Implementation from the Ground Level

There's never a dull moment overseeing the CareFirst legal team, and Randy Sergent faces all of the unknowns with the same commitment to thoroughness

At any given moment, Randy Sergent has a lot on his plate working for CareFirst BlueCross BlueShield, but it’s a scenario that he’s been preparing for his entire career.

Sergent, who is the vice president, deputy general counsel, and assistant secretary for CareFirst, manages the Baltimore legal office, which is roughly half of the company’s legal department. He leads his team of attorneys in providing advice on the corporate and regulatory issues for the company, while also managing a team that prepares and obtains approval of member benefit contracts, policy forms, and similar documents. Before taking on this role, though, it was his career path itself that made him more than ready to take on this type of leadership position.

Prior to joining CareFirst, Sergent was a partner with Venable LLP, where he was involved in insurance regulatory matters and litigation. He also served as deputy counsel to the Maryland Insurance Commissioner and as an assistant attorney general within the civil litigation division of the office of the Maryland Attorney General.

“In a heavily regulated industry like health insurance, it’s important to have a broad perspective,” Sergent explains. “For what we do day to day in-house, we quickly need to recognize which are the important issues and which are not, and how the business project is going to be shaped by the regulatory environment. It often requires a lot of nuance and understanding, and a broad background and deep business understanding really is necessary to bring your full abilities to bear on what you’re doing.”

Sergent is constantly working on numerous projects, but one of his team’s most important ongoing initiatives is the provision of advice-to-patient care initiatives, such as CareFirst’s Patient-Centered Medical Home (PCMH) program, among other programs designed to better integrate patient data, to provide better resources for primary care, and to improve and streamline care for the sickest members. The CareFirst legal team has played a vital role in ensuring that such programs are developed and implemented in compliance with a broad array of federal and state laws, as well as regulations.

Sergent and his team must also help guide each initiative through issues such as conflicting state and federal privacy laws, insurance laws, federal tax laws, laws governing the provision of medical care, marketing laws, and more. “For all of those programs that can have a direct impact on member care, it’s important that my team is able to get in at the ground level and help design the program in a way that it works for the business within the existing regulatory framework,” Sergent says.

When he’s not handling complex projects, Sergent’s days are spent handling the challenges that come with being a legal professional in the medical industry. One such challenge is the sheer volume of new laws his team encounters. The Affordable Care Act and its regulations stand out, but other examples include changing privacy regulations, state insurance laws, and antikickback and antifraud requirements.

“If there was one thing I would tell a young lawyer on how to become successful in this field, it would be to learn not just the law, but learn your client’s business thoroughly.”

Sergent and his team must also rapidly digest new and changing laws as they emerge in order to enable CareFirst to adjust its operations as needed. “The key is that we have to be proactive as a department. We can’t wait for someone to bring problems to us,” he says. “We have to understand deeply what the business needs are, where it’s going, and what it wants to do so we can identify the legal problems before they become business problems.”

Sergent is in an interesting position, as he doesn’t just manage other lawyers, but he also gets into the mix when needed. He will often take a lead role, particularly on high profile, sensitive projects. He also has to find time for the third leg of his managerial role: overseeing and supporting the contracting team that prepares and obtains approval of policy forms, contracts with employers, and similar documents.

While it’s not strictly a legal function, it is an important role for the company that is highly deadline-oriented and involves making sure approvals are obtained and forms are loaded into the company’s system for the entire spectrum of the company’s products.

“I think you balance [different roles] by paying close attention to all of them and giving them the time that they need,” he says. “I’m not sure I have a magic formula to it, but the variety keeps you on your toes. It certainly makes me a better lawyer to have a business unit with non-legal concerns as part of my responsibility. The real key, though, is to have an excellent team on whom you can rely. Our legal and contracting teams are highly skilled and motivated, and often, I am supporting them as much as or more than directing them.”

The general counsel isn’t shy about admitting his job is challenging, but he also believes it’s a good time to be an in-house counsel. One main reason is because he gets to be part of a team pursuing a company mission rather than just serving as an outside consultant and because in-house legal work is becoming increasingly sophisticated. As in-house counsel, he gets an opportunity to learn about a variety of different subjects, and he believes it’s important to know how the business operates nearly as well as his clients.

“For example, if I need to advise finance on something, I’m going to also need to understand the non-legal constraints that finance is functioning under to give legal advice that makes sense and is workable,” he says. “If there was one thing I would tell a young lawyer on how to become successful in this field, it would be to learn not just the law, but learn your client’s business thoroughly. Your solutions will make sense only when you understand the problems that your clients face.”