90 - How Lobbyists Quietly Shape the Future of Your Healthcare! w/ Jenna Paladino

Show Notes

In this episode, Marcus and Vic are joined by Jenna Paldino, a healthcare lobbyist and founder of Paladino Advocates. They discuss Jenna’s work in lobbying for healthcare, including the influence of public policy, the impact of lobbying at both state and federal levels, and the importance of building relationships with legislators. Jenna provides insights on how startups can engage with lawmakers, the role of advocacy in shaping healthcare policy, and the complexities of navigating government regulations. The conversation also covers the differences between private equity and venture capital in healthcare lobbying.

Connect with Jenna:

• Linkedin - https://www.linkedin.com/in/jenna-paladino-fl/
• Website - https://www.paladinoadvocates.com/

00:00 Introduction and Hurricane Impact

01:00 How Marcus Met Jenna at a Conference

03:00 Jenna’s Role as a Healthcare Lobbyist

06:00 Lobbying and Relationship Building with Legislators

10:00 The Influence of Public Policy in Healthcare

12:00 Differentiating Startups from Private Equity in Healthcare

15:00 The Role of Venture Capital in Healthcare Policy

18:00 Importance of Networking and Relationship Mapping in Lobbying

22:00 Engaging Legislators with Startups and Innovation

25:00 The Challenge of Healthcare Regulation and Reimbursement

30:00 How Lobbying Shapes Healthcare Policy and Technology Adoption

35:00 The Role of Technology in Shaping Future Healthcare

40:00 Final Thoughts on Lobbying, Long-Term Relationships, and Political Influence

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What is Health:Further?

Every week, healthcare VCs and Jumpstart Health Investors co-founders Vic Gatto and Marcus Whitney review and unpack the happenings in US Healthcare, finance, technology and policy. With a firm belief that our healthcare system is doomed without entrepreneurship, they work through the mud to find the jewels, highlight headwinds and tailwinds, and bring on the smartest guests to fill in the gaps.

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Thank you.

All right.

Uh, welcome back to tell further our guest series, uh, bringing in a friend who I met last year while I was on the road and, uh, doing a keynote at the national hospice and palliative care organization meeting in Little Rock, Arkansas.

Uh, after I got done, I was getting ready to.

And was it at the coffee shop in the in the hotel?

And, uh, this, uh, very outgoing, uh, sort of very happy, uh, woman.

Jenna just sort of reached out and was like, Hey, you know, can we talk?

So you're on stage?

Uh, can I buy you this coffee?

And we got into like, we were like, What felt like about a 45 minute conversation where she really, uh, piqued my interest into all things in the world of lobbying, something that you and I sort of never spent any time talking about.

Right?

And so over the course of the last year, we've just kind of kept the conversation ongoing via email.

And, uh, as the podcast kind of got to a point where we were really focused on getting guests on regularly, I was like, Jenna, you know, would you like to come on the show and, and, uh, you know, educate us live in front of the whole world about how stupid we are about lobbying.

Uh, and she was gracious enough to accept.

So Jenna Palladino, welcome to the show.

Thanks guys.

Thanks for the invite.

I'm coming to you live from Tampa and yes, that coffee was worth my effort of 5 or however much it costs.

So, so thank you for the introduction.

Hey, really quickly.

Um, how's everything in Tampa?

My, my friend Edmondo Robinson, uh, who's an Aspen fellow with me, he lives in Tampa and he was actually here in Nashville the week of, of Helene and, uh, he, he was delayed going home because the airport was shut down and I know stuff, you know, I know there was.

Some flooding there.

Everything okay there at the moment.

Yes, we're um, north of the city and we're fine, but I do have some dear friends over the last few days that I've been helping schlep stuff out of their house.

I never thought I'd have that role, but um, we're going to be okay.

Tampa, Tampa will be fine.

Okay, we'll get back.

Thanks.

Yeah, thanks.

Thanks for sharing.

Um, all right.

Well, I guess we can just start.

Vic.

Do you want to start?

Do you have the first question?

I'm happy to start.

No, go ahead.

All right.

All right.

So, so Jenna, like, do me a favor and just frame up for us.

What it is you do, um, on a, on a day to day, week to week, month to month basis.

Like, what it is you do and where we might find you physically in the world doing what you do.

Like, I want to get a full visual of the work that you do as a lobbyist in health care.

Okay.

I am the original influencer before social media hijacked that word.

I like to think that public policy can be influenced, even in my home office here, which I've been doing for 10 years as the founder of Palladino Advocates.

I problem solve for my clients at the state and federal level.

To understand how just changing a little bit of a policy, um, or introducing a new bill could directly impact their growth segment, their ability to expand maybe even a market that they hadn't even thought about that I already know Congress is talking about.

So I am that influencer.

I'm able to see the big picture, package it easy for, uh, your startup investors or your Um, CEOs that are starting out and then make sure that I hold their hand the whole time and say, have you thought of and did you think of this?

And did you know that when they pass this bill 5 years ago?

It's coming back around for renewal because I've been around long enough to know that.

After that five year, uh, carve in, it's now going to be a carve out or, uh, pieces like that, that institutional knowledge comes with being a lobbyist.

Got it.

And, and are you, like you said, you're doing it from your home office.

Um, how much time are you spending, uh, in the legislative halls actually, you know, shaking hands, meeting with people, getting time on their calendar versus just sending emails or doing research?

Like what, what is, what does that sort of division of time look like?

Much like buying you that coffee, I buy a lot of coffee.

Um, I think it's better than beer and wine.

Uh, you can get people when they're alert and awake.

So I hit the halls of the Capitol all the time.

Um, even when they're not in a session.

So in the state legislatures, they're usually in session in the springtime.

Sometimes they're every other year.

Sometimes they're full year.

Most of them are part-time.

And then in Congress, you know, they say they're not year round, but they are, they still have a full office staff there.

And as a former legislative aide, I can tell you that those are the ones that get the job done.

So if I can go into a legislator's office or a member of Congress, uh, in the off season with, um, that cup of coffee and a conversation with maybe a.

bring along one of your startup find, you know, founders, then we can get a lot done.

So year round, I travel DC state legislators offices.

And then in the election season, um, I average about a hundred candidate interviews across several states to get to know them before they get elected.

That's important because my clients, um, want to see the landscape for the next two years or four years.

We can't look past those four years because we really don't know who's going to be in power, but we can at least see two years, you know, before term limits.

And it's nice to do some relationship mapping for them, figure out, um, if Representative so and so, you know, donates to the local synagogue or church, or maybe they go to the same place.

And I do all of that for my clients, making sure that they know before that session starts, um, why we're going to work with Senator so and so instead of the other one.

And I make sure that I work with D's and R's, which is pretty rare.

But I, I usually lead any interview by saying that I believe that health care is universal, but it doesn't have to be universal health care.

That's my tagline.

So tell us a little bit about like, what the.

The field of play looks like when it comes to lobbying in healthcare, right?

So you're out there, you're doing work.

There are other folks out there also doing work.

Is it like, basically you go in with your agenda of things you are trying to influence and you're trying to find people who can be influenced.

Do you run into people with a counter agenda and, you know, you have to sort of maybe even triangulate where.

You don't want to be shouting in both sides of the ears of, you know, whoever your target is.

And you have to find a way to sort of meld that message.

Like, because I know it's not just you when you're out there sort of interfacing with legislators.

So I like to say that I'm an advocate as well as a lobbyist.

So the lobbyist is the profession.

Advocacy is, um, you standing up against your HOA and saying, no, you're not going to put that, uh, insurance right here where you want it over here.

And you work, you know, as a volunteer.

So I have a lot of experience taking volunteer groups, as well as for profit entities, putting them together, building some alliances together.

And then when we go to do our meetings, we're well prepared on what both sides could be.

Because volunteers will, will tell you that they can be pretty strong on one side, but then I can also get the other side to come to the table for that same meeting.

So I'm, I'm never going to pound my fist and, you know, go to the media and, and holler that, you know, there's injustice.

I can fix injustice.

That's easy.

I, I can, I can work as an advocate and get all of those folks together and take my passion in a different direction.

So I'm curious, um, how much is you meeting the candidates before they're elected and then kind of getting to know them so that you understand their, their favorite, um, initiatives or their, their real passions.

And then for a client, you know, Okay, these state, uh, legislatures and these national legislatures, they'll be very receptive because I already know they're passionate about your topic.

Or alternatively, are you trying to change minds and like introduce something that the legislator hasn't thought of yet?

What, what's the balance?

Is it, is it more one than the other or is it just depend?

During COVID, it was really easy to get to know candidates because they were all in their bedroom or maybe in their living room.

And they had the kid running by with the soccer ball and they were trying to do life while they were trying to be a candidate.

And I can say there's some pretty, uh, high powered, high influence folks that I've seen, um, you know, quickly turn and swat at the kid who's running by.

because they were in real life.

And so those folks, I got their cell phone numbers, you know, we chit chat about the soccer game or, or whatever, you know, it might be, they got a new dog and they send me a photo.

So I bring my clients along for that.

It doesn't have to be a big spend.

I'm not looking for the next client that has a huge PAC, a political action committee, I'm looking for the next client that says, you know what, we really could have done a better job of letting our legislators know that in their backyard, there's a great new startup.

And we're different than a private equity that's trying to come into healthcare and dominate.

You have to delineate yourself right away.

So that conversation at the beginning when they're just a candidate and they really want to help the world, because I do believe that people run for office because they want to help, You have to keep them engaged with, Hey, don't forget this startup.

You know, it's more than just a ribbon cutting or you coming, uh, you know, to see our office one day.

It's you inviting that founder to come to the Capitol for a founder's day in the Capitol.

And then we both get the benefit of that relationship.

So I think that starting when they're a candidate is the first step.

But it can't just drop off.

I can't just send them dog pictures and baby pictures after that.

You know, I then have to have that founder, that startup person, come with me and bring them to the district office or the, wherever we're headed.

Um, and then the ribbon cutting.

And then there's, there's different steps along the way.

Well, before we need a bill passed,

you, you, uh, you brought up differentiating startups from private equity.

We, we are constantly sort of covering, uh, the, the discussions around private equity in healthcare, uh, kind of across the country.

Um, probably the two biggest states that we are mostly covering are Massachusetts because of everything going on with Stewart health.

And then also California, just because of some of the, the laws that are on the, that are We can being considered to be on the books there.

Um, you know, you brought that up as as something that was important for startups to, uh, differentiate from.

And I get that.

I can see why on a myriad of different levels, it makes sense.

It's more sort of, you know, Main Street versus Wall Street, et cetera, et cetera.

But like, what can you tell us about how private equity is doing?

In healthcare in government right now, you know, with, with legislators, like, you know, do they have lobbyists in there sort of working to try to clean up their image?

Cause it, it seems like the image is, is really, um, getting a hatchet job from a PR perspective.

You know, we see so many stories in the wall street journal and the New York times targeting private equity and healthcare.

You know, inside of the actual legislative halls.

Are you seeing more discerning conversations about that or and we're not private equity.

So, you know, I think we're just we're just sort of curious about where this is all going because it does affect M and a later on.

Right?

Um, what are what's kind of your your sense there?

So I have represented, represented PE in the past.

Um, we did some really great things for PTSD, for first responders, getting them better work comp coverage.

So there are altruistic, um, thoughts on PE.

And I think that, Your question about the halls of government.

Um, you really have to pay attention to Senate Bill 4804 and that's the, um, the new Health over Wealth Act.

And that's, that's a senator from Massachusetts.

So that's, that's the correlation you just brought up.

Um, that's looking at disclosure for those that were employed before they were acquired.

and making sure that, you know, they still have a job, they still have the same rights, all of those things.

But I think that's also a really great opportunity for VC to come in and say, okay, while you think that big bad PE is, uh, you know, taking everyone over, let me show you where we're starting.

Let me show you how we're innovating and our strategy to grow these mom and pops.

In the technology, in the integration of what the strategy is already, you know, we're not, we're not creating, um, uh, we're not all creating new lines of business.

We're improving what's there.

And if there is a new line of business, then jump and scream and shout and show it off.

Do you see VC like in the lobbying world, generally speaking?

I mean, um, It feels like over the last year, VC has gotten very political.

Um, you know, we're, we're, I mean, I think we can, we can.

Reference injuries and Horowitz as a, as a firm that just was always very much about innovation and capital.

Um, but this year is actually, you know, focusing on politics.

It's, it's right on their homepage right now.

They've got sort of a whole manifesto around little tech and their sort of positioning around the differentiation between big tech and little tech and really being, um, very outspoken about the way in which they perceive government to be trending as it pertains to embracing the innovation from little tech, AKA VC, you know, um, the only thing I've ever sort of encountered from a lobbying perspective with VC as an organization called engine, uh, that, that like basically does advocacy on behalf of the entire venture capital and no knock to them, but I've never felt that compelled by the, you know, the different things they email me about.

It just doesn't feel like it's that consequential.

Um, it feels like I'm glad somebody is out there doing it, but not enough to be like, okay, I'm going to show up to their events or things like that.

So are you seeing a shift recently where you're seeing more VCs recognize, um, the impact and maybe, maybe even more so in healthcare VC, but.

Uh, we're seeing more VCs saying, actually, we have to find ways to, to get involved.

And it's important for us to not sit on the sidelines because there's real implications of what happens in, in DC, at least in particular, uh, to our industry writ large.

So government is set out to be reactionary, not proactive.

And if you think of that all the time and you're able to follow the money, yes, there's always a campaign component.

But that's because it costs money to run a campaign to get people elected, so it shouldn't make you shy away or say, you know that we're a lost cause or we don't have money to play.

There's always money to play.

You always have the opportunity to even write the 500 check and help the local person who then can help guide your board and maybe they have a consulting job on the side because they all have second jobs.

Um, they're all involved in something and they're able to help guide and say, Hey, this is where we're headed.

So bring that legislator on board.

As an advocate of their own, you know, they probably have some great business venture that they're looking to launch to, but we wouldn't know if we didn't ask them.

So I think that yes, there is VC advocacy and lobbying.

Um, I'll stick to the lobbying side because I only know of that one organization that you mentioned.

There's not a lot of them.

Yeah, but if we go into the policy side, you and I talked briefly after that hospice, um, uh, conference, but then there's also hospital at home.

There's, we're going to bring everything that you need into your home.

We're going to assume all the risks and you're going to be great.

You're not going to be readmitted and we're not going to get dinged for that.

Okay.

That sounds really nice.

But what just happened here in Tampa?

We had an onslaught of bad weather.

We had folks who were in the hospital at home program from our local hospital, which I don't want to throw out the name.

They were in a shelter and unable to even talk to the hospital.

So we have, we have little incremental steps of where we're able to age in place where we're able to get people into their homes, but we really don't have great research yet.

Yeah.

It's only the top tier hospitals that are providing those services.

Hospice keeps getting their rates cut and they'll get cut again after sequestration and everything else that keeps falling into into place.

And that's where you fall into place saying, Hold on.

We have some technologies that would allow that person to keep in contact with that hospital.

We have some technologies that are available in in whatever setting doesn't matter where they are.

I went through your portfolio quickly and said, Oh, this would have worked in that hurricane.

This would have allowed people to communicate with their practitioners.

And are those are stories that you, that you feel like immediately after the fact, like while it's fresh on people's brains, you should be saying, Hey, you know, this is something to kind of put on people's radar.

Like, okay, this happened.

There was a gap in communication.

This kind of technology may have been able to create a solution and maybe, you know, not necessarily immediately, but over the course of two years, you can have a conversation that can lead to potentially a pilot, you know, with, with the state Medicare and Medicaid, you know, is that kind of where you're going with that?

I'm trying to understand like the practical, like how, how would we, the next

part is.

You know, pilot programs are great because you can get a chunk of money to start the research, basically.

And then you become that subject matter expert.

And you mentioned Massachusetts and California.

Florida loves them, too.

Um, you know, Rick, come on down.

I'll show you around.

But it's a really great caveat to say We've already been, um, orchestrating this in these states, or we have this kind of, uh, data already, and we're ready for that next storm, because it's not an, uh, an if, it's a when.

It's coming.

And with 11, 000 new, um, Medicare beneficiaries every day.

The the market's there and as far as medicaid, there's some other states I'd probably prefer over florida, but uh, we could talk about that another time.

Yeah, so jenna i'm interested in Um, we we hear stories of big money Lobbying like, uh, peter teal supporting particular candidates or or funneling money in who's a, you know, famous vc other other folks where Um, for me and for a lot of the startups and even the audience members that are investors or healthcare executives that are listening, I don't have that kind of money.

And it seems like you're implying that for smaller amounts of money, you could group together and talk about a topic that you have a creative, innovative technology solution, you know, better, faster, more effective for the nurses and doctors and patients.

What is the budget, or how do people approach this if they don't have that, that huge war chest and they want to come to you and just get some advice, some help?

How do they start?

So I'll give one example and then answer your question if you don't mind.

Um, when I first started lobbying, I had the national multiple sclerosis as my first client.

And there's roughly a hundred thousand folks living with MS that affects your central nervous system.

And you may not know that someone has it.

So I would take folks to the Capitol and they'd go, well, they look fine, every, everybody looks fine.

What's the big deal here?

What do you really need?

But then we did a really great demonstration and we had them put on slip, um, mask and snorkel feet and some crazy gloves.

This was to show what optic neuritis and your central nervous system shutting down and you with drop feet trying to walk.

Immediately, those 100, 000 people that I was speaking on behalf of with the three or four in that room, we got their attention.

If we can show, back to your question, Vic, if we can show that we are a solution to a problem, then the big checks are a nice to have, but everyone likes to hang their hat on what's going on in their district.

They like to be proud of what you guys are accomplishing, and if we can do some relationship mapping and figure out that, you know, Mary, who works on an app that you just helped fund, lives in so and so's district, I, I can run the course with that conversation and, and get them in front of the right people.

So checks come into play, um, more for Congress than state.

Because those campaigns are incredibly expensive in Florida.

You can run a campaign for a house district.

That's about 150, 000 people.

You can run off of about 200 300, 000.

So just magnify that for Congress and see how much more they need for for a major city.

Um, and the Senate's totally different.

So signing up to be a part of their dialogue before they're elected, and then taking the steps to make sure that they understand the value before they get elected, then they bring you along.

A lot of them form different, um, uh, uh, like community leader groups after they've gotten elected to help them navigate policy because they really They can't possibly know it all.

So I've sat on a couple of those, um, coordinated groups, you know, Hey, we'll get the best brightest in the room to talk about healthcare policy in the district.

Those types of things happen as soon as they get elected.

Um, and that's kind of how you bootstrap your way through.

So that's, that's pretty interesting.

Um, there are definitely a fair number of, um, healthcare startups around the country.

This is not just in our portfolio, but we certainly have.

Uh, a critical mass of them.

So I can say this is representative of the broader, you know, startup universe that are trying to sell into state managed care organizations.

Um, state Medicaid agencies, um, or, you know, state Medicare trying to get state Medicare contracts.

Right.

And I think generally speaking, they are focused on, uh, selling into the state agency.

and or the managed care organization in that particular state, right?

Um, what can you tell us about situations where you have seen organizations who are doing that, where they've leveraged lobbying to also have, um, influence with.