Managed Care Background Morphs Into Obamacare

, The Connecticut Law Tribune

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Virginia Lamb
Virginia Lamb

"Managed care was a new concept for hospitals then, and insurance companies were being set up in networks and provider groups," she said. The hospital had to have contracts with these networks, whether PPOs or HMOs, and the contracts often had to be updated.

It was there that she learned to navigate the complicated and "nuanced world," as she puts it, of health insurance networks and managed care.

When the Manchester hospital combined with Rockville General Hospital to form Eastern Connecticut Health Network, Lamb was elevated to a position as a senior vice president overseeing managed care for the network. In that capacity, she worked with state and federal officials to enter agreements for Medicaid and Medicare payments to the hospitals.

During that time, she said, a lot of her efforts were also focused on new treatment programs that were created by the hospitals. For instance, in establishing a diabetes self-management program, Lamb led a team of outside counsel to ensure the treatments would be covered by government-funded programs, including Medicare.

"If you're developing a program" to treat patients, naturally "you want to want to get paid," she said.

She left the position and started a solo practice in the New London area, which included advocating for some of the hospital group's 1,800 employees and many patients who had health care insurance concerns. "I was interested in consulting patients" about being covered for their medical care, "and I got involved in advocacy work for patients," she said. The work included representing clients who had been denied coverage. "You might have someone with a workers' compensation claim," she said. "I handled some veterans' administration claims as well. And some labor law representation. It was very rewarding."

Obvious Choice

But she missed the hustle and bustle of a busy practice. When Lamb heard about the exchange being created, she had an executive recruiter contact its leadership team and she applied for the position.

Lamb was selected in a competitive hiring process, which sought to bring in a chief legal officer who had both a technical understanding of the new health care law as well as the ability to manage a department.

Kevin Counihan, the chief executive officer of Access Health CT, found that Lamb was the obvious choice among the candidates. "Virginia combines excellent technical skills, with practical and insightful good judgment," Counihan said. "I depend on her for a variety of strategic recommendations in the administration of the Connecticut exchange."

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