I devote to writing and speaking. They have a narrower view of what a lawyer should do, and don’t understand why I do what I do. I thought it would be useful to share the evolution of how I got to the drive to write the book, why I keep up such a busy schedule of work, speaking gigs, and writing, and why I’m still practicing law. It requires a little backstory on how my thinking has evolved over the years.

Keeping Law Practice Dynamic

Last month marked 24 years since I graduated the University of Michigan Law School in 1992. I have loved practicing law, and especially being able to advise clients in the topsy-turvy world of healthcare regulatory compliance and reimbursement strategy.

I didn’t always feel that way. There was a point early on in the mid-90s when work slowed down as my original firm, Butler Rubin (which I loved and to which I am so grateful for so many invaluable lessons) grew and I had to share my workload with newly hired lawyers. The experience of not being busy enough imprinted on me the imperative of making business development a priority to stay and keep everyone busy. I also had a miserable time after two of my mentors made the decision to break away from my the firm, leaving me uncertain whether to leave to join them or to stay without them and become a partner (which is what I did). And, above all, there was the misery of being stuck in a failed partnership, where trust eroded and I came to work for two years with a knot in my stomach almost every day over a broken personal relationship.

But those three stretches have been thankfully brief exceptions. In general, I love being of service as an attorney. I feel blessed to be in a role where people bring me puzzles and trust my colleagues and me to help solve them. Being a trusted advisor is an unbelievable privilege. Getting paid well for it is almost too good to be true.

I’ve gotten to a place where I feel like I’ve achieved a mastery of many complex subjects around healthcare regulatory and reimbursement strategy, which has pushed me for new ways to keep learning and growing: new skills and new subject matters. On the most basic level, I believe that a certain restlessness that pushes people to grow is essential to a healthy professional career.

There are two distinct challenges that keep me pushing myself: first, how do you work to grow your skill set and avoid coasting and stagnating? And, second, in a world where information is constantly being commoditized, how do you stay ahead? The first question goes to keeping practice dynamic on a personal level—finding new skills and areas for personal professional growth.

The second question goes to building and maintaining a competitive edge on an organizational level. In the past few years, we’ve watched many big law firms “rediscovering” healthcare (which many of lost interest in years ago when other sectors were hotter and more profitable) and competing with us. So the process of looking down the road to where client needs are evolving is an important process. We leverage our current lead to keep our leadership role in advising the industry. I’ll write more about how we do this in the future, but it’s secondary to my topic today.

Rethinking Our Role from Lawyers to Problem-Solvers

Personally, pushing into new areas of healthcare work has not just been about expanding expertise. One direction of growth has been towards rethinking the nature of what “the work” is that we do. Rather than limiting ourselves to giving legal advice that relates to the healthcare and life sciences industry, I’ve come to the view that we have a broader role as problem-solvers, and that legal analysis and advice are a key part of our toolbox, but just one part.

So I started thinking about how to give advice that was not just narrowly legal, but strategic. Plenty of clients come to us looking for a more technical analysis and specific set of legal services, and that’s fine. But what I personally enjoy the most is working with clients who value our strategic perspective as much as our technical advice. One manifestation of this is going from advising clients in a binary way about what they can and can’t do, and instead advising on how to achieve their goals. Too many lawyers and law firms in our area of work limit themselves to “yes, you can,” and “no you can’t” instead of embracing the harder question of “how” and what’s possible.

Part of this is about the nature of the organization: in a large organization, when a general counsel looks for guidance, he or she is answering to a CEO, who in turn is answering to a board of directors, and everyone is looking to make sure that they are protected from embarrassment. The goal is “CYA,” and this drives the advice that is desired from the lawyer.

By contrast, when you work with entrepreneurs, founder-led, family-owned, middle-market or early stage clients, people don’t have the luxury of worrying about “CYA.” Clients are looking for value. That’s the universe firms like ours thrive in. Over the years, we have built a nice group of large institutional clients, but, in many ways, we are built for clients with direct “skin in the game,” people whose success depends on figuring out what the best strategy is, not just what the safest and least risky path forward is. It’s harder work, but it’s much more gratifying to answer the hard questions. To use a baseball metaphor, the infielders who win the Golden Gloves are not the guys who play it safe avoiding errors; they’re the ones who dive reaching for the toughest catches, sometimes making unbelievable grabs and throwing guys out. OK, the metaphor only works to a point; we don’t have the luxury of making errors. But the point is: the work I relish is the hard work, not the easy stuff.

In trying to figure out how to be of greater service as problem-solvers in a broader sense, we started off looking for trusted partners to do things that we can’t or don’t do well. Our 2013 strategic partnership with Epstein Becker Green was one example of finding like-minded healthcare experts who cover more ground than we do. We also found a variety of specialized consultants who do things we don’t, like subject matters to help negotiate in-network insurance status or that run clinical trials for new FDA drug and device applications.

Along the way, it became clear that there were certain pieces just missing: things we couldn’t do efficiently but also couldn’t find strategic partners or consulting groups to do efficiently, either. While there is almost always someone out there who can do the thing needing to be done, the question is whether their price is viable for our clients.

The way this need became apparent was the discovery that I would pat myself on the back about some good advice we’d given, and then check back a few months later to discover that it had ended up being unhelpful because the client had never found anyone to train their staff or put together policies and procedures to implement our advice. While a handful of clients would hire us for the implementation, most were looking for a more affordable option. If you have a million dollar budget, there are plenty of people who will help you, but if you’re a small or middle market company with a fraction of the budget for implementation, good luck.

When we realized that we couldn’t find the same quality of compliance implementation services that the consulting giants offered to large institutional healthcare organizations, we decided to build it ourselves. The result was a spin-off that has grown into a healthy company of it own.

There have been a bunch of smaller collaboratoins since then. The latest chapter of redefining our role as problem-solvers included a shift that surprised many people. Over the years, clients regularly asked us to help them find investable healthcare opportunities. Others asked us to help them find buyers when they wanted to exit healthcare businesses. While we knew some good brokers and investment bankers, we also felt there were gaps here. We saw an opportunity to look for opportunities where we might want to forego an advisory role and instead use our toolkit to be able to direct investment in a way where we could move quickly and seize opportunities. It led us to launch the Adaptive Healthcare Fund. It involves a different kind of problem-solving that required us to build a different kind of expertise , including bringing in investment professionals. But even early on, it’s clear to me that it’s already made us a much stronger group. It’s forced us to adapt to a different methodology and to speak a different language, but I believe deeply that all of our clients benefit from this added depth.

I don’t know when will be the next time that we’ll find something that other people aren’t doing and that we feel we can pull together the talent to do well, but I assume it will happen again, eventually. And when it does, my goal is not to be locked into a narrow sense of what we are, but instead to look at the problem, the need, the solution, and what competencies we would need to expand to add to our toolbox.

Towards Broader Social Impact

While expanding our thinking about what we do has helped, there is still another dimension that was gnawing at me. The great blessing of the work that we do as healthcare lawyers is that clients bring us these complex problems and ask for our help to address them. The work is challenging, interesting, and neverending. It provides an honest living for both our steadily growing group of 35 lawyers and staff. I actually love the work, which is one thing that I think differentiates me from many friends and colleagues who have given up law practice for more lucrative and less stressful existences.

The place where it falls short, for me, is that, by definition, the work is mostly secret and confidential. We work under attorney-client privilege, which means that we get to examine challenging problems, develop creative solutions, execute them, and then move on to the next challenge. By definition, our social impact is limited to a relatively small group of clients. We try to build clusters of clients with the same issues, to deepen our expertise and spread the cost of developing an up-to-date knowledge base across a group of similarly situated clients.

Over the years, I’ve looked for ways to help share key learning, driven by a belief that a little good advice applied proactively can cost-effectively prevent major legal headaches. In part, it goes back to my “middle market” mentality: large institutions tend to have the resources to invest in compliance and risk management as a core competency, but too many small and mid-sized companies just can’t afford and/or don’t invest in advice that is often hard-to-find.

So I’ve looked for ways to disseminate information that are sustainable. One driving belief is that an attorney-client relationship may not be the best option to solve the problem we’re trying to solve for. Many clients have good lawyers who give them corporate, employment, and general business advice. All they are missing is the specialized content to understand the distinctive regulatory issues in their part of the healthcare universe. My working theory is that, if we could give these people (and their more generalist lawyers) the right information in some other form, they can do the rest. We will have had a broader impact, they will have gotten the essential information, and everyone wins.

The organization that’s taken this the furthest is the American Addiction Treatment Association (AATA), which is taking a hornet’s nest of confusing topics and working hand in hand with leading addiction treatment industry groups to clarify and help treatment providers avoid problems. I am excited about the model of sharing information in a way that can impact not just a small number of clients, but an entire industry. We’re already seeing AATA have a broader impact in making treatment safer, getting provider paid for the valuable work that they do, and ensuring that they are more compliant with confusing laws and regulations. I believe this will serve as a model for simplifying compliance challenges across other parts of the healthcare universe.

The Book

So where does the book fit in? Over the last several years, healthcare has been front and center in the national discourse, largely as a result of the enactment of the Affordable Care Act and the repeated attempts to repeal it. I’ve felt that there was a bigger contribution I could make to thinking through and articulating what is coming next, not just for particular segments of the healthcare providers or investors, but for the entire industry and for patients and healthcare consumers.

But I quickly learned that, while I’ve earned a good name for regulatory compliance expertise, I was still seen as “in the box” of being a narrow technical expert.  It became clear to me that it was a reflection of my work product to date, which has been focused exclusively on healthcare providers and investors, and does not addressing the “pain” felt by patients or the bigger policy issues.

With the help of a few friends, in particular Mark Goulston, who challenged me to think in bigger terms about what I was trying to do, I realized that if I really wanted to contribute to the broader discourse about the future of healthcare and offering ideas about healthcare policy, it would require a different medium – and, more importantly, a different message.  Quoting President Kennedy’s 1961 mission to land a man on the moon, which led to multiple manned missions into space, Mark challenged me to find my own “moon mission” – a breakthrough, disruptive vision that was bold and big enough to get other people to collaborate with me and to get beyond ego.

As I noted in my last post, I had already been working on a book, with multiple false starts, where I started but couldn’t get all the way there.  But Mark’s challenge helped me refine my personal mission.  With a sense of purpose to bridge the gap between the “muddle” of healthcare and the real world, I was able to finish the book.

The most exciting part of bringing From ObamaCare to TrumpCare to reality is that I feel like I “cracked the code” of getting ideas out to a wider audience. The book is still being printed as I write this, and while I’m still eager to share the message of this book and get feedback, I’m already thinking about how to develop the bigger messages I am passionate about beyond health reform.

The Spiritual Dimension Beyond the Work

I’m still working on the personal mission.  While I love the “moon mission” as a starting point, there’s also a bigger spiritual dimension that I think about.  Every so often, I imagine myself at the end of my days standing before the Creator and being asked what I did to make the world a better place. Will all of the good work with clients count for much? Will writing books change the world for the better?  Am I really living up to my potential to change the world?

I think about my father (May he live and be well) and my grandfather of blessed memory, for whom I’m named, and I think about the impact they’ve had. Throughout my life, I’ve encountered hundreds and hundreds of people who shared the stories of countless acts of compassion, of their teaching, of the pastoral work, of helping families through difficult moments of grieving, illness, conflict, and other meaningful roles in people’s lives.  And I think of the relatively modest impact that I’ve had in my own work and even through my words.

One story that stays with me happened about six years ago when a young entrepreneur, Zach, sat in my office. Although I usually meet clients in a conference room, we had a full office of meetings that day, so I brought him into my personal office.  He looked around and saw many religious texts and mentioned that his father was a rabbi.  I shared that my father was as well. At the next meeting, a week or so later, Zach told me that it turned out his father knew mine and that my grandfather had actually introduced his grandparents to each other. Zach’s grandmother had grown up as a young woman in in my grandfather’s congregation in Bridgeport, Connecticut. My grandfather had met Zach’s grandfather in New York, and thought that he should meet Zach’s grandmother.  And so it was that a kindness done some 60 years earlier, connecting two souls, was brought back to life in our meeting.

The story is just one of several that has led me to think about what legacy I want to leave behind.  I am envious of people whose work, like my father and grandfather, revolves day in and day out around taking more profound kinds of care. While I didn’t feel cut out for taking that on as a vocation and while I love “the work” that I do, the bigger question on my mind is how I can use it to take care of those around me who are in need. I want to find more ways to have more impact on more people — in measurable ways.

I know for many people there’s a bifurcation: people think of work as a “means to an end” to earn a living, take care of the people they love, support good causes, and think of a legacy in terms of philanthropy or good works.  I am deliberately leaving the topics of philanthropy and communal service, which I believe in deeply, for another day.  For today, I’m trying to explore the limits of work as a form of personal mission and ministry. If you’re thinking about these issues, I’d love to hear from you.

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