Payor Contracting and Value-Based Care

Telehealth, digital health, and other technology enabled care delivery models often lead to challenges relating to health plan contracting because they do not squarely fit within existing contracting and reimbursement pathways or involve a novel combination of services that may include both clinical and non-clinical features. Value-based care, with its own dynamic, novel innovations adds further layers of complexity in the contracting world.

We specialize in helping businesses overcome these challenges and support health care organizations in their partnerships with health plans and government payors, including complying with health insurance, managed care, and government program requirements; managing and expanding risk-based arrangements, drafting and negotiating agreements; and advising on reimbursement pathways, business development opportunities, and government policies.

Our work in this area includes:

Helping businesses establish and formalize relationships with health plans, managed care organizations, self-funded employers, and other payors of health care services. We provide advice on how to structure these relationships, help develop strategies for contracting with payors, draft and negotiate payor agreements, and provide ongoing legal support relating to health plan, government, and managed care operations.

Guiding the design and implementation of telehealth, remote monitoring, and other digital health products and solutions for Medicare, Medicaid, and other government and commercially insured populations.

Helping organizations develop, negotiate, and prepare agreements, applications, and operational approaches for participation in value-based care arrangements within specific payment populations (Medicaid managed care, Medicare Advantage, ACOs, employer-funded programs, CMS innovation programs, etc.).

Strategically deploying consultants and making key industry contact introductions to further bridge the legal and operational landscape.

Creating and operationalizing value-based contracting organizations like clinically integrated networks, direct contracting entities (now known as “ACO Reach”) and accountable care organizations.