When Saint Thomas Health developed MissionPoint Health Partners, the first accountable care organization (ACO) in Tennessee, its leaders knew they could count on Bradley attorneys to provide the level of skill and experience necessary to handle legal matters related to its structuring and subsequent expansion.
The number of ACOs in the nation dramatically increased in response to the Affordable Care Act. The ACA’s ACO provisions encourage doctors, hospitals, and other providers to coordinate their care in search of more efficient and cost-effective solutions. MissionPoint was chosen to participate as an ACO in the Medicare Shared Savings Program in January 2012.
Subsequently, in October 2015, MissionPoint entered into an agreement to manage Humana’s Medicare Advantage patient population in Tennessee. Under this agreement, MissionPoint assumed financial responsibility for the cost of care in excess of premiums. In return, Humana will pay any premiums to MissionPoint that are left over after payment for costs of care.
MissionPoint is a unique organization whose business is at the forefront of the ongoing transformation of the healthcare industry, and the legal issues facing MissionPoint include a number of novel matters that require new legal structures and documents. Among the projects required to build the ACO are: advising on the structure of arrangements with employers and providers, navigating various state law issues raised by these arrangements, and drafting and negotiating all contracts and other legal documents. The agreement to manage Humana’s Medicare Advantage patients is also a cutting-edge arrangement that is among the first of its kind.
Bradley has assisted MissionPoint in expanding its operations into 12 new markets in seven states by entering into agreements with employers in those markets to manage the healthcare costs of their employee populations and to build clinically integrated provider networks. In addition, the firm worked with three of these newly formed networks in submitting applications to participate in the Medicare Shared Savings Program.
For the Humana transaction, Bradley acted as counsel to MissionPoint in creating the financial model, drafting the agreement between the parties, and advising on the federal and state regulatory requirements applicable to risk assumption agreements. This representation included meetings with state insurance regulators to explain this new model and obtain regulatory approval.
Thanks to Bradley’s help, the MissionPoint network had 7,900 participating physicians and 250,000 members as of 2015, and has already facilitated nearly 79,000 patient visits in addition to rolling out a telemedicine program to help patients obtain access to care remotely.