In Brief: A Digest of Healthcare Provider Alignment Projects

Client Success

Represented hospital systems and medical groups in developing, negotiating and implementing service line management agreements.
Assisted hospital systems and physician groups with the sale and acquisition of medical practices and other affiliations.
Assisted multispecialty physician groups in developing and applying for approval from Centers for Medicare and Medicaid Services (CMS) as shared savings ACOs.
Assisted ACOs in negotiations with health plans for commercial products and analyzed antitrust issues regarding the joint negotiation with health plans based on clinical integration.
Represented provider networks and quasi-networks such as IPAs, PHOs and ACOs in provider contracting, quality assurance, utilization review and claims payment. We also counseled on risk-based contract negotiations, gain sharing, insurance and licensure.
Assisted a children’s hospital in preparing a comprehensive analysis of alternative contractual relationships with an ACO-like organization affiliated with another pediatric hospital. We handled the contract negotiations and analyzed federal antitrust, tax and healthcare regulatory matters for the new network.
Created a multi-community, clinically integrated PHO involving two hospital systems.
Participated in American Health Lawyers Association’s work groups for Managed Care and ACO and Bundled Payment.
Advised providers on antitrust implications of joint venture transactions, development of ACOs, integrated networks, managed care contracting, and price and cost surveys among competitors.