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    5. Managed Care Contracting & Network DevelopmentHealthcare

    Managed Care Contracting & Network Development

    Nixon Peabody works with an extensive array of integrated healthcare delivery organizations in evolving managed care models.

    Overview

    Successful managed care arrangements require a thorough understanding of the practical and operational considerations unique to contracting in this industry —from traditional fee-for-service to risk-based, bundled payment. We routinely advise providers and managed care organizations on pay-for-performance programs, quality bonuses, gain sharing programs, fee-for-service arrangements, value-based contracting models, and clinical integration initiatives. Our team members also have extensive experience with payor-provider litigation and arbitration. Our role is to maximize your expertise and bring our breadth of real time contracting knowledge to your managed care negotiations.

    Representative Experience

    • Five-hospital health system: Represented in the formation of a physician joint-venture with over 800 physicians for purposes of creating a managed care narrow network, system-wide co-management and a framework for clinical integration
    • Licensed health plan: Advised on the creation of and launch of its special dual-eligible, Medicare-Medi-Cal Health plan (D-SNP) and related support services
    • Large health plan: Counseled on in several matters, including advice regarding the development of plan-sponsored incentive payment programs with contracting providers
    • Managed care insurance plan that contracts with various providers: Represented in connection with their structuring of quality improvement programs and incentive payments to provide value-based care to beneficiaries
    • Represented numerous clinically integrated networks with respect to network formation, governance, and contracting in connection with the creation of a narrow network product with shared risk with a commercial health plan and employer self-funded plans
    • Represented several hospital systems, health plans, IPAs, and medical groups with respect to their managed care contracting strategy, joint contracting, the establishment of narrow networks, risk pools, and delegated services arrangements

    Recognition

    • Named as a leading firm in Healthcare by Chambers USA in 2021; 31 healthcare lawyers ranked
    • Ranked Tier 1 nationally for Healthcare Law by U.S. News—Best Lawyers “Best Law Firms” in 2021 and in consecutive years prior; named “Law Firm of the Year” in Healthcare Law by U.S. News—Best Lawyers “Best Law Firms” in 2016; 31 healthcare lawyers ranked 
    • Recognized as a top law firm in Healthcare by the American Bar Association’s Health Law Section
    • Ranked nationally as one of the largest healthcare firms by Modern Healthcare

    Our Team

    See Full Team
    • Jill H. Gordon

      Partner / Co-chair, Life Sciences Practice / Strategic Impact Partner
      • Los Angeles
      • Office:213.629.6175
      • jgordon@nixonpeabody.com
      Jill H. Gordon
    • Harsh P. Parikh

      Partner
      • Los Angeles
      • Office:213.629.6108
      • hparikh@nixonpeabody.com
      Harsh P. Parikh
    • Laurie T. Cohen

      Partner
      • Albany
      • Office:518.427.2708
      • lauriecohen@nixonpeabody.com
      Laurie T. Cohen
    • Peter J. Millock

      Senior Counsel
      • Albany
      • Office:518.427.2651
      • pmillock@nixonpeabody.com
      Peter J. Millock
    • Philip Rosenberg

      Partner
      • Albany
      • Office:518.427.2709
      • prosenberg@nixonpeabody.com
      Philip Rosenberg
    • Sarah E. Swank

      Counsel
      • Washington Dc
      • Office:202.585.8500
      • sswank@nixonpeabody.com
      Sarah E. Swank
    See Full Team

    Insights And Happenings

    • Alert

      NYS Department of Health proposes clinical staffing regulations for general hospitals

      March 6, 2023
    • Alert

      How healthcare providers can plan ahead for COVID-19 emergency declaration expiration

      Feb 15, 2023
    • Press Release

      Nixon Peabody continues its West Coast expansion, adding another partner to its Los Angeles office

      April 25, 2022

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