JoAnn Dalrymple brings over 30 years of experience in the healthcare legal area, including a 23-year commercial litigation practice focusing on healthcare reimbursement and ERISA benefit disputes prior to becoming a full-time neutral in 2017. She first joined the AAA’s roster of arbitrators ten years ago and currently serves on its healthcare, commercial, consumer, and pension/ERISA panels. As a solo arbitrator, chair, and wing panel member, she has served in over 130 arbitration matters across the country.
We asked her how her expertise informs her approach on the American Arbitration Association® Healthcare Panel.
Q. Tell us about your background in healthcare law, the healthcare industry, or your time on the bench handling healthcare-related cases.
Prior to becoming a full-time neutral in 2017, I practiced commercial litigation for 23 years in state and federal courts and arbitral venues across the country, focusing on healthcare reimbursement and ERISA health and welfare benefits disputes. I had the opportunity to represent and counsel healthcare providers, plans, insurers, claims administrators, employers, and employees in a variety of health and managed care (physician, facility, behavioral health, drug/pharmacy, and ancillary services) reimbursement disputes, ERISA and plan benefit-related litigation, and regulatory and contracting matters. This work also included intricate contract disputes involving multiple parties that needed to create or preserve good business relationships with each other and thus required practical approaches to reach “win/win” solutions. As an AAA healthcare arbitrator for the past ten years, I have served in over 50 healthcare disputes, drawing on my prior healthcare litigation and counseling experience to conduct the arbitrations in an efficient and thoughtful manner.
Q. What types of healthcare disputes do you typically handle as an arbitrator or mediator?
As a AAA healthcare arbitrator, a majority of the matters I handle are payor/provider reimbursement disputes involving upwards of thousands of healthcare claims with millions of dollars at issue. These matters have included managed care (private and Medicare/Medicaid) reimbursement claims of all types for various physician and facility specialties (e.g., coding, pricing, claims submission and payment policies, prompt pay, level of care, medical necessity, etc.), 340B drug pricing programs and other inpatient/outpatient/specialty drug reimbursement and pharmacy benefits, and behavioral health and ancillary services disputes. I have also handled medical practice governance and separation disputes and contract disagreements between medical practices and their supporting vendors.
Q. What drew you to ADR work in the healthcare space? What do you value most about serving as a neutral on the AAA’s Healthcare Panel?
From my litigation and counseling experience in the healthcare industry, I have seen the various perspectives and interests of the different parties involved in the space and have learned pathways to achieving the cooperative balance needed for the healthcare delivery system to properly work. I wanted to bring that experience to aid in the resolution of disputes that invariably arise in the industry. As an AAA arbitrator, I value being a part of the AAA’s well-constructed process that allows parties to quickly, efficiently, and cost-effectively resolve their issues so that the parties can get back to their business of providing healthcare services.
Q. Are you noticing any emerging issues or trends in healthcare cases coming to arbitration?
Disputes involving the 340B drug pricing program have grown over the past couple of years. For payor/provider disputes with large claim volume, I see more parties collaborating early on regarding ways to streamline discovery and final evidence presentation, e.g., utilizing a joint statistician expert for any sampling to reduce costs.
Q. What advice do you have for parties preparing for arbitration or mediation in complex healthcare disputes?
First, examine the disputed issues as early as possible so you know the most appropriate and efficient path to resolution or conclusion. Be ready at the preliminary scheduling conference to discuss best avenues to evaluate and present at final hearing complex issues like voluminous and varied claims disputes. We move faster in arbitration, which requires preparedness and efficiency. Second, cooperate whenever feasible. Cooperation among the parties is key to achieving efficiency for everyone and getting the parties back on track to their primary business of delivering healthcare services.