Exploring Critical Business and Legal Issues across the Healthcare and Life Sciences Industries
Exploring Critical Business and Legal Issues across the Healthcare and Life Sciences Industries
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Investing In a Healthier Future: The Investor’s Perspective On Value-Based Care

In this session, McDermott Will & Emery Partner Joel Rush moderated a discussion exploring investors’ interests in, opinions on and strategies for entering the value-based care (VBC) market. The panel discussed factors taken into consideration when choosing if and when to invest in VBC opportunities, issues that arise when collaborating with health systems, and ways to evaluate risk models and support improved care delivery.

Session panelists included:

  • Lauren Brueggen, Partner, Heritage Group
  • Devin Carty, Chief Executive Officer, Martin Ventures
  • Roger Kueny, Senior Vice President of Corporate Development, Alignment
  • David Pontius, Partner, WindRose Health Investors
  • Karey Witty, Managing Director, Valtruis

Top takeaways included:

  1. When it comes to investing in VBC, the tailwinds are just beginning to pick up after the COVID-19 pandemic reduced reimbursement volume. During that time, physician practices that were leaning on fee-for-service (FFS) reimbursements saw their volumes drop close to zero during the COVID-19 pandemic. Hospitals began to get crushed by the rates, and much of the volume has yet to return to normal. One way to solve this problem is by moving physician practices into VBC and to demonstrating that VBC is a bonus, not a penalty, and probably the only way to get back to the earnings they previously had. Also, when looking at hospital systems, investor-based hospitals performed significantly better during the pandemic. Innovative programs like the Accountable Care Organizations Realizing Equity, Access, and Community Health (ACO REACH) model are showing hospitals and physicians that the market is experiencing a technology shift, [...]

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Top Takeaways | How to Succeed in CMMI Payment Models

In this session, McDermott Will & Emery partner Matthew Perreault moderated a panel that discussed the current state of value-based care in original Medicare and lessons learned from the panelists’ experiences with various Center for Medicare & Medicaid Innovation (CMMI) models.

Session panelists included:

  • Rob Cetti, President, CareAllies
  • Stanley D. Crittenden, MD, FASN, CHS, Chief Medical Officer, Evergreen Nephrology
  • Tim Gronniger, Chief Value-Based Solutions Officer, Signify Health
  • Kim Phan, Chief Executive Officer, CareConnectMD
  • Moderator: Matthew Perreault, Partner, McDermott Will & Emery

Top takeaways included:

  1. When evaluating participation in CMMI models, stakeholders should recognize that the models are focused on innovation and may be more susceptible to redesign and changes in CMMI priorities than Medicare Shared Savings Program (MSSP) models. Participants in CMMI value-based care models must be ready to engage with changes that will impact revenue. The desire of the Centers for Medicare & Medicaid Services (CMS) to build around full-risk models and streamline benchmarks may have larger-than-anticipated economic impacts for stakeholders with conservative investment views.
  2. High-needs populations under the Accountable Care Organizations Realizing Equity, Access, and Community Health (ACO REACH) and specialty models, such as the Comprehensive Kidney Care Contracting model, offer an opportunity to address historically neglected patient populations. To succeed, companies must align with physicians to ensure that their physicians understand and employ the right tools to improve the quality measures that CMS establishes, such as patient activation measures, and foster patient engagement.
  3. In contrast to the widespread adoption of ACO participation by primary [...]

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VBC Symposium 2023 | Find Your Niche: Value-Based Models for Clinical Specialties

During this session, Partner Jeremy Earl moderated a panel that collected insights on how specialists can participate in value-based care and the unique challenges specialists face in maximizing value-based care opportunities.

Session panelists included:

  • Marissa Brittenham, Executive Vice President and Chief Strategy Officer, Surgery Partners
  • David Dempsey, Chief Operating Officer, Heartbeat Health
  • David Eagleton, Senior Vice President, Oncology Care Partners
  • Josh Goldenberg, Group Vice President of Payor Partnerships, DaVita Inc.
  • Moderator: Jeremy Earl, Partner, McDermott Will & Emery

Top takeaways included:

  1. While some specialists are comfortable in the value-based care world, others have been slow to engage with and adopt value-based care initiatives. Convincing providers who have been paid on a fee-for-service basis their entire career to shift and take on risk can be challenging. These shifts can begin slowly, for example, by offering initial quality bonuses and then building up to longer-term strategies. However, the transition often involves a shift in mindset and can be challenging to accomplish at an organizational level.
  2. Specialists may only have insight into a small portion of a patient’s life, so it can be hard to engage in the patient’s full care journey when specialists are not at the center of care. However, where specialists can provide a service for a fraction of the cost—for example, through site-of-care shifts—specialists can still have a large impact on costs and outcomes.
  3. Different specialties are at different points in the value-based care transformation. The panelists representing ASCs and oncology, cardiology and dialysis providers, for [...]

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VBC Symposium 2023 | Innovations in Value-Based Care for Complex Populations

During this session, Partner Jeremy Earl moderated a panel that discussed how value-based care models are delivering care to individuals with complex conditions and those with significant healthcare and social needs. The panel also provided perspectives from executives at companies that are revolutionizing the delivery of care to high-needs populations and demonstrating how doing good can also be a successful business model.

Session panelists included:

  • Christopher Aguwa, Executive Vice President & Head of Growth and Business Development, Cityblock
  • Benjamin Kornitzer, MD, Chief Medical Officer, agilon health
  • Hank Watson, Chief Development Officer, American Health Partners
  • Lea Tompsett, Head of Provider Enablement, Waymark

Top takeaways included:

  1. Focus on Empowering and Elevating Providers. The companies that are successfully delivering care to complex populations are those that are focused on empowering and elevating providers to fill in gaps in care; such entities also succeed on cost and outcome goals as a result. These companies primarily focus on primary care providers (PCPs), nursing homes and related front-line providers. The panelists who focus their efforts on primary care do so in the belief that primary care can have the greatest impact on outcomes. Traditionally, primary care has been delivered within the four walls of a PCP’s office, with fee-for-service (FFS) reimbursement. Companies take different approaches to moving outside of this traditional model: Some focus on extending services outside of the PCP’s office to fill in gaps in care, such as deploying nurses to the home. Others seek to enable PCPs with data and [...]

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VBC Symposium 2023 | Weathering The Storm: A Data-Driven Perspective on Value-Based Care, by Bain & Company

In this session, Erin Ney and Jason Slocum of Bain & Company provided data-driven insights on the current state of the value-based care industry. The session provided a look at the factors influencing provider adoption of risk-based adoption, the most promising investment opportunities in value-based care, and how likely the value-based care industry is to weather an economic downturn.

Top takeaways included:

  1. Nearly 60% of healthcare payments in 2021 had at least some element tied to quality and value. However, the majority of these payments were upside risk, with less than 20% incorporating down-side risk. At the same time, nearly 40% of healthcare payments are not in value-based care models.
  2. Around 80% of physicians surveyed are interested in participating in value-based care arrangements. However, that interest significantly decreases as the level of risk to the provider increases.
  3. Providers continue to face financial, operational and administrative hurdles to adopting value-based care. Providers’ sense of preparedness across the financial, operational and administrative dimensions have decreased since 2017, with providers surveyed feeling less equipped to adopt and succeed in value-based care models.
  4. To make providers more inclined to adopt value-based care, providers stated that they needed more sufficient financial resources, more effective coding and billing processes, and investments in additional staff to manage data, reporting and outreach. Similarly, providers reported they needed three key groups of enablers in order to transition from fee-for-service to risk-based models: (1) clinical care model enablers, (2) data and technology enablers, and (3) payor contracting enablers.
  5. There [...]

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This Week in 340B: January 31 – February 6, 2023

This weekly series provides brief summaries to help you stay in the know on how 340B cases are developing across the country. Each week we comb through the dockets on more than 40 340B cases to provide you with a quick summary of relevant updates from the prior week in this industry-shaping body of litigation.

Issues at Stake: Medicare Payment; Contract Pharmacy
Where Things Stand:

  • In three Medicare payment cut cases, the district court judge has signaled her inclination to transfer the cases to the judge handling most other Medicare payment cut cases, and has asked for the parties to enter any objections to a transfer.
  • In one contract pharmacy case, the parties requested a stay pending the D.C. Circuit Court’s ultimate decision in Novartis Pharmaceuticals Corp. v. Johnson and United Therapeutics Corp. v. Johnson.
  • The drug manufacturer party in a contract pharmacy-related antitrust case filed a letter with the court to advise it of the Third Circuit Court of Appeals’ recent decision in Sanofi Aventis v. HHS and ask that it reach the same decision.
  • In the contract pharmacy-related antitrust case, the drug manufacturer parties filed a notice of supplemental authority with the court citing the Third Circuit Court of Appeals’ recent decision in Sanofi Aventis v. HHS in support of their motion opposing the plaintiff’s motion to amended their complaint.

Get more details on these 340B cases with the 340B Litigation Tracker, a subscription product from McDermott+Consulting.

5 Questions with a Health Lawyer: Sharon Lamb

Sharon Lamb
Practice Focus Area: Health and Life Sciences
Office: London
Years at Firm: 4

What is your favorite part about practicing health and life sciences law at McDermott?
This is an easy question to answer! McDermott has a truly international health and life sciences practice with talented lawyers with deep expertise across all disciplines around the world– our lawyers truly works together as an integrated team and share a collective enthusiasm and energy for advising our international clients in a way that helps them move their businesses forward. I feel really privileged to work with such dedicated and talented lawyers. Our practice is both regulatory and transactional, meaning we support our clients on cross border investments and acquisitions to expand their businesses but also on strategic and regulatory issues, such as licensing, collaborations, and market access. The pandemic has been challenging on many levels – working remotely has been just one part of that. But, on the other hand, the move to virtual meetings and ease of zoom calling has created even more cohesion across our international offices.

What is the biggest opportunity and greatest challenge facing clients in your area of focus today?
Our health and life sciences clients have been at the forefront of the fight against Covid-19 – whether that be providing care to patients or developing drugs and devices such as vaccines, and diagnostics. Many [...]

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5 Questions with a Health Lawyer: Dr. Deniz Tschammler

Dr. Deniz Tschammler 
Practice Focus Area: Health and Life Sciences
Office: Munich/Frankfurt
Years at Firm: 2

What is your favorite part about practicing healthcare law at McDermott?
Apart from exciting clients and projects, a great privilege of my work at McDermott is to closely collaborate with a wide range of inspiring and outstanding health and life sciences lawyers – in our German offices, across Europe and the US. I am regularly working on large collaboration, market entry or compliance projects that involve multiple jurisdictions and/or require different legal perspectives. In such projects, it is invaluable to be surrounded by the right team of experts. After more than two years at McDermott, I am still impressed to see how quickly you find such helpful team across all offices. Moreover, everyone shares the same attitude and passion for achieving our clients’ goals. It is magnificent to be a part of this.

What is the biggest opportunity and greatest challenge facing clients in your area of focus today?
For many clients, the answer is digitization. At great speed, digitization is turning the health markets upside down. Digital health has started to revolutionize research and development, create entirely new ways of diagnosing and treating diseases, make the patient’s trip to the doctor or pharmacy unnecessary, and facilitate communication among all public and private players in the various health markets. This not only results in abolition and liberalization of outdated legal regimes, but also in new [...]

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5 Questions with a Health Lawyer: Brian Hall

Brian Hall
Practice Focus Area: Healthcare Transactions & Regulatory
Office: Washington, DC
Years at Firm: 3+ years

What is your favorite part about practicing healthcare law at McDermott?
It’s easily the colleagues I work with on daily basis. I’m fortunate that my practice requires me to work with attorneys across the entire Healthcare practice group and other practices at the Firm. Having colleagues who are the best at what they do is a tremendous resource for myself and our clients. I also really enjoy working on the cutting-edge legal issues our clients bring to us. Healthcare law is never static and forces us to always be learning to help clients navigate this increasingly complex legal landscape.

What is the biggest opportunity and greatest challenge facing clients in your area of focus today?
My practice is focused primarily on healthcare transactions/M&A and related regulatory issues, representing investors like private equity funds and the healthcare providers they partner with. The healthcare delivery market continues to be highly fragmented with many specialty areas attractive to potential investors. This benefits healthcare providers who are facing increasing reimbursement and cost pressures while needing to invest heavily in technology to take advantage of telehealth modalities and value-based care arrangements. One of the greatest challenges facing investor clients today is the growing competition they face from other investors as the healthcare delivery space continues [...]

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5 Questions with a Health Lawyer: Caroline Reigart

Caroline Reigart
Practice Focus Area: Fraud & Abuse and Reimbursement
Office: Washington, DC
Years at Firm: 2.5

What is your favorite part about practicing healthcare law at McDermott?
McDermott is fortunate to be on the cutting edge of many of the legal issues that shape the healthcare industry. My favorite part of practicing healthcare law at McDermott is collaborating with and learning from my colleagues as we tackle novel and challenging problems. The McDermott health team is known for its collaborative approach and I love being able to discuss potential approaches and strategies with my colleagues. I am constantly learning from my attorney and professional colleagues and solving obstacles with my colleagues for clients makes the workdays pass quickly.

What is the biggest opportunity and greatest challenge facing clients in your area of focus today?
Telehealth and digital health have been around for a while now, but with COVID-19 the widespread adoption of these technologies has presented huge opportunities but also significant challenges for our clients. In response to the pandemic, there are new opportunities for reimbursement for services and products provided remotely. However, the legal issues presented by these new technologies and partnerships that providers and innovators are seeking to offer are complex and require a thoughtful approach. Payment policies and guidance have also been evolving quickly, which makes staying on top of the changes difficult for clients.

What kind [...]

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