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The stakeholders in the health industry include all levels of government, private insurance payers, Federal/State Medicaid, Medicare, Medicare Advantage, Tri-Care, Veterans Administration, Managed Care Organizations contracted with state Medicaid agencies, Managed Care Organizations holding Medicare Advantage Contracts, Third-Party Administrators for delivery of services and payment of claims, self-funded health insurance programs, providers of care to individual patients, private vendors offering billing and management services to providers of care, electronic medical record and intellectual technology systems, and of course – PATIENTS.
These stakeholders created a one-dimensional health industry focused on sickness and disease. Over time, the totality of culturally transmitted behavior patterns, social beliefs, the comfort we feel from our operating institutions and other products of human work and thought strengthened and safeguarded this one-dimensional paradigm.
The lawyers at Dickinson Wright recognize that the time has come to shift the paradigm of the health industry and abandon the one-dimensional focus on sickness and disease, and instead pursue the adoption of a multi-dimensional focus on the health of the patient.
Dickinson Wright lawyers work shoulder to shoulder with our clients to implement the client’s integration strategy to create certainty in this constantly changing, ambiguous and uncertain health industry revolution. Dickinson Wright has a proven track record as the leader in the national legal community through pursuing solutions that implement integration strategies. For example:
1. In 2009, Russ Kolsrud and Greg Moore established the first “Behavioral Health Care Law Practice Group” in the country for a large law firm. This group published a book for the American Healthcare Lawyers Association entitled “The Basics of Behavioral Healthcare Law.”
2. Dickinson Wright lawyers create local, statewide, and multi-state Clinically Integrated Networks (CIN). A CIN is a way for providers to collaborate for the purpose of increasing quality, improving outcomes while decreasing utilization and the overall spend for consumers. It is not full financial integration. Many form CINs to maintain independence and culture while leveraging relationships to gain market strength, particularly when negotiating with payors. CINs can be formed as freestanding corporations or virtual organizations through a series of agreements.
The Behavioral Healthcare payor system is rapidly changing both in the Medicaid / CMH payor system and in the commercial payor system. As we move away from cost reimbursement and into more risk bearing models, the art of negotiating a payor contract takes center stage. Providers with little to no market strength will not achieve the better contracts nor will they be invited to participate in networks under the industry’s new obsession with the narrow network.
3. Dickinson Wright lawyers have effectively used the existing group practice rules to allow for integration and coordination of patient care through the formation of large scale group practices. This includes the formation of multi-specialty and single specialty group practices that can establish and exceed high quality practice metrics while achieving lower costs for the patients and payors. This group practice formation includes joint physician ownership and control over high quality lower cost delivery systems such as urgent care, out-patient ambulatory surgical and endoscopy centers; anesthesia services; laboratory services; weight management operations; research initiatives; insurance; screening and imaging services; senior assisted and memory care facilities as well as on-boarding or incorporation of dynamic and robust information portals; tele-medicine and in-house Behavioral Health professionals and protocols.
4. Dickinson Wright lawyers are not tied to the traditional fee-for-service legal engagement agreements. We frequently design engagement agreements to fit inherent developmental stages of implementation of a client’s strategy to adopt a multi-dimensional system for delivery of care to the individual patient.
5. Dickinson Wright created the first Health Information Exchange premised upon a technology platform designed to allow legally compliant secondary disclosure of all behavioral health care records and alcohol and substance abuse records. The Behavioral Health HIE contracts, protocols, releases and participation agreements were congruent and tied together to avoid disclosure errors.
6. Dickinson Wright lawyers worked with a start-up tele-psychiatry company to prepare protocols and contracts that complied with all state regulatory requirements and licensing obligations to allow insertion of tele-psychiatry into the primary care setting and rural hospital EDs.
7. Dickinson Wright lawyers devised cost saving methodologies to relieve hospitals from their psychiatric boarding challenges, including relieving the hospital of EMTALA obligations.
8. Dickinson Wright lawyers created start-up psychiatric urgent care facilities that took on the responsibility to coordinate and supply care to patients at discharge when the patient no longer met inpatient acute care psychiatric criteria. The urgent care facility did not merely coordinate care through a referral, but instead took on full risk for all patients to receive appropriate care thereby substantially reducing the risk of future hospitalization and other high cost services. There was an immediate 35% cost reduction in hospital readmissions for these patients.
9. Dickinson Wright lawyers enabled clients to create pilot projects with payors in the court-ordered evaluation arena. These projects substantially reduced the time patients spent waiting for an evaluation and simultaneously eliminated psychiatric boarding issues. The success of these pilot projects has evolved into long term provider contracts with payors.
10. Dickinson Wright lawyers are strategizing with clients to establish protocols to determine what patient information should be contained in the patient’s medical record under new outcome measures and performance based treatment standards required by private payors and the government.
11. Dickinson Wright lawyers strategize with clients to develop business models to manage patients with complex needs.
Dickinson Wright health industry lawyers enable their clients to execute strategies that become the true drivers of health outcomes. Our clients use data analytics to measure performance, identify high cost patients and predict those who may become high cost patients. Innovation is the key component to all successful integration strategies.