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.