Our attorneys are on the forefront of innovation in managed care under the new rules associated with the Affordable Care Act (ACA). We have assisted on the formation of general accountable care organizations (ACOs) sponsored by our large clinic clients and have negotiated agreements for provider services with large ACOs across the country on behalf of new innovative providers.
Our attorneys drafted the first and second editions of the American Medical Association's Model Managed Care Agreement. We also argued successfully before the U.S. Supreme Court on a matter of first impression regarding how, within the context of the Employee Retirement Income Security Act of 1974 (ERISA), the relationship between an HMO, a physician and a patient should be balanced (Rush Prudential Inc. v. Moran et al., 536 U.S. 355).
We draft and review agreements, negotiate unique arrangements and litigate over deals gone bad. We form managed care networks consistent with antitrust laws, negotiate risk-based contracts, assist with the development of clinically integrated networks and help major players in a community come to grips with the competing imperatives of payors who demand both price competition and quality.