Speaking metaphorically at AHLA

William H. Gates Sr. was the first of two keynote speakers at this year's annual meeting of the American Health Lawyers Association, held in Seattle from June 27-30. Gates, otherwise known as Bill Gates' dad, had a long career as a lawyer himself and now works on directing his son's vast fortune toward global health initiatives as co-chair of the Bill and Melinda Gates Foundation.

Peter Leibold, the AHLA's executive vice president and CEO, told me Gates was chosen because the foundation's work is in tune with the public interest component of the association.

But let's be honest. All those lawyers, more than 1,300 of them, were there to hear about and talk about healthcare reform, and the other keynote speaker, U.S. Sen. Ron Wyden (D-Ore.), took care of that.

Gates humbly suggested, “My hope is that you'll be able to draw some connections between your work and ours.”

I'll draw some forced, metaphoric ones.

The world, Gates said, is close to eradicating polio. After marshaling immense resources across the globe to vaccinate newborns, 1,604 cases were recorded last year. “It's tempting to think that's enough,” Gates said. But the virus will come roaring back unless completely eliminated. “Those resources simply aren't sustainable year after year.”

A bit later that morning, Wyden said he thought Congress must do more in the area of cost-containment than was accomplished in the Patient Protection and Affordable Care Act. Eric Zimmerman, a partner in the law firm McDermott, Will & Emery and a registered lobbyist, asked Wyden how Congress could possibly come back and do more to rein in healthcare costs after an improbable alignment of health industry stakeholders and political will was required to just barely pass a law that does things that are arguably an easier sell, such as expand coverage and whip insurance companies (my words, not Zimmerman's).

The effort required to pass healthcare reform, Zimmerman seemed to suggest, was as unsustainable as the worldwide effort to eradicate polio.

This segues into my next forced connection. As Zimmerman posed his question, he noted that the law does take “important steps” toward controlling costs.

Wyden got some laughs by asking Zimmerman to name some of his favorites, and the senator probably is not used to getting an answer. Zimmerman, who was going to be addressing the topic as a presenter, replied, “I do think some of he demonstration programs that will start to align incentives between healthcare providers will be the key to cost control in the future, and I think those are much more powerful than the across-the-board types of cuts.”

Back to Gates. The Gates Foundation, he said, has established a new grant program with an extremely streamlined application process that doles out $100,000 to people with compelling research ideas. If the preliminary work shows promise, it will get more funding. It's called Grand Challenges Explorations.

“We fully expect failures,” Gates said. But if the project yields just a few breakthroughs, he added, “the initiative will be a resounding success.”

This idea sounds not unlike the demonstration projects included in the reform bill and the new Center for Medicare and Medicaid Innovation, which will study which innovations in healthcare delivery and payment show promise in improving quality and controlling costs. The government is going to fund innovation, test the results and pick winners.

One project Gates mentioned is research that would rejigger the DNA of mosquitoes so that the insects either couldn't smell humans or preferred a scent emitted by traps. Mosquitoes infected with malaria could be everywhere and it wouldn't matter. “They just don't infect you because they don't know you're there.”

So here is perhaps the most forced connection I'll make between Gates' speech and the business of lawyers working to understand healthcare reform and shape its regulatory aftermath.

Let's say mosquitoes are like providers who rip off the system with fraudulent schemes, entrepreneurial claims coding and tainted financial relationships.

The health reform law is packed with provisions intended to improve the government's ability to prevent, identify and punish fraud and abuse of the system. Meanwhile, the enforcers are grappling with their role in policing the integrated delivery and payment models encouraged by the new law.

“I'm curious of your thoughts how we're going to reconcile the Affordable Care Act's effort to improve innovation (such as the ideas tested in demonstration projects) with the fraud and abuse laws, some of which are perceived as inhibiting the innovation we want to encourage,” someone in the audience asked Wyden.

Wyden admitted it wasn't his area of expertise, though he made an astute and relevant observation in his response. “Healthcare as you know is so complicated it essentially resembles an ecosystem,” Wyden said. “You move over here and it sloughs off over there. The question you're asking is illustrative of it.”

“Obviously you're a practitioner who knows a lot about it,” Wyden told his questioner. “If you see areas where the Congress is going to have to come back, I'd very much like to see it.”

Wyden didn't appear to recognize the man as Lewis Morris, chief counsel in HHS' inspector general's office. I asked Morris later about the exchange, and he said he and his colleagues are already at work on formulating some recommendations.

Gregg Blesch covers legal affairs and regional healthcare business news in Illinois, Indiana, Michigan and Ohio.