Value Based Care

Frier Levitt has been at the forefront of many of the latest cutting-edge developments in the value based care space and understands the potential opportunities and pitfalls for the multiple and diverse stakeholders involved. We have promoted novel arrangements among providers, manufacturers, payors and Plan Sponsors. We have litigated groundbreaking cases in the Medicare Advantage risk adjustment space relating to alleged payor data mismanagement, in addition to pressing various payors to favorably reassess shared savings payment determinations on behalf of physician practices and ACOs through strategic and targeted pre-litigation negotiation tactics. Providers seeking fresh, sophisticated and unique approaches to evaluating new value based care opportunities or to resolving ongoing value based care-based disputes should consider consulting our value based care team.

BACKGROUND

In recent years, the transition from traditional fee-for-service or volume-based care to value based care has sped up exponentially. Value based care payment models are diverse and constantly evolving, and with each new model comes distinct legal challenges – negotiating reasonable and provider-friendly metrics in a given value based care contract, pressing payors for data and methodological transparency, ensuring compliance with newly emerging regulations and regulatory guidance within the space, and litigating, as needed, claims against commercial carriers, Medicare Advantage Organizations and even Medicare (or Medicaid) itself, to vindicate a practice’s rights under a value based care agreement, among many other issues. Further, under these new metrics-driven payment models, data scientists and actuaries are, along with experienced healthcare counsel, essential allies for providers operating in the value based care space, as these disciplines are critical to intelligently addressing challenges at every level of the value based care contracting process – from assessing the feasibility/advisability of a particular shared savings calculation methodology in a new shared savings contract, to assisting as experts in litigating a breach – and Frier Levitt has built strategic relationships with such professionals with proven track records of success.

VALUE BASED CARE PAYMENT MODELS

Frier Levitt is equipped to advise providers  of all stripes and sizes, including CINs, IPAs, ACOs, manufacturers and self-funded health plans, in connection with a multitude of different value based care payment models, including but not limited to:

WHAT WE DO

Frier Levitt can assist your practice at every stage of the value based care contracting process. Services include but are not limited to:

Establishing compliant legal framework for value based care-centric provider entities:

Negotiating value based care contracts that are fair and equitable for the provider:

Keeping Your Practice Compliant in Light of Value Based Care Specific Regulations and Guidance

Keeping Payors Honest

Defending Providers in White Collar Criminal and/or Civil Investigations or Prosecutions Matters Arising Out of a Value Based Agreement

WHO DO WE REPRESENT?

Frier Levitt has represented a diverse range of provider entities or their subcontractors in value based care related matters, including:

QUESTIONS?

Jonathan Levitt, Esq., Daniel Frier, Esq., and Jason Silberberg, Esq. currently head Frier Levitt’s value based care group. Contact Us today to speak with one of our attorneys specializing in value based care.