Strategic Health Plans

Overview

Healthcare costs and outcomes are a critical concern for employers, which currently provide approximately half the healthcare coverage delivered in the United States. It is possible for employers to take a more active role, make changes and, in doing so, deliver better and more cost-effective healthcare to their employees and their families.

Our multidimensional Strategic Healthcare team helps both employers and their sponsored health plans understand and succeed in this changing landscape. We have deep experience in designing and implementing innovative arrangements along a spectrum based on risk, cost and potential reward. We help companies harness innovation and transform their benefit plan and business models to focus on healthcare delivery, management, cost reduction and effective data utilization.

We are experienced in direct contracting, ownership of data, specialty carveouts, nontraditional pricing structures, creating high-performance networks and other initiatives in this evolving space. Our full-spectrum counsel effectively manages Employee Retirement Income Security Act (ERISA) programs, pharmacy services, data privacy, intellectual property, complex contractual arrangements, and corporate governance and transactions.

Employer counsel includes:

Optimizing employers’ positions as payers in the healthcare system.
Facilitating employers working directly with other stakeholders, such as healthcare providers and pharmacies.
Achieving greater transparency by leveraging health plan assets, such as health plan data, to improve cost and quality outcomes.
Designing plans to comply with the overlapping and complex regulatory frameworks.
Navigating compliance with data-regulating frameworks, such as the Health Insurance Portability and Accountability Act (HIPAA) and the California Consumer Privacy Act (CCPA).
Protecting health plan data ownership and usage rights to enable and maximize current and future opportunities.
Assisting employers in establishing on-site health clinics, contracting with providers and billing for healthcare services.
Advising wellness companies on structure, services and support for employers and health plans.

We counsel many clients on direct provider contracting, including a diversified multinational mass media and entertainment conglomerate and a national manufacturing company.
We advise on direct provider contracting for a large, regional, multicampus nonprofit health system.
We represent an organization made up of large, self-insured employers regarding data rights and regulatory compliance. We have negotiated employer-favorable data-sharing agreements with industry-leading third-party administrators that are allowing this organization to conduct advanced data analytics on the health plan data of millions of covered lives on behalf of its employer members. These analytics are providing employers with insights on both the quality and cost fronts.
We regularly work with a variety of clients with traditional health plan structures in protecting their ownership of their own data in agreements with vendors, including third-party administrators.
We have counseled employers with traditional pharmacy benefit management arrangements in carving out specific services, such as specialty pharmacy.
We have represented an aerospace manufacturer in the negotiation of a bundled pricing arrangement for surgery services.
We have represented several employers in establishing a reference-based pricing infrastructure for the payment of healthcare based on a multiple of Medicare reimbursements.
As counsel to a multinational retailer, we advise regarding plan design, direct provider contracting, data rights and regulatory compliance. We negotiated the network services agreement and coordination of a tiered network structure for this very large employer as it sought to provide employees in two geographically concentrated areas with access to high-quality providers.
We represent a multiemployer coalition of 50-plus major private-sector corporations in data use, medical and pharmacy contracting strategies to transform and improve the purchase of healthcare through the members’ self-insured health plans representing over 7 million covered lives and $27 billion in annual healthcare spending.