Frier Levitt is at the forefront of the latest developments in the value based care space and understands the potential opportunities and pitfalls for the multiple and diverse stakeholders involved. We have extensive experience structuring novel arrangements among providers, manufacturers, payors and plan sponsors, and we have litigated groundbreaking cases in the Medicare Advantage risk adjustment space relating to alleged payor data mismanagement. We have also been successful in pressuring various payors to reassess shared savings payment determinations favorably on behalf of physician practices and ACOs through strategic and targeted pre-litigation negotiation tactics. Providers seeking innovative, sophisticated and unique approaches to evaluating new value based care opportunities or resolving ongoing value based care-related disputes should contact Frier Levitt’s experienced value based care team.
In recent years, the transition from traditional fee-for-service and volume-based care to value based care has accelerated exponentially. Value based care payment models are diverse and constantly evolving, and each new model presents 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 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. Under these new metrics-driven payment models, data scientists and actuaries, along with experienced healthcare counsel, are 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 calculation methodology in a new shared savings contract to assisting as experts in litigating a breach, Frier Levitt has built strategic relationships and developed a substantial track record of success.
Frier Levitt is equipped to advise providers in various sectors of healthcare in connection with a multitude of value based care payment models, including:
Establishing compliant legal framework for value based care-centric provider entities:
Structuring and establishing Value Based Enterprises (VBEs):
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