Under value-based payment models, providers’ payment depends on their management of the overall health outcomes and costs of their patients. These arrangements can be extraordinarily complex and they pose new legal and business opportunities and risks for providers. Most importantly, providers must develop innovative new strategies to succeed in a payment environment that prioritizes value over volume.
Polsinelli’s team of professionals combines technical expertise, practical experience, and innovative perspectives to support a wide variety of participants in today’s changing value-based environment. We work with clients including hospitals, integrated health systems, physicians, post-acute providers, and other licensed health care provider entities to evaluate and develop strategies for success under these models. Our team can help you understand the advantages and disadvantages of participating in innovative public sector, commercial and direct-to-employer (or self-insured) value-based care models across the nation.
We also support innovators and entrepreneurs who administer or manage value-based operations, develop technologies to assist with care transformation, and design new ways to work with patients and providers to deliver better care.
Our team of attorney advisors includes former officials with CMS and the HHS Office of Civil Rights, former valuators, and attorneys with extensive experience helping entities establish and operate under Accountable Care Organizations and other value-based models. We have deep expertise in substantive areas including fraud and abuse, reimbursement, payor contracting, licensure and enrollment, data privacy and analytics, technology development and transactions, antitrust, state insurance laws and regulation of financial risk, public policy, FDA, government contracting and many other areas relevant to this complex and changing field.
Our services include the following:
- Financial relationship compliance analysis.
- Payment model design, selection, and implementation as well as evolution using current operations and infrastructure.
- Comprehensive support for clients engaging in value-based care, at all stages from corporate formation, to operations advice, to accommodating growth and evaluating potential exit strategies.
- Population health management advice regarding risk adjustment strategies and interventions to address social determinants of health.
- Legal services related to health care technology, including intellectual property, product licensing, and developing and optimizing compliant data security and monetization strategies.
- Advising and assisting with corporate structure, governance, finance, tax and M&A, contracting strategies, labor and employment, and regulatory compliance.