value-based care Archives - HEALTH & LIFE SCIENCES NEWS

value-based care

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

by McDermott Will & Emery | Jun 20, 2023 | Uncategorized

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:

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.
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.
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.
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.
There [...]

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PPM ASC Symposium 2023 | State of the PPM Industry: Perspectives from Top CEOs

by McDermott Will & Emery | Jun 12, 2023 | PPM/ASC

During this session, Partner Jerry Sokol moderated a panel in which top CEOs shared their insights on capitalizing on opportunities and overcoming obstacles in the current environment. They discussed the transition to value-based care, the No Surprises Act (NSA), physician alignment and the future of the physician practice management (PPM) deal landscape, among other topics.

Session panelists included:

Bob LaGalia, President & CEO, Unified Women’s Healthcare
James Swift, MD, CEO, Pediatrix Medical Group, Inc.
Corina Tracy, CEO, U.S. Urology Partners
James Weber, MD, CEO, GI Alliance
Rich Whitney, Founder, Chairman & CEO, Radiology Partners

Top takeaways included:

Value-Based Care.
- At this time, industry players are focused on building capabilities to ensure they are ready for the transition to value-based care. Changes to payment programs may take a long time, but using this time to prepare and focus on adding value can help with long-term success.
- One of the biggest challenges platforms face when adopting value-based care models is physician engagement. Strategies for enhancing engagement include aligning economic incentives (while protecting physicians from risk) and investing in the right technology infrastructure and tools to support value-based care delivery.
- Data aggregation and actuarial analysis are critical to success in a value-based environment. Providers and platforms need to understand the historical costs, treatment patterns, and other characteristics of their patient population and carefully assess the financial implications of a value-based care arrangement before making the jump.
- Payors are not always ready for value-based care, even when platforms and providers [...]
  
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Advancing Primary Care in Washington, DC, in 2021

by McDermott Will & Emery | Nov 19, 2020 | Digital Health, Reimbursement

Guest post by Mara McDermott, Vice President at McDermott+Consulting.

With the 2020 election almost in the rearview mirror, clinicians and policymakers alike are turning their attention to the 2021 agenda. For primary care providers, 2021 will hopefully bring COVID-19 recovery and response efforts, additional opportunities to pursue value-based payment arrangements, and ongoing deployment of telehealth and virtual technology.

The 2020 presidential election is expected to bring about a change in administration. However, the “blue wave” Democratic sweep projected by some pundits and pollsters failed to materialize. Instead, in Washington, DC, we will have a closely divided US Senate, with the final balance of power to be determined by two run-off races in Georgia. The US House of Representatives will remain in Democratic control, but by a smaller margin. The narrow margins in the House and Senate will likely constrain the extent to which Democrats are able to advance progressive policy changes. Instead, both sides of the political aisle in Congress are likely to focus on bipartisan areas of agreement. For primary care clinicians, this environment may be encouraging, as members of both parties share goals around protecting and advancing primary care across the country.

COVID-19 Response

When the new Congress begins and President-Elect Biden is inaugurated in January 2021, COVID-19 relief is expected to be at the top of the agenda. Expect President-elect Biden and the incoming Congress to pursue economic and public health relief. Clinicians across the country who have faced depressed revenue as [...]

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Five Questions with a Health Lawyer: Nicholas Alarif

by McDermott Will & Emery | Feb 28, 2020 | Fraud & Abuse

Nicholas Alarif
Office: Washington, DC
Years at Firm: 3

What is your favorite part about practicing healthcare law at McDermott?

I hate to sound like a broken record, but the best part about practicing at McDermott is the innovative and collaborative culture. I have found that McDermott fosters a team-based approach to solving client issues. The opportunity to interact with experts in so many disciplines and sub-disciplines to achieve common goals for our clients has been fantastic. Further, I have found that my colleagues are open to new approaches to tackle client issues and are always happy to streamline internal processes. Innovation is not what you typically think of in a law firm environment, and McDermott’s embrace of change makes for an exciting and fun place to practice.

What is the biggest opportunity and greatest challenge facing clients in your area of focus today?

The biggest opportunity and greatest challenge may actually be the same—a shifting regulatory landscape. For instance, the Centers for Medicare and Medicaid Services and the Office of Inspector General recently published proposed revisions to the physician self-referral law (Stark Law) and the Anti-Kickback Statute (AKS) regulations, which, among other things, are attempting to foster transitions from fee-for-service medicine to value-based care. These proposed changes will potentially allow providers broader flexibility when engaging in financial relationships with a value-based goal. The proposed changes [...]

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Five Questions with a Health Lawyer: Matt Perreault

by McDermott Will & Emery | Feb 14, 2020 | Hospitals & Health Systems, Uncategorized

Matt Perreault
Office: Boston
Years at Firm: 2

What is your favorite part about practicing health care law at McDermott?

As so many of my colleagues have expressed throughout this series, my favorite part of practicing healthcare law at McDermott is being a member of a collaborative and collegial team that is advising our diverse clients on their most critical and pressing issues. Having spent much of my career in-house, I have experienced firsthand how McDermott’s approach to client service, anchored in humility, empathy and practicality, consistently delivers differentiated value and results for our clients.

What is the biggest opportunity and greatest challenge facing clients in your area of focus today?

I believe that the transition to value-based arrangements will continue to accelerate. Collaborative Transformations will proliferate and present both tremendous opportunities for, and challenges to, traditional healthcare providers. Hospitals, health systems and other providers who embrace the challenges and opportunities presented by this paradigm shift will reap the benefits of their investments. Those who resist this cultural change risk losing ground and market share to their competitors.

What kind of client work gets you most excited when it comes across your desk?

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2019 Hospital and Health Systems Year in Review

by McDermott Will & Emery | Feb 7, 2020 | Hospitals & Health Systems

Hospitals and health systems are facing consumer demand for innovation, the need to expand and enhance streams of revenue and the push for improved quality, all while navigating changing regulations, federal enforcement, antitrust litigation and business pressures. 2019 saw hospitals and health systems navigate these challenges and more, with valuable lessons for 2020.

This Special Report presents some of the key legal actions and trends impacting hospitals, health systems and investors in the space, along with insights on how these developments will impact organizations in 2020. We address, among other topics:

2019’s transformative regulatory changes and legislation, and the legal challenges that followed
Financial distress signals, pricing strategies and contracting practices
Collaborative Transformation at work in a variety of sectors and the increase in innovation centers
Data privacy and cybersecurity challenges impacting the healthcare space

Click here to read the full report.

Five Questions with a Health Lawyer: Joe Parise

by McDermott Will & Emery | Jan 27, 2020 | Health M&A

Joe Parise
Partner
Office: Boston
Years at Firm: 6

What is your favorite part about practicing healthcare law at McDermott?

In short: the people. I have always had a cross-office practice, and as a result have been lucky enough to work with many different attorneys within the Health practice group. I am constantly impressed by the depth and breadth of experience that the group offers, as well as the creativity and thoughtful approach that our attorneys bring to tricky client issues. Being surrounded by talented attorneys (from the senior partner to the junior associate ranks) makes me want to “raise my game” and, I think, brings out the best in each of us.

In addition to the professional qualities, I am grateful for the fact that our attorneys bring a positive attitude each and every day, and create an enjoyable working environment. I have made some great personal connections over the years, and consider many of my colleagues to be good friends.

What is the biggest opportunity and greatest challenge facing clients in your area of focus today?

For the most part, I work with healthcare services providers and those that invest in such providers. I think the biggest opportunity for my clients relates to innovation in healthcare services delivery. Embracing new technologies (including those related to telehealth), optimizing the collection [...]

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