CAPABILITIES

Provider-Owned Managed Care, ACOs, and Clinically-Integrated Networks (CINs)

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Overview

For over 35 years, Hooper, Lundy & Bookman has served as a trusted partner for those spearheading innovation or expanding their reach into emerging health care delivery and payment models. Our extensive work with evolving value-based arrangements and new iterations of managed care organizations extends to provider-owned Managed Care Organizations (MCOs), Accountable Care Organizations (ACOs), and Clinically Integrated Networks (CINs). HLB’s combination of industry-leading regulatory expertise, payment and reimbursement experience, and extensive corporate and transactional capabilities allows us to provide comprehensive, forward-thinking representation for providers entering this evolving space.

As more providers explore opportunities in the managed care space and new structures and relationships proliferate, HLB is well-positioned to deliver the counsel that can help our clients reach their business and patient care goals. Whether coming to us with a blank slate or seeking assistance to build on an existing concept for payment and coordination of care, clients rely on us to lead them through a regulatory thicket and economic landscape defined by continuous change. Our work developing provider-owned models extends from organizations with just a handful of providers to designing and implementing an innovative and groundbreaking joint venture between a large employer, expansive hospital system, and third-party administrator. 

HLB’s robust managed care practice forms the foundation of our work with provider-owned MCOs, ACOs, and CINs. Our Managed Care Working Group meets regularly to coordinate efforts, share insights and perspectives, and increase efficiencies in our managed care representation. We also draw on the cross-disciplinary talents of attorneys who can collectively address every legal and operational issue that providers face as they enter, expand, or enhance their managed care presence. The very nature of these models implicates a host of regulatory, fraud and abuse, payment, licensing, and antitrust concerns, among other issues. All these matters are right in HLB’s wheelhouse, ensuring our clients receive sound counsel and the efficiencies that follow from having all of their legal needs met in one place.   

From inception to implementation to coordination to litigation, Hooper, Lundy & Bookman provides a complete suite of services for providers of all stripes in the managed care space, including:

  • Analysis, development, structuring, and refinement of provider-owned managed care models, including:
    • Clinically Integrated Networks 
    • Accountable Care Organizations 
    • Independent Physician Associations 
    • Integrated delivery systems
  • Network formation, integration, and contracting
  • Structuring and implementation of payor arrangements
  • Establishment, monitoring, and assessment of compliance programs to address state and federal laws and regulations implicated by managed care and value-based arrangements 
  • Compliance counseling and defense of fraud and abuse, Stark Law, and state and federal anti-kickback matters
  • Government investigations, audits, and enforcement actions
  • Medicare and Medicaid participation, payments, and reimbursements
  • State licensing and insurance issues
  • HIPAA, patient privacy, and data security matters
  • Litigation and resolution of payor and other disputes
  • Counseling on operations, growth, and potential exit strategies

Professionals

Monica Herr Massaro
Director, Government Relations & Public Policy