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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.