Forming Provider-Payer Partnerships: Key Considerations for Providers
Evaluating Product, Membership, Network, Partnership Model, and Financial Model When Pursuing Partnerships
Recording of a 90-minute CLE video webinar with Q&A
This CLE webinar will guide healthcare counsel on provider-payer partnerships and the critical considerations for providers. The panel will evaluate product, membership, network, partnership, and financial models when pursuing a partnership, as well as outline navigating the process.
Outline
- Provider-payer partnerships
- Emerging trends
- Key considerations for providers
- Product
- Membership
- Network
- Partnership model and governance
- Financial integration
- Best practices for navigating the process
Benefits
The panel will review these and other vital issues:
- What are the current and emerging trends with payer-provider partnerships?
- What are the key considerations that healthcare providers should evaluate before entering into a partnership with health plans?
- What are the potential hurdles facing providers who want to enter into a payer-provider partnership?
Faculty
Gregory R. Mitchell
Counsel
McDermott Will & Emery
Managed care companies, insurers, hospitals, health systems, physicians, and other payors and providers turn to Mr.... | Read More
Managed care companies, insurers, hospitals, health systems, physicians, and other payors and providers turn to Mr. Mitchell to represent them in managed care and reimbursement arrangements. He assists his clients in negotiating every form of reimbursement arrangement, including fee-for-service agreements, full-risk capitation models, and all other value-based payment models. Mr. Mitchell facilitates the entire arrangement process, from advising on the corporate structures necessary to enter into value-based payment models in each state, to drafting and preparing network participation agreements between IPAs, PPOs, and similar intermediary networks and providers, to drafting and negotiating complex compensation arrangements between payors, intermediary networks, and providers. In addition, Mr. Mitchell has spoken and written on various healthcare topics, including value-based payments, price transparency, social determinants of health, and the ACA’s impact on health insurance and providers. He is a co-editor of the 2021 edition of the American Health Law Association’s Health Plans Contracting Handbook: A Guide for Payers and Providers, and an author of Epstein Becker Green’s Value-Based Payments: A Comprehensive State Survey.
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Michael Ruiz
Associate Director, Healthcare
Guidehouse
Mr. Ruiz provides strategic network leadership that delivers measurable network management strategies to organizations... | Read More
Mr. Ruiz provides strategic network leadership that delivers measurable network management strategies to organizations ranging in size from $1B to $120B in revenue. He has in-depth experience and expertise spanning both payers and providers across commercial and government products. Mr. Ruiz builds and implements innovative provider arrangements and clinical initiatives that drive results efficiently and effectively; develops, strengthens, and maintains provider relationships to achieve growth and high-quality, cost effective care and services for members/patients; and has extensive experience in an insurance company setting and understands the complex payment methodologies of both commercial and government programs.
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J. Mark Waxman
Retired Partner
Foley & Lardner
Mr. Waxman is former Chair of the firm's Health Care Industry Team. He focused on healthcare issues and handled... | Read More
Mr. Waxman is former Chair of the firm's Health Care Industry Team. He focused on healthcare issues and handled issues related to research and technology, integrated delivery systems, trade associations, governance, strategic business counseling, federal program fraud and abuse, reimbursement and managed care contracting. Prior to joining Foley, Mr. Waxman served as President and General Counsel of CareGroup Inc
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