Pamela Jones: Managing Risk, Reimbursement, and Real-Life Care
In this insightful episode of How Health Systems Work, hosts Jim Burke and Steve Pratt sit down with Pamela Jones, Vice President and General Counsel at Reid Health in Richmond, Indiana. With decades of legal experience in healthcare, including 18 years with Franciscan Health and time in Texas, Pamela brings a unique perspective on the regulatory, operational, and community challenges facing rural health systems today.
Pamela shares how Reid Health is navigating high ED utilization tied to behavioral health and substance use disorders, the hospital’s innovative committee-based approach to “frequent flyers,” and how the organization has implemented a value-based enterprise (VBE) to improve care and reduce overuse of the ED.
The conversation dives deep into the legal frameworks around emergency detention orders, the role of the hospital police department, and how guardianship has become part of the care discharge process. Pam also highlights how engaging legislators, building trust with physicians, and shifting the hospital mindset toward social services are all critical to delivering sustainable, community-centered healthcare.
The episode closes with guidance for aspiring in-house counsel and reflections on what it takes to serve the full breadth of a healthcare organization—from legal compliance to Friday night calls from the ED.
Chapters
00:00 – Introduction to Pamela and her healthcare journey
01:40 – Transitioning from large systems to rural health at Reid Health
03:00 – ED overuse and substance abuse challenges in rural settings
04:50 – Reid Health’s committee-based approach to high ED utilizers
06:00 – Structuring a Value-Based Enterprise with physician alignment
08:00 – Emergency detention orders and court cooperation
10:00 – Guardianship and legal support for complex discharges
12:00 – On-call legal counsel, risk aversion, and team education
13:00 – Legislative outreach and engaging state policymakers
15:00 – Misconceptions about hospitals and consumer frustration
16:00 – Reid Health’s expanded social services and community safety net role
18:00 – The challenge of pivoting from acute care to population health
20:00 – VBEs and reimbursement strategies for healthier communities
22:00 – Government payor risk shift and the upcoming TEAMS initiative
24:00 – Current revenue focus: 340B, provider-based transitions, and DSH
26:00 – Physician governance and engagement at Reid
28:30 – Advice for aspiring in-house healthcare counsel
