The stakeholders in the health industry have created a one-dimensional industry focused on sickness and disease. These stakeholders include: government; private insurance payers; federal and state Medicaid; Medicare and Medicare Advantage; Tri-Care; Veterans Administration; Managed Care Organizations (MCOs) contracted with state Medicaid agencies; MCOs holding Medicare Advantage Contracts; Third-Party Administrators; self-funded health insurance programs; providers of care to individual patients; private vendors offering billing and management services to health care providers, electronic medical record keepers, and intellectual technology systems; and of course, the patients themselves.
Over time, the totality of culturally transmitted behavior patterns, social beliefs, and the comfort we feel from our operating institutions have strengthened and safeguarded this one-dimensional paradigm.
In 2009, Russ Kolsrud and Greg Moore recognized that the time had come to shift the paradigm of the health industry and abandon the one-dimensional focus on sickness and disease to pursue the adoption of a multi-dimensional focus on the health of the patient. Together they established the country’s first Behavioral Health Care Law practice group for a large law firm. This group published a book for the American Healthcare Lawyers Association entitled The Basics of Behavioral Healthcare Law.
Today, our team
works shoulder to shoulder with clients to create certainty in this ambiguous and uncertain health industry revolution. We have a proven record as a leader in the national legal community through pursuing solutions that implement integration strategies. We 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.
Local, statewide, and multi-state Clinically Integrated Networks (CIN).
A CIN is a way for providers to collaborate for the purpose of increasing quality and improving outcomes while decreasing utilization and the overall cost 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 and Community Mental Health Development (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.
Large Scale Group Practices.
We 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.
Personalized Service Agreements. Dickinson Wright
is 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. Additionally, our lawyers devise cost saving methodologies to relieve hospitals from their psychiatric boarding challenges, including relieving the hospital of The Emergency Medical Treatment and Active Labor Act (EMTALA) obligations.
Health Information Exchange (HIE).
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.
We work 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 emergency departments.
Psychiatric Urgent Care Facilities.
Our lawyers create start-up psychiatric urgent care facilities that take 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.
Dickinson Wright lawyers enable clients to create pilot projects with payors in the court-ordered evaluation arena. These projects substantially reduce the time patients spent waiting for an evaluation and simultaneously eliminate psychiatric boarding issues. The success of these pilot projects has evolved into long-term provider contracts with payors.
We strategize 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.
We work with clients to develop business models that assist patients with complex needs involving autism, diabetes, substance abuse, HIV, and comorbidity.