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Value-Based Care

Partnering with Health Care Industry Stakeholders to Achieve Success in Value-Based Care

Leveraging our deep regulatory and transactional experience, Mintz’s forward-thinking team collaborates with health care industry clients to drive success in value-based care. We have the technical capabilities, practical experience, and innovative approaches needed to support health care organizations in today’s constantly evolving value-based care environment.

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Our Approach

Value-based care is a payment and health care delivery model through which payors offer health care providers and suppliers financial incentives to meet performance measures intended to improve quality of care and to reduce costs, as opposed to traditional fee-for-service reimbursement. Value-based care arrangements can be extraordinarily complex and can present unique opportunities and challenges for health care organizations.

Mintz works with clients across the value-based care spectrum, including accountable care organizations (ACOs), commercial insurers, health systems, physician practices, telemedicine companies, and population health managers. Our broad-based experience equips us to advise on a variety of legal and business issues affecting value-based care stakeholders.

Our team has the regulatory capabilities and business knowledge needed to assist population health managers and ACOs navigate the complexities associated with participating in various Center for Medicare and Medicaid Innovation (CMMI) models and engage health care providers in compliance with health care fraud and abuse laws.

Our Experience
  • Served as corporate and regulatory counsel to a leading population health services organization in a strategic joint venture and in related growth strategies intended to enhance the ability of physicians to succeed in value-based care by providing capital, technology, tools, and clinical support resources
  • Drafted and negotiated participant and preferred provider agreements for Medicare Shared Savings Program (MSSP), Racial and Ethnic Approaches to Community Health (REACH), and commercial ACOs.
  • Represented a value-based care provider in a False Claims Act investigation concerning compliance with the federal Anti-Kickback Statute in the Medicare Advantage context
  • Established affiliated physician practices for ACOs and population health managers in compliance with corporate practice of medicine restrictions
  • Represented private equity firms and venture funds in transactions involving value-based care providers and companies
  • Advised on strategic joint ventures with nephrologists and dialysis providers participating in the Kidney Care Choices Model
  • Represented a value-based care company in a False Claims Act investigation focused on risk adjustment and diagnosis coding practices
  • Advised ACO clients on compliance with state and federal fraud and abuse laws in their relationships with participating providers
  • Drafted and negotiated a variety of strategic contracting arrangements on behalf of value-based care providers and other risk-bearing entities
  • Advised value-based care companies on compliance with state licensure laws, including those applicable to risk-bearing entities
  • Advised on MSSP and REACH participation requirements, including requirements for ACO financial arrangements, the roles and responsibilities of governing bodies, and requirements for beneficiary engagement activities
  • Counseled entities participating in value-based arrangements regarding questions related to risk adjustment
Service Areas
  • Compliance with the requirements of various CMMI models, including Medicare Shared Savings, Kidney Care, and REACH
  • Fraud and abuse, including compliance with the Stark Law, the federal Anti-Kickback Statute, and the Medicare/Medicaid beneficiary inducement prohibition
  • Reimbursement issues, including incident-to rules, risk adjustment/diagnosis coding, and annual wellness visit requirements
  • Drafting and negotiating of ACO provider participation and other agreements
  • HIPAA/health care privacy and security
  • Corporate transactions and financing
  • Antitrust counseling
  • State and federal licensure, telemedicine standards, and corporate practice of medicine
Clients Across the Value-Based Care Ecosystem
  • ACOs and ACO support and management companies
  • Health systems
  • Payors
  • Physician practices
  • Population health managers
  • Telemedicine companies
  • Vendors

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