Public Health Unscripted, Episode 49: MHA/JD Alum & current Associate Attorney at Spencer Fane LLP, Kaleb Rasmussen

[Music] Hi, I'm Molly Griffin and welcome to the Public Health Unscripted Podcast. Join us as we share our mission to pursue health, wellbeing, and social justice for and with communities through nationally renowned teaching and research, practical applications of knowledge, and authentic partnerships inspired by our Jesuit tradition and identity. [Music] Welcome back to the Public Health Unscripted Podcast. I'm Molly Griffin and I'm here with MHA J.D. alum Caleb Rasmussen. Caleb, thank you so much for joining us for this next episode of the season. Yeah, thanks Molly, I'm happy to be here. We'd love to have us get started by just having you introduce yourself and give us kind of a quick overview of your background, which can include your education, internships, extracurriculars, past and present work experiences, kind of the whole picture. Sure, I'm Caleb Rasmussen, I belong to Sarah, my wife, and Cadence, my one-year-old at home. I got a bachelor's in economics from the University of Utah and a JD/MHA dual degree from St. Louis University, just graduated last year, passed the bar. And my internships involved health insurance administrators, consulting firms, health system, and an attorney general's office. I currently work at Spencer Fain, a national law firm with an office in Clayton, and I do health care and employee benefits. Very neat. And what made you pursue that dual degree? Did you think of law school first of the MHA program? Growing up, I always thought I was going to be a doctor. I pivoted when I realized my skills were better suited for the office setting. So I thought about going to law school, but I knew if I did, I would only be health care. Okay. So dual degree was really important because then it said, yes, I'm a lawyer, but I'm a health care lawyer. And what made you come to slu for that education when you first went to Utah? Slu is one of the only schools in the nation that have a dual degree program. Okay. Other schools might have a concentration, but Slu is one of the few that was on the list. And it stood out because of that. What sectors are you available to work in now because you have an MHA along with your JD? Yeah, that's significant. A lot of the hospitals will value the MHA because now I understand the business side of things, whereas most of the time when a health administrator, hospital administration asks the legal question, it's like, okay, we got to take this with a grain of salt. They don't know the business side. It's like, clearly they're just going to say no. Now that I have an MHA, I can say, okay, margin is really important. This is how the legal ramifications play into the margin. And I can be more effective in explaining my point. Many of your colleagues have an MHA or an MPH as well who are in the more health care side of law stuff. It's a good question. I far infuse between. Not very common, but whenever they come up, we reach out to each other, so it feels kind of common. I know everyone in the club. Yeah, I've had people reach out on LinkedIn that I have like 20 virtual contacts. And I'm like, okay, I don't know you, you don't know me, but clearly we have the same passions. Because you have the MHA JD degree from Iowa or whatever. We'll chat about it and talk to you tonight. And that's nice. Did you look into the Master of Public Health or were you set on the MHA? Yeah, I did look into the Master of Public Health. The MHA has finance and accounting that the MPH does it for my understanding. And so I knew that I was going to want that accounting back a little bit more than the public health. Okay. Can you give us an overview of your time in both the JD program and MHA program kind of how you're structured out what you're doing which classes? Yeah, I often think of the dual degree as kind of like a marriage. It's never 50/50. Okay. So you're giving 60/40/70/30/90/10 if somebody's totally wiped. But when with the JD and the MHA it's so different. The programs are using different sides of your brain. The classes are structured differently. The time slots are just totally contradictory. So you usually end up first year at the law school. Okay. And then you apply to the MHA the second semester. Within six months of in law school you apply to the MHA and then you enrolled the MHA program taking both about half and half. Okay. So that's the second year I said in law school for years total. And then from there you kind of pick and choose how you want your classes structured. And for me I ended up taking more law school classes to finish out the law school first. And then my last semester was the MHA. Okay. But that's not required at all. It just depends on what experiences and what things you want to prioritize. Like case competitions, internships and DC and things like that. You really have to pick and choose what you want and make it your own. With the JD side of it just because I'm not super familiar with the class structure. Is it any point that if you're also doing the MHA program you're missing out on classes that like some of your peers. Would be in or is that that those peers can take those classes any time. So it's okay. Could you give some background if that makes sense? Yeah, that's a good question. There are classes that I missed out on. Okay. So I was taking MHA classes. But that also goes for MHA classes too. So vice versa. It's tricky trying to line up all the electives in both degrees. And because of that you have to plan ahead and time management is really important. How did you go about balancing both the JD and MHA program? Did you put one above the other? Did you try to keep it pretty important? Yeah. Why is that they're both a lot of the same amount of time? That's a good question. I think I didn't try to pick one over the other. I intended when I started the MHA classes to put both feet in. And I think I did that. But there were opportunities that at the law school were very attractive. Like there's a DC internship that I was applying to. And so I said no to some things. Like the UAV case competition my third year, I think it was my second year. I was an observer at the UAV case competition. And I wanted to do it my third year. But then I ended up saying no because there are there was that DC internship. I didn't end up doing the DC internship. But there were case competitions other than the UAV that I did end up doing. Those case competitions are super helpful. And I think that I wanted to prioritize both. I didn't really want to prioritize one over the next. Yeah. With those case competitions that you talked about, what kind of unique perspective do you think you brought to the team? Because you had more of that lost side and that perspective. Do you think you had special skills or knowledge that maybe some other teammates didn't know about? The law school teaches you a way of thinking. I don't know that there's any like secret sauce that I had that other people wouldn't. Obviously there are laws that people like know about, you know about the Affordable Care Act. You know about hip-hop, you know about cobra. You know there's antitrust laws out there. When you get into the nitty gritty is less about knowing the law nuances and more about the structure of how the healthcare system works. And when you need to pause and say, okay there's a legal issue here, let's dig in. That's the more way of thinking that the law school helps. And I think I brought to the table that other people might not have had. What advice would you maybe give to someone who's in that first year of the JD program? And maybe honestly just heard about how they could get an MPH or MHA. What would you share with them about maybe the benefits or some things to think about before? Doing it. It's more money for sure. But it's a lifestyle. You're looking for it. You want to establish yourself as a healthcare attorney and you're passionate about patient outcomes. You're passionate about the social justice in healthcare. You want to see the big picture. It's not one area that's too niche. That's kind of how I see it. And as a 1L looking back, I think there's a lot of people that don't want to be boxed in. They want to keep their options open. That's great. I would recommend talking to it to an alumni, like me or lots of other people that have graduated from the dual degree program. And go from there. Very nice. Can you talk maybe about your transition? You mentioned that you were in law school and then you finished the MHA program last. How was that transition moving from the two programs but then back into the workforce after you took a break maybe from law school for a bit? It was tricky to make decisions. I was planning for the bar after I graduated from master's program. I took the bar and passed the bar, but I had to plan that out. And so when I graduated from the law degree first and then did the MHA, I actually started prepping for the program. bar exam. Wow, I was studying for my MHA classes. - Oh, okay. That's a lot of work. - I had my wife gave birth at the same time. So it was like, so much going on. - Yeah. - So I'm not sure that I would recommend doing it the way I did it. - Yeah. - But, no regrets. I passed my babies alive, and happy, and cute. My wife's, I think happy. Shout out Sarah. I think it was finding balance is like, like imagine. I would say the relationships that I built over the past three, four years, Marcia, Kevin, Father, Rosier, Dr. and Ard, all of them were vital in establishing that continuity, the balance, the important relationships that I built were vital. - Yeah. Can you tell us about your current role at Spencer Fane, LLP? - Yeah, Spencer Fane is a national law firm. So the people that I work with are not just in St. Louis. I do work all across the country. And I work in healthcare and employee benefits. Mostly healthcare. I've done projects for health systems, private providers, and insurance companies trying to help them navigate the contracts in between each other, the different entities as well as the national and state regulations. There's plenty of laws and new rules from state agencies, federal agencies that impact day-to-day operations. And a lot of the work that I do is quick research, a little bit in depth, but just letting them know this is what to expect. Let me know if you need more. And then I'll also dig into potential issues, like the World Health Transformation Program or the Vaccine Recommendation Guidelines that just came out. Those impact clients and we'll have people ask, okay, what do we do now? Is this an issue, medical malpractice? How do we frame our new vaccine recommendations? Those are all very impactful. We have a lot of people asking about the World Health Transformation Program. I can't speak specifics, client confidentiality. But I think it's helpful to know each state's approach. Missouri has Department of Health and Senior Services. The website is dedicated to the Rule Health Transformation Program. It has RFPs on there, quarter one, quarter two, quarter three. Hospitals are hoping to get money from the World Health Transformation Program. And it's hard to know exactly how much they're gonna get. And we're nervous that the money from the federal government that's coming down to the states through that R-H-T-P won't go to hospitals, that they're gonna go through the RFPs and it's gonna get stuck a little bit. But we'll just have to see how it all shakes out and hope that the World Health Transformation Program is helpful to hospitals and providers. - How do you go about educating yourself if you're working with different clients all across the United States when healthcare differs so much by state? How do you go about keeping your knowledge up? - Yeah, you do have to specialize in specific states. - Okay. - So I'm licensed in Missouri. I just applied for the Utah Bar. - Okay. - So I grew up in Utah. I live here in Missouri. I'm thinking about more states, but the more states you have, the more you have to say that you know. And you have to research those. - So are your clients then specifically Missouri clients? - I'll say this. I don't have any clients. - Okay. - A lot of the partners I work for, they have the relationships with the clients. And so those, I don't know all of the clients that I've done projects for who they belong to and like what those relationships are. But I do know those relationships are across the country. And so when I do research for it, it's not necessarily just Missouri or Utah. It can be in multiple states. The key though is when you go to court, that's when you need the license and saying, okay, my name's on that piece of paper. I'm a lawyer in Missouri. - Yeah, what's the typical timeframe of when you might have the opportunity to move into that kind of position? - Yeah, so that's the important timeline is when you look at law firms and how they bring new associates in and then partner track or of council. I didn't know what of council was until, like a year and a half ago. Basically it's like an associate that is not on partner track, but they've worked long enough to know what they're doing. Associates are usually in a law firm for about seven, eight years and then when you get to 10 years, that's when you start thinking more about the partner. You can also go out to become a general council or an in-house council. And a lot of people do that in the healthcare space. But there's also consulting options and analyst roles that are helpful, especially in like actuarial science and insurance. There's plenty of work there. - Where do you see yourself in five to 10 years? Have you considered everything about maybe general council for a hospital? - Yeah, I have. That's an option. I think I could either be a in-house or a law firm. Long term, I don't know, 15 years from now, I hope to be kind of in a state government board position or advisory commission or some sort of insurance entity that has a broad impact on the structural economics of the insurance and the state federal level. I think the private employers have a lot of power over what their employees insurance is. And that impacts patient outcomes. More than I think people are noticing. You wanna work in a hospital and impact patients, but what about their insurance? That's also a big part of it. - Just like curiosity, is there any specific class you took throughout your MHA program that you think you always are referencing or thinking about? - Yeah. Father Rojars Ethics class was probably the biggest one that stood out to me. And I always found that when you are analyzing the problems in our healthcare system and patient individual decisions stepping back and thinking about, okay, why is this the way it is? Let's pause, let's process this and what's the right decision to be made here? Sometimes there isn't one. Sometimes it's just like black and white, sometimes it's gray. Those ethics classes are very important. And I think those ethics decisions and those ethics teachings can be disseminated into lots of different classes. So like Professor Walter might teach a class about ethics, but it's not actually named ethics, but she helps you introduce it. Dr. Anard as well. And I think there's a couple new professors that I'm not familiar with. You'd be surprised at even in accounting. You're asking questions about like, what category does expenses and profits go into? But those decisions where you categorize different things can actually have ethical implications. Maybe I'm an nerd, maybe I get to when I reach there, but that kind of thing would be enjoyable. I miss Professor Arons. I think he's not here anymore, but if I had to say second class, that would be an accounting by Professor Arons. How do you keep ethical decision making at the forefront of your work? Yeah. Does it have to be like a rinder on your laptop? You know, is there something you do that sparks your mindset to remain ethical? Yeah, ethical decisions kind of sneak up on you. Most people don't realize that they have an ethics issue in front of them, and then after the fact they're like, oh, I wish I did that differently. I think a lot of people do that. I think trying to stay on top of your ethical mindset, I'm not gonna say that I'm good at it, but I think in the healthcare setting, it's really important. And especially with a lot of the headlines that come out, that pops up. Like, the others and ethics problem. Most people don't immediately see it. Moving more into that world of law, are there any specific legal updates that you think are important for our listeners here from topics you've been working on to topics you might just have observed on the news or anything that you really wanna highlight today? Yeah, yeah. So the one big beautiful bill act, healthcare providers have been scrambling to stay in business. And since the pandemic, the hospital margins have been sometimes negative, less than 2%, sometimes negative four. That's not sustainable. And when you're not breaking even, something needs to change. With the one big beautiful bill act, there will be a $1 trillion reduction in healthcare spending to help those providers by 2034. And Medicaid reductions, $819 billion. And the next two years, $60 billion in reduction for healthcare providers. So all of these people that are struggling to stay in business and help their patients, it's gonna be crippling. And those safety net providers will be selling their hospitals, their businesses, critical access hospitals, or they will end up closing. So when you look at those legal implications, when a bill is passed, that has implications. and trying to stay on top of things for healthcare providers is really important. really hard when you have so much reductions in spending from the one big beautiful bill act. Another update I think is the vaccine recommendations. A lot of providers have been just following the same recommendations for a long time and it's not a big change, not a big deal. And with these new vaccine recommendations, providers will have to make a choice. It's the CDC recommendations or an alternative recommendation. And there's that's a new dynamic. Yeah, I kind of heard of that. It just happened in the past month. Okay. And it's well not in the past month. It's been happening over the past six months and then last month it was official. So felt like that was a helpful legal update. No, that's a good one. Just going back on the one big beautiful bill because I did have a question that came to me. You know, St. Louis is just such a unique market where we have three really big competing healthcare systems. Do you foresee these three healthcare systems coming together? The marketplace becoming more competitive? What do you think will happen? Yeah, it's a good question. Consolidation is happening at a faster rate. You'll have a lot of hospitals that are that will have to be creative. Affordable Care Act presented the ACO models. And so you'll see a lot of health systems incorporate smaller providers. And those smaller providers will try to take on those consolidated competing roles, whether it's actually selling to one of these BJC SS type health systems, or maybe it's just a like a contractual agreement to share insurance rates. But as far as SSM BJC consolidating, that's never going to happen. Yeah. Hey, never say no. Yeah. But I'd be surprised. Consolidation is definitely ramping up though. And that's something to watch out for. No, definitely. There's always so many new things going on, especially in the legal realm. What would you recommend students do to kind of stay updated on all the ever new changing laws and updates occurring every single day? Yeah, I'm sure I'm not the first person that will have said this, but backers, hospital review is amazing. They do really good job. And you can go on the website and there's like 10 different types of email subscriptions. You can sign up for it. And I've signed up for like three of them. Obviously, I can't get to everyone, but on a day to day to day basis, that'll keep you pretty well updated. There's also Kaiser Family Foundation, Modern Healthcare, and then LinkedIn. It's the most productive doing scrolling I think I've ever done. It's just it's pretty helpful. You obviously have to find the people that you're going to give those good updates. I think it's a less well-known power tool for students. It's a lot of there's a lot of good internship opportunities only done as well. And I know that that's something as a student, I was so focused on. Once you graduate, it gets easier. People are more aware of you. And you're like, oh, yeah, okay, you might be a good fit for our organization. But as a student, you're just grinding. Just like looking for any opportunity, any internship, any fellowship. I remember I wanted to do a fellowship and I was really, really invested in that. And I pivoted and I was like, okay, no, I need to go to law firm. And that's where I'm at right now. Well, switching directions a little bit, we also want to take some time to highlight a really important organization to yourself. Can you talk a little bit about what kindness begins with me is? Yeah, kindness begins with me is a nonprofit I got involved with when I was a student. I needed sandfowers. And so I looked up an organization that was local nonprofit organization. And so I got easy sandfowers by driving refugees to and from English classes, driving permit classes, and women's social programs. There are opportunities, Mondays, Tuesdays, and Thursdays. And I wanted to let you guys know about these opportunities. And I'll send out more info. But these are really helpful for students and there's a need. Our nonprofit uniquely provides transportation to and from each event and program for the refugees. But we often have refugees that cannot attend these events because of our lack of enough drivers volunteers. So every driver would need to use their own car and insurance. But all transportation volunteers are eligible for gas reimbursement. And they can get to know the programs and the refugees and it's so helpful to the community. So I just wanted to put a plug-in for that. Yeah, I know that sounds like a great organization. Did you say you're on the board? Yeah, I am. I joined the board about last year, last year ago now because I felt like it was such an important thing for our community. We have a lot of refugees and the women's programs that are part of this nonprofit is actually growing a ton. And we have a lot of women that are getting their permits and their licenses and getting jobs and using their own knowledge from back home that can be applicable here in St. Louis. It's fantastic to see. Yeah, as the vice president of Service for SAMH by fully encourage all CPHSJ students and any student listening to get involved. Honestly, community members too. Is it open to everyone or specifically for students? No, it's open to everyone. So specifically for students, I will say that there's a ready board and the ready board is for we have lots of SLU students that participate and that helps create kind of a normal process for a lot of students that have the same experiences. They have classes to go to. They have a lot of social life. And when as a student, you know that other students are going through the volunteer process through the ready board, you know that there's a need to process. Can you give us a little bit more information as far as what is the typical hours or times most common that volunteers are needed? Yes, I can. The Women's Social Program is on Mondays from 10 am to 130 pm. The social circles are on Tuesdays from 4 to 6 30 pm. And there is driver's permit classes on Tuesday nights from 6 30 to 8 pm. And English classes probably our biggest recurring event is 6 30 to 8 on Thursdays. And there are other social events that happen, especially in this summer. And so you'll just have to keep an eye out. And once you sign up, you'll be in the loop on all of those events. Our volunteers usually require you to drop off and pick up. How does that partnership kind of go? Yeah, it depends on the availability of the student. It's pretty flexible. You just have to let them know, hey, I can't pick up today. I can't drop off. Like how does that work? Yeah, you can ask. It's very individualized. But the nonprofit kind of begins with me's coordinator, volunteer coordinator, Tony Zakinski is fantastic. She has a really good relationship with students. She knows the lifestyle. I think she got two students, two of her kids are students. Okay, yeah. So she understands. Yeah, no, that just sounds like a phenomenal opportunity. I feel like two students who are looking to get service hours, you know, and being able to directly impact community members who are our neighbors. Yeah, exactly. Yeah. Well, we always like to end our podcast with a fun question. So, Caleb, what's one hobby or school you've been wanting to pursue or get better at? Yes, cross stitching. My wife is good at cross stitching. I think my mom also did it. But I always thought I was like, no, I'm not going to give it to you. As I was spending more and more time with my wife, I'd like turn on a TV show and she should pull out her cross stitch. And so eventually, that's like, okay, wait, what is this? Let me see this. And so I ended up cross stitching one. And I think my first cross stitch pattern was forgive me. I am from the 1900s. And it was like a cassette tape and a VCR. And it was just like, I was born in 1997 and most people was like, okay, are you are you 20, 22, 23? No, I was born in the 1900s. So, anyway, cross stitch is the thing. It's an expensive hobby. Yeah, you have to buy a bunch of stuff. I didn't think of that. I'm also a big quote, guy. So I have lots of quotes that I like to keep track of. And when you cross stitch and you can you can cross stitch a lot of quotes. That is fun. Yeah. Well, Caleb, thank you so much for joining us on the podcast today from legal updates to learning more about kindness begins with me. I feel like we've just learned so much. So I really want to thank you for being here today and giving our listeners a understanding more, I think, to about dual degree programs at SO because sometimes it's it's important to hear about opportunities that you might not think of. You know, some JD students might not know that they can get that RMAJN MPH. So yeah, absolutely. A great perspective today. Yeah, thank you. I'm glad to be here. Thank you for joining us for Public Health Unscripted, produced by the staff and students of the St. Louis University College for Public Health and Social Justice. [BLANK_AUDIO]