Managed Care and Clinically Integrated Networks
Quarles & Brady's experienced Health Law Team works with various types of health care entities in providing legal and strategic guidance related to managed care transactions and the creation, development, and administration of clinically integrated networks. Providing such guidance efficiently requires not only understanding each client and its unique business needs, but an understanding of the business of health care generally.
Quarles & Brady Health Law attorneys have experience regarding contract and insurance law, data privacy and cybersecurity, HIPAA and antitrust compliance, reimbursement methodologies (including value-based compensation, risk-sharing, and episode-based payments), legal entity selection and governance, and other related areas. We are committed to helping clients achieve their managed care and clinically integrated network goals in a proactive, cost-effective manner.
The Quarles & Brady Managed Care and Clinically Integrated Networks Team differentiates itself based on years of experience identifying and resolving the "day-to-day" legal and strategic business issues confronting our clients, while also possessing depth and breadth on a national scale. We focus with our clients on finding practical solutions, while at the same time mitigating risk, achieving legal compliance, and maintaining such compliance in constantly evolving legal and business environments.
Our Managed Care and Clinically Integrated Networks Team includes attorneys who have served as both in-house and outside legal counsel in hundreds of managed care transactions. We provide managed care counsel to providers (including individual managed care transactions controlling revenues in excess of $200 million annually) and payers (including individual managed care transactions controlling revenues in excess of $250 million annually), and our lawyers have assisted both providers and payers in value-based arrangements distributing in excess of $30 million annually. Our experience also includes the development and documentation of innovative reimbursement and incentive programs (supporting clinical quality, operational and financial efficiency, and contractual performance) which both achieve our clients' goals and maintain legal compliance.
Quarles & Brady attorneys also provide clients with extensive, real-world experience in the exploration, establishment, and administration of clinically integrated networks. We have helped clients create and operate fully functioning, successful clinically integrated networks with as few as 100 clinicians, as well as one of the nation's largest clinically integrated networks consisting of over 50 hospitals, over 1,000 clinics, and over 8,400 clinicians. Our work on behalf of these clients includes:
- Antitrust and insurance law compliance;
- Clinical integration program design and implementation;
- Data sharing, aggregation and analytics compliance (including the development and negotiation of vendor agreements);
- Regulatory compliance (including advising clients regarding fraud/abuse issues, such as the Stark Law, Anti-Kickback Statute, and False Claims Act);
- Insurance company formations, mergers, acquisitions, and regulatory actions;
- Corporate governance and administration (including developing operating agreements, company policies and procedures, conflict of interest review frameworks, and more); and
- Guidance on unique managed care contract structure and negotiations.
Attorneys on the Quarles & Brady Managed Care and Clinically Integrated Networks Team work with:
- Health care providers, including vertically and horizontally integrated health systems, clinically integrated networks, accountable care organizations, physician-hospital organizations, large and small individual hospitals and hospital systems, critical access hospitals, large and small physician groups, solo practitioners, individual practice associations, pharmacies, and ancillary providers;
- Health care payers, including indemnity health insurers, health maintenance organization insurers, self-funded employers, reinsurers and stop loss carriers, and Taft-Hartley trust funds; and
- Other health care entities and related companies that support the health care industry, including third-party administrators, pharmacy benefit managers, preferred provider networks, health care technology solutions companies, bundled health care services providers, and more.