Strategic Healthcare Initiatives

Overview

Healthcare costs and outcomes are a critical concern for employers, who 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.

Furthermore, it’s no longer enough for providers to offer care, convenience or technology. Led by federal programs like Medicare and Medicaid, value-based purchasing programs are presenting new challenges and opportunities for providers. Providers are now looking to deliver a higher quality of care with better outcomes, paired with an efficient cost structure and improved accountability.

Our multidimensional Strategic Healthcare team helps both employers and healthcare organizations 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 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.
Provider counsel includes:
  • Emerging models of care and reimbursement (Medicare/Medicaid, ACOs).
  • Design of payor contracting platforms (value-based contracts, centers of excellence, and bundled payment arrangements).
  • Strategic affiliations and initiatives.
  • Innovative solutions that work within complex and evolving regulatory frameworks such as the Department of Health and Human Services’ “Regulatory Sprint to Coordinated Care.”
  • Compliance with state and federal laws and regulations, including anti-kickback, self-referral, gainsharing, privacy and security, licensure and certification.

Select Experience

Employer experience
  • We counsel many clients on direct provider contracting, including a diversified multinational mass media and entertainment conglomerate and a national manufacturing company.
  • We counseled a national manufacturing client on all aspects of an innovative health plan arrangement, including maintenance of a custom network of specialty providers.
Provider experience
  • We advise a large regional multi-campus nonprofit health system in creating a custom network to offer direct access to employers in its region to streamline competitive pricing and better access for employees.
  • We assist hospital systems in evaluating decisions concerning participation in ACOs, alternative payment models, and value-based programs, including entering, exiting and reporting under the CMS Quality Payment Program.
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Professionals

Name Title Office Email
Counsel Columbus
Partner Cleveland
Partner Atlanta
Partner Cleveland
Partner Columbus
Partner Cleveland
Partner Cleveland
Counsel Philadelphia
Associate Atlanta
Partner Washington, D.C.
Partner Philadelphia
Partner Houston
Partner New York
Associate Atlanta
Partner Houston
Partner Atlanta

Experience

Employer experience
  • We counsel many clients on direct provider contracting, including a diversified multinational mass media and entertainment conglomerate and a national manufacturing company.
  • We counseled a national manufacturing client on all aspects of an innovative health plan arrangement, including maintenance of a custom network of specialty providers.
  • 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 quality and cost fronts.
  • We work with a variety of clients with traditional health plan structures in protecting their ownership of their 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 seeking to provide employees in two geographically concentrated areas with access to high-quality providers.
Provider experience
  • We advise a large regional multi-campus nonprofit health system in creating a custom network to offer direct access to employers in its region to streamline competitive pricing and better access for employees.
  • We assist hospital systems in evaluating decisions concerning participation in ACOs, alternative payment models, and value-based programs, including entering, exiting and reporting under the CMS Quality Payment Program.
  • We counseled a community hospital in the development of a clinically integrated network (CIN) of providers, including evaluation of corporate structure and regulatory issues and preparation of governance documents, participation agreements, and CIN policies and procedures.
  • We advise a fully integrated healthcare network in contract and regulatory matters, including affiliations with community health systems.

News

Publications

Changing the Trajectory of Employer-Provided Healthcare