Changes in integrated care delivery models as a result of the Affordable Care Act have led to increased use of employment models. More than a quarter of practicing physicians are now employed by a hospital or health system, however, employment is not the only or necessarily preferred model in all situations, and many organizations seek creative alternatives.
Our team works with health care clients to address the antitrust, fraud and abuse, and tax compliance issues that arise in the development of new care delivery models.
We have experience serving clients in the following areas:
- Development and implementation of clinically integrated networks, whether in the form of Accountable Care Organizations (ACOs), PHOs, or IPAs, that typically align independent physicians with hospital systems and their employed physicians
- Negotiation of ACO arrangements offered by third-party payers
- Formation of service line joint ventures
- Negotiation and implementation of co-management arrangements
- Development of Captive PC structures
- Development and expansion of more traditional Management Service Organization (MSO) models
- Practice acquisition and physician employment, including practice valuation and assessment of physician compensation models
Health systems, provider networks and health plan alignment
- Provider-payer strategic partnerships and joint ventures
- Creation and representation of provider-sponsored HMOs and PPOs
- Representation of disease management organizations
- Payer contracting, including capitation and risk contracting