Downstream risk contracting

We are the most experienced law firm in Pennsylvania in drafting and negotiating favorable "win-win" risk contracts between HMOs and provider organizations, having successfully concluded 18 such agreements to date. Our experience includes contracting with commercial, Medicare and Medicaid HMOs - two of which are "Blues" plans.

We have been in the forefront of development of "ramp-to-risk" deals, in which the providers enjoy the immediate right to share in any gains realized, but do not assume risk until a few years into the contract. We are also experienced in working with actuaries to assure that the providers do not assume risk for costs beyond their control. In particular, we are proud to have been the law firm involved in the design of an innovative "care management system" which integrated a physician group's quality assurance efforts with those of the HMO and its health system parent.

Through our relationship with PennMed Member Services Company ("PMSCO"), the endorsed management services organization of the Pennsylvania Medical Society, we perform a key role in the negotiation and implementation of provider-friendly gain-share contracts, in which the insurer may earn a profit without bankrupting its provider partners.

Formation and representation of physicians and practices

Contract review and negotiation services

Formation of provider organizations

HIPAA contract analysis and HIPAA compliance-related services

Downstream risk contracting