Health-e Law Podcast Ep. 22
J.P. Morgan Healthcare 2026 and Beyond: Regulation, Technology and the Future of Health Equity
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Listen to the podcast released March 5, 2026, here: https://www.sheppard.com/insights/podcasts/health-e-law-episode-22-J.P.-morgan-healthcare-2026-and-beyond-regulation-technology-and-the-future-of-health-equity
Welcome to Health-e Law, Sheppard’s podcast exploring the fascinating health tech topics and trends of the day. In this episode, partner and host Michael Orlando welcomes Adam Herbst, a partner in Sheppard’s Healthcare industry team, to explore key insights from the 2026 J.P. Morgan Healthcare Conference and discuss both the pitfalls and opportunities the One Big Beautiful Bill (OBBBA) presents for the healthcare sector.
About Adam Herbst
Adam Herbst is a nationally regarded authority at the intersection of healthcare law, policy and delivery, with nearly three decades of experience spanning government, health systems, nonprofits and the private sector. He advises on the full range of corporate and transactional healthcare matters including mergers, acquisitions, joint ventures and financings involving hospitals, long-term care facilities, managed care organizations and private equity funds. He is also widely recognized for his mastery of Medicaid law, financing and policy. His Medicaid work includes 1115 waivers, state-directed payments, managed care contracting, HCBS waiver design, PACE program expansion and long-term care reimbursement across multiple states. Adam regularly structures governance arrangements, negotiates complex management and administrative services agreements and guides providers and investors through multi-state regulatory approvals and compliance regimes.
Clients value Adam’s ability to combine inside knowledge of government with sophisticated deal experience and a genuine understanding of mission-driven care. Whether guiding a multi-state transaction, structuring a PACE or HCBS program, advising on Medicaid waivers or supporting aging and disability service organizations, he brings a holistic approach that integrates law, policy, operations and strategy, helping clients build sustainable, compliant growth models while advancing care for vulnerable populations.
Before joining Sheppard, Adam served as Deputy Commissioner of the New York State Department of Health and as a special advisor to two governors, where he led major initiatives in Medicaid transformation, long-term care reform, and managed care modernization, and chaired New York’s Master Plan for Aging. During the COVID-19 pandemic, he played a critical leadership role in the state’s emergency response—coordinating with federal partners, standing up COVID-only nursing facilities, managing hospital surge capacity and supporting one of the largest vaccine distribution efforts in the country. His career has also included running a children’s hospital, leading a major community health center and advising faith-based organizations and disability service agencies through periods of growth, transformation and financial stress.
About Michael Orlando
Michael Orlando is a partner in Sheppard’s San Diego (Del Mar) office. He is team leader of the firm’s Technology Transactions team, a member of the Life Sciences, Healthcare and Artificial Intelligence teams, and co-leader of the firm’s Digital Health & Innovation team. Michael has more than 20 years of experience advising health technology companies, insurers, healthcare systems and providers, academic medical centers and research institutions, medical device manufacturers, and pharmaceutical and wellness companies on intellectual property and business transactions in key strategic areas, including EHR systems procurement and integration, telehealth, mobile health applications, clinical decision support technologies, artificial intelligence, data use, wearable devices, remote patient monitoring, and other medical devices, research and collaborations, patent licenses, software licenses, joint ventures, mergers and acquisitions, revenue cycle management, and other outsourcing transactions.
Michael founded a software-as-a-service company before entering private practice and completed an in-house secondment at a publicly traded biotechnology company, an experience that informs his practical and business-focused approach to client engagements.
Transcript:
Michael Orlando:
From hospital boardrooms to startup war rooms, this is Health-e Law, powered by Sheppard’s Digital Health and Innovation team. We bring you quick and candid conversations with industry leaders, bringing sharp analysis and critical insights into what’s next.
Welcome to the Health-e Law Podcast. This is Mike Orlando, your host for today. I’m a partner at Sheppard, and today I’m pleased to have Adam Herbst, who is a partner in Sheppard’s Healthcare group, which was recently named “Healthcare Practice Group of the Year” by Law360 for the fifth time. Adam’s practice focuses on Medicaid, Medicare reform, health equity, particularly among New York’s aging health population, and advising clients on healthcare transformation. As the former Deputy Commissioner for New York State Department of Health, Adam has become a very influential voice in reshaping what health equity means for New Yorkers under 1115 waivers, state-directed payments, managed care contracting and Medicaid reimbursement strategies. Welcome, Adam.
Adam Herbst:
Thanks, Mike. It’s great to be here with you today. Thank you.
Michael Orlando:
So coming out of J.P. Morgan, where the focus has been on AI, innovation and similar digital health offerings for streamlining access to care, what were your takeaways on what the increased use of technology means for the aging population?
Adam Herbst:
Sure. So I think if you zoom out, OBBBA, the One Big Beautiful Bill, which is where we spend a lot of time at J.P. Morgan discussing the digital front door, and the changes in economics and the friction points, and what is trapping a lot of the billing issues that are showing up in real life for providers. If you zoom out, the One Big Beautiful Bill is going to shape and reshape digital economics, less by creating brand new Medicare telehealth payment universe, but more by changing the coverage and the funding, whether digital models depend on it or not. And it’s going to depend on a couple of drivers. It’s going to depend on the demand and the benefit design, and a lot of digital-friendly pieces of telehealth and remote care, safe harbors and Medicaid financing constraints and program integrity pressures. So for a lot of systems, the digital front door is going to be ROI supported by Medicaid managed care dollars and waiver dollars, and the extra payment streams that are going to make transformation financially survivable.
So, the One Big Beautiful Bill is what we spend a lot of time talking about at J.P. Morgan. It’s a lot of trending conversations, and we’re going to see limits on Medicaid state directed payments. And that’s a big deal, Mike, because the SDPs have been used directly or indirectly to help stabilize a lot of the hospitals and safety net finances while systems invest in access and navigation and RPM and workforce models. And where the federal government is now, this is the kind of thing that doesn’t sound like digital health, but it absolutely changes whether CFOs and CEOs are greenlining a lot of innovation in their budgets right now.
Michael Orlando:
Considering this significant discussion around that adoption of the new billing requirements under OBBBA, and from your experience, what key considerations should the healthcare leaders keep in mind as they adapt to OBBBA when caring for aging population? And are there any unique billing issues they should be especially mindful of?
Adam Herbst:
Yeah, absolutely. Where billing and reimbursement friction is going to show up in practice are going to be asking, “Who is the billing provider and under what benefit?” So when I said “digital front door,” I often mean that as a triage or navigation, and that becomes a clinical care matter. So, if it crosses the line into clinical services, the question’s going to become, Mike, is it billed as professional services or facility or incident, too? And that’s a big issue from a workflow perspective, in terms of supporting documentation requirements.
It’s also going to come up for billing in terms of site of service and setting creep. So you have home and workplace and assisted living in the long-term care sector, virtual first clinics. Each are going to create different payer expectations and coverage edits. And then you have the cross-state care, right? The billing risk is often not, can I support a claim, but were we appropriately licensed and credentialed and contracted for where the patient was located? That’s a silent audit issue, but a very big one from a billing and reimbursement question. And then RPM-style programs are also there. I think the biggest trap I’ve seen in programs that are scaled operationally before someone verifies it, ordering the provider relationship and the patient consent. So, those are big issues with lining up with payers and what they actually will reimburse.
From my time as a regulator in government, and also I was an operator, I think the most expensive telehealth mistake is rarely fraud, Mike. It’s usually a workflow issue that was built by really smart people who assume the billing would be easy. It’s healthcare and nothing is easy in healthcare. If it were easy, none of us would have jobs, really. So, I think that’s a big missed opportunity for people to start planning with respect to workflow now and the billing issues later.
Michael Orlando:
What practical challenges do you anticipate for providers that are seeking to deploy technology solutions to address the additional OBBBA restrictions? Are there any restrictions or limitations that may affect previously, right, on in-network or hybrid in-and-out of networked revenue streams?
Adam Herbst:
Yeah, it’s a great question. Let me say this, carefully, and I think accurately. The biggest out-of-network billing framework in the market right now is still driven by payer contracts and state law and the federal No Surprises Act. Right? So, it’s not unique by OBBBA. So if someone is pitching OBBBA created a sweeping new kind of ban, I’d pressure test that claim. That said, to your point, your diligence is exactly what’s really important, because investors are routinely underwriting digital platforms on optimistic reimbursement assumptions, and regulators and payers are not sentimental about the hockey stick refs.
What I’d want investors and boards to watch for is, a lot of the revenue concentration or the gray zone reimbursement areas. So if a platform’s pro forma assumes, we’ll stay out of a network initially and bill at X, I think that deserves some red flags and some follow-up questions like, what happens when X becomes zero or becomes in dispute for 18 months? That’s a really important aspect with respect to revenue concentration.
The other is like the second opinion and the episodic specialty consult models. These could be clinically great, but financially fragile if the model depends on premiums or on patients paying large balances, like which the market is increasingly hostile to. And the care settings are obviously very messy with payer rules. Again, going back to long-term care and in the home-based and the DME adjacent workflows, and anything that looks like bundling clinical services with a subscription fee.
So, I think how sophisticated investors are weighing this risk versus scale coming out of J.P. Morgan is underwrite it to a contracted or collectible revenue case, not like the claim is technically there, it could be submitted, kind of case. And I treat reimbursement as a product feature—can it be platform reliably reduced in a clean claim and appeal to the packages? If it’s not, growth is just going to scale denials faster, and that’s a real thing and it’s not just a compliment.
Michael Orlando:
So, do you anticipate OBBBA will prompt changes in the way health systems structure partnerships or negotiate payer contracts? And if so, how do you see that?
Adam Herbst:
I do. And this is where I think proactive legal and compliance strategies are going to help systems and digital companies implement a lot now, and how general counsels and CFOs should balance innovation with enforcement risk. If I were advising a GC or CFO and a digital leader in the same room, I’d frame it like this, Mike. Innovation is allowed, but unenforced errors are optional, right? Practical steps that reduce exposure without killing a lot of the momentum.
So, from a contracting and structure perspective, it’s very important to define who is providing the clinical services. And this is not just under OBBBA, this is making sure like MSAs and SOWs don’t accidentally imply the vendor is practicing medicine. And that is something that’s going to be very true in our OBBBA world that we’re seeing now. You have to align fee structure with the actual reimbursement pathway, and you should look at licensure and documentation support around cybersecurity and claim support. That’s really important from a compliance perspective in OBBBA world today. And how GCs and CFOs balance this innovation with risk is really important in today’s posture.
And speaking as a former regulator, a lot of these systems should be thinking today about assuming that if the model scale someone’s going to eventually ask, show me how you knew this was compliant, because of all of the opportunity, but all of the compliance that’s going to be coming with OBBBA. You should build that story now while everyone still remembers why the decisions were being made.
Michael Orlando:
So, we focus a lot on the challenges and the pitfalls, providers, health systems and being mindful of the updates and the changes under OBBBA. But if possible, can we talk a little bit about the positive outcomes that may come with these changes?
Adam Herbst:
Absolutely. There’s definitely opportunity as the market is adjusting to collaboration and deal-making. And I think I’m seeing more diligence on reimbursement quality, and that’s going to help with addressable market. There’s going to be assumptions with respect to investors and strategic partners with growth, and they’re going to want collectible growth. So, more interest is going to be in platforms that help systems do the hard things cheaply, but also to build it out in today’s world and where we’re going to go over the next 12, 24 months. We’re going to see a lot of eligibility navigation and access management and documentation support and a lot of workforce leverage. So, that’s going to help reduce a lot of the friction in the Medicaid populations. And that’s an opportunity, and quite a bit of this is going to be placing where margins and mission can work together.
And I’ll add that what we talked about at J.P. Morgan was that everyone says that AI-enabled, and the winners are going to be right with AI-enabled, and it’s going to be about ensuring how it gets paid for without giving your general counsel heartburn. So, there’s a lot of true opportunity right now with respect to compliance and workforce leverage and a lot of that access management. So, a lot of positivity coming out of adjusting to the collaboration of the market for deal making in the next 12 to 24 months.
Michael Orlando:
So, let’s keep on that positive note. I want to finish by asking a question going back to J.P. Morgan and ask, what, if any, anticipated changes to healthcare delivery has you excited about the future of health equity?
Adam Herbst:
It’s a great, great question. I’d say that right now, what excites me most is that health equity is really moving from a value statement to an operating principle. Right? We’re seeing real shifts in how care is delivered, more care in the home and community, and better use of data to identify who’s falling through the cracks. And the payment models that at least begin to reward the prevention and continuity and the outcomes, rather than just volume.
So I’m really encouraged, Mike, by the integration of medical care with the support services and the social supports like housing and nutrition, a lot of caregiver support and behavioral health, because that’s where equity actually lives or dies, I think. And the expansion of these models with team-based care like community health workers, and again, the AI and technology, is going to help extend the reach without replacing a lot of the human judgment, which is also powerfully done when it’s done correctly and thoughtfully. So, I think the opportunity now is execution. And if we stay focused on designing systems around people rather than the institutions and hold ourselves accountable for the results across that geography and income and race and disability, I’m really optimistic that we can make equity durable and not just episodic.
Michael Orlando:
This was an excellent take on that, Adam, and I really appreciate you taking the time to be with us today. Thank you so much.
Adam Herbst:
Thanks so much, Mike. I had a lot of fun.
Michael Orlando:
That’s a wrap on this episode of Health-e Law, powered by Sheppard’s Digital Health and Innovation team, where health innovation meets legal expertise. Until next time, stay healthy and stay informed.
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