Leaders in Clinical Integration
The combination of in-depth knowledge of hospitals, physician practices, and managed care with antitrust expertise and transactional acumen makes HMBR’s attorneys uniquely capable in the formation and implementation of clinically-integrated physician and hospital networks. At HMBR, we believe strongly in the value of clinical integration – both in the way it fosters collaboration among independent doctors to increase the quality and efficiency of patient care, and in its ability to provide a basis for collective physician and hospital negotiations with PPOs and other fee-for-service health plans. Further, clinical integration can uniquely position physicians and hospitals for emerging reimbursement models like episodic bundling, pay-for-performance, and shared savings.
The health care practice of Hogan Marren Babbo & Rose, Ltd. provides a comprehensive catalogue of legal services relative to creation of Accountable Care Organizations (ACOs), IPAs, PHOs, and other provider networks, as well as the evaluation, development, implementation, and operation of clinical integration programs.
Clinical Integration, Accountable Care and Physician Alignment
HMBR has counseled clients extensively in clinical integration matters, and has assisted clients in establishing Accountable Care Organizations through which the independent and employed physicians can develop, implement, and coordinate a clinical integration program and engage in joint contracting activities with managed care organizations. In addition to traditional contracting and transactional legal services, HMBR offers its clients a comprehensive menu of clinical integration development tools such as a readiness assessment, network contracting risk assessment, vendor and consultant selection and retention, clinical integration program formation and evaluation, proper messenger model formation, and educational support for executive, board and member levels.
- ACO/IPA/PHO Formation – the creation of a well-structured business organization through which the independent physicians can develop, implement, and coordinate a clinical integration program and engage in joint contracting activities with managed care organizations.
- Clinical Integration Readiness Assessment – the evaluation of existing infrastructure and programs to determine an organization’s preparedness to engage in clinical integration activities.
- Network Contracting Risk Assessment – the evaluation of past and current contracting activities to determine the antitrust risks, if any, posed by this conduct.
- Vendor and Consultant Selection and Retention – identification and evaluation of technology vendors and other consultants necessary to implement and operate a clinical integration program.
- Clinical Integration Program Formation and Evaluation – consultation and advice in the formation of clinical integration and pay-for-performance programs that satisfy prevailing legal and regulatory standards.
- Proper Messenger Model Formation – consultation and advice in the implementation of “messenger model” procedures that satisfy FTC guidelines.
- Executive, Board, and Member Education – presentations regarding the legal and business case for clinical integration for the organization’s management team, board of directors, and general physician membership.
- Contracting and Transactional Support – legal review and advice regarding contract negotiations and language for clinically-integrated, fee-for-service arrangements.
- Representation in Litigation – aggressive legal defense in federal and state court actions, as well as private arbitration.
- Advisory Opinion Practice – petitioning the FTC and U.S. Department of Justice to obtain regulatory advisory letters in connection with a physician or hospital network’s clinical integration program.
- Government Investigation Practice – vigorous representation and advocacy in response to FTC and U.S. Department of Justice inquiries into the contracting conduct of physician and hospital networks.
Pay-for-Performance and Shared Savings
HMBR has advised clients in the development of benchmarks and report cards for physician performance. Further, we have worked with hospitals and health plans to develop shared savings and pay-for-performance models that work to align the economic incentives of physicians in order to improve clinical quality and reduce the cost of care. Hospitals, medical staffs, PHOs, IPAs, private payors and governmental payors are increasingly focused on the rising health care costs and means of encouraging physicians to deliver quality health care in a cost efficient fashion. Working in collaboration with qualified consultants, HMBR is expert at establishing workable programs that improve physician performance in a manner consistent with legal and regulatory requirements.