Our Healthcare Practice Group has been at the forefront of the transformation of healthcare payer arrangements to models focused on rewarding quality and cost reduction. Since helping launch the first accountable care organization (ACO) in Tennessee in 2011, we have worked with ACOs; clinically integrated networks; and health systems seeking to enter into shared savings, bundling, and other value-based payment arrangements. Our work with these providers has required our healthcare attorneys to solve a number of novel issues and create new legal structures and documents for arrangements for which there was no blueprint.

We understand that the world of accountable care and population health is evolving rapidly, and we believe our head start in working with clients on these issues makes us uniquely situated to help clients looking to take a first step into value-based contracting, as well as clients already engaged in these arrangements who are seeking more experienced counsel.

Bradley is counsel to an ACO with operations in multiple states, as well as several hospital systems and clinically integrated networks that are parties to value-based contracts. Our work for these clients includes advising ACOs on participation in the Medicare Shared Savings Program, working with hospital systems on bundling arrangements, and assisting ACOs and hospital systems in entering into shared savings and other value-based payment arrangements with self-insured employers, commercial insurers, Medicare Advantage plans, and Medicaid managed care organizations. In addition to assisting our clients in negotiating the arrangement with the applicable payer, we have extensive experience in developing provider networks, including participation agreements and allocation methodologies under which physicians and other providers share in savings and other incentive payments.

In the traditional managed care area, we regularly review and provide legal advice on agreements for a broad cross-section of providers, including hospitals, physician practices, imaging centers, and provider networks. Because these contracts have a significant impact on reimbursement, we work with providers to protect them from unfair payment denials and delays. We also review these agreements for compliance with applicable legal requirements, such as state laws on prompt payment and retroactive denials.