Negotiating Managed Care Contracts with MCOs, ACOs and for Health Exchange Products

Tools and Strategies to Maximize Benefits and Avoid Becoming Unlicensed Insurer

Recording of a 90-minute CLE webinar with Q&A

Conducted on Tuesday, November 11, 2014

Recorded event now available

or call 1-800-926-7926
Course Materials

This CLE course will equip healthcare provider counsel with tools and strategies for structuring and negotiating contracts with accountable care organizations (ACOs), managed care organizations (MCOs), and state health exchanges on behalf of providers. The panel will discuss key provisions in these agreements and methods for resolving common areas of dispute.


Industry consolidation and an emphasis on outcomes over services have changed the game for how providers deal with managed care contracts going forward. The emergence of ACOs and state health exchanges requires new approaches for structuring contracts. As the reimbursement models move toward more assumption of risk by providers, it is becoming more critical to become aware of how to avoid becoming an unlicensed insurer.

Counsel for providers negotiating contracts with ACOs, MCOs and state health exchanges must carefully consider several highly technical and complex provisions and anticipate and proactively address potential areas of dispute.

Practitioners also need to be prepared with steps to minimize potential exposure for nonperformance of obligations under managed care contracts.

Listen as our authoritative panel explains best practices for providers negotiating managed care contracts in the new healthcare marketplace. The panel will review current trends in contract negotiations, key contract provisions, and ways to address potential areas of dispute.



  1. Overview of current legal trends under healthcare reform
  2. Contracting with ACOs and for health exchange products
  3. Managed care contracting
  4. Practical tips and strategies for negotiating key contract provisions
    1. Definitions of payor, covered services, medical necessity and standard of care
    2. Provider obligations
    3. Claims submission and reimbursement
    4. Avoid becoming an unlicensed insurer
    5. Retroactive claim adjustments
    6. Term and termination
    7. Other key provisions


The panel will review these and other key issues:

  • How is healthcare reform impacting the negotiation of agreements with ACOs and state health exchanges?
  • How should counsel approach contracting with traditional MCOs?
  • What strategies are effective for providers’ counsel in negotiating favorable managed care contract provisions?
  • What types of disputes should counsel anticipate arising during contract negotiations—and what are effective approaches for resolving them?


Kathrin Kudner
Kathrin Kudner

Dykema Gossett

Ms. Kudner's practice is devoted to the representation of healthcare providers, payors and biotechnology...  |  Read More

Neil M. Sullivan
Neil M. Sullivan

McElroy Deutsch Mulvaney & Carpenter

Mr. Sullivan specializes in healthcare and insurance law.  Over the course of his career he has served as...  |  Read More

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Strafford will process CLE credit for one person on each recording. All formats include course handouts.

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