Overview
– The Legal 500 US, Healthcare: Health Insurers
Healthcare innovation and new payment and reimbursement models are top priorities in managed care law, with partnerships and consolidation taking center stage to provide – and get paid for – better health outcomes. Those who want to grow and innovate within this evolving healthcare environment face complex regulatory requirements and significant scrutiny around transactions. To thrive despite these challenges, you must be willing to take calculated business risks and adapt to a shifting landscape.
Creative solutions for complex ACO, health plan, and managed care legal matters
Our experienced Accountable Care Organization (ACO) law team anticipates change and crafts creative, strategic solutions in even the most complex markets. Clients turn to us for our depth of knowledge on key issues and our unmatched skill in navigating the complicated industry issues they face, including numerous types of managed care arrangements, new reimbursement and care delivery models, and integrated delivery systems for health insurers, hospitals, academic medical centers, other institutional inpatient and outpatient facilities, medical groups and independent practice associations, physicians, medical discount programs and employers, as well as for investment bankers, venture capitalists, and individual entrepreneurs. Our Firm also works closely with health insurers and pharmacy benefit managers (PBMs) on prescription drug plans and pricing issues.
We work tirelessly to facilitate connections through mergers, acquisitions, affiliations, and joint ventures between traditional healthcare companies and non-traditional players, conducting full due diligence while identifying and negotiating arrangements built with regulatory and technological assessments and solutions in mind.
Our team provides guidance to ACOs on the Medicare Shared Savings Program requirements for organizational and contractual arrangements. We also advise trade associations on communications to members regarding legal developments, draft comments on proposed regulations and subregulatory guidance, and offer strategic counseling in dealing with state and federal agencies.
As the United States’ top-ranked health & life sciences law firm, we offer unmatched experience addressing the legal obstacles facing health plans, managed care organizations, and ACOs, including providing counsel on:
- Administrative services only arrangements
- Requirements under the Affordable Care Act, such as tax issues and risk management
- Antitrust and trade regulation
- Bankruptcy and workout plans
- Consumer-directed health plans
- Prescription drug pricing
- Conversions and tax-exempt issues
- Corporate integrity agreements and compliance programs
- ERISA
- The Federal Employees Health Benefits Program
- HIPAA privacy and security
- Tiered-benefit arrangements and disease management programs
- Medical discount programs
- The Medicare Advantage Program and Medicare Part D
- Federal and state licensure of plans and insurers
Drawing on our deeply experienced team of healthcare lawyers, we provide cutting-edge solutions and creative counsel to our health plan and ACO clients to help them achieve their business goals.
