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Fundamentals of Value-Based Care: Risk Capability and the Ability to Optimize Value For CINs/ACOs


Level: Advanced
Runtime: 92 minutes
Recorded Date: October 25, 2018
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Agenda


  • Defined strategies focused at optimizing the value of ACOs/CINs
  • Developed funds flow methodologies used to distribute value-based rewards across eligible providers
  • Optimal legal structures and key considerations to achieve enterprise sustainability across your CIN/ACO
Runtime: 1 hour and 30 minutes
Recorded: October 25, 2018

Description

Accountable Care Organizations (ACOs) and Clinically Integrated Networks (CINs) are highly structured collaborations between health systems and clinical providers designed to coordinate the resources needed to achieve Triple Aim goals and create a legal “safe harbor” for groups to affiliate in innovative ways for greater efficiency and community benefit. By thoughtfully designing processes that manage medical care throughout the spectrum of services and utilizing the most efficient, evidenced-based practices, these clinical networks are intended to achieve the best quality of care at the lowest cost value. These legal entities are also utilize to joint contract across payers/employers for rewards attributed to demonstrated improvement.

This program was recorded on October 25th, 2018.

Provided By

American Bar Association
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Panelists

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Matthew Fadel

Senior Manager
Sg2

As a member of Sg2’s Consulting team, Matt focuses on physician-hospital alignment models (eg, accountable care organizations [ACOs], clinically integrated networks [CINs], co-management) and enterprise strategic planning, both service line–wide and enterprise-wide.

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John Kirsner

Partner
Jones Day

With 25 years experience, John Kirsner has a national practice representing health systems and large provider organizations on cutting-edge reform-driven transactions. John has assisted in the formation and operation of more than 20 clinically integrated networks. He has assisted clients in more than a dozen MSSP ACOs. He advises ACOs on creative uses of the ACO waivers. He assists in the negotiation of shared savings arrangements with payers as well as hospital quality and efficiency programs and related co-management ventures. John is extremely conversant on the operation and regulatory implications of health care network messenger models. He has exceptional experience in the area of payer/provider contracting, including payer financial distress and preference matters.

John has led multiple engagements creating innovative affiliations between large multispecialty physician group practices and hospital systems. He has created working foundation models, models similar to the Kaiser model, as well as looser affiliation structures. He has considered the impact of equity and debt financing in the context of these transactions (including situations where a provider is in financial distress) and has worked through the medical staff implications on such affiliation structures. He also has extensive experience in joint venture, joint operating agreement, and entity formation. He represents hospitals and other providers in transactional work, including M&A.

John serves as board advisor to several health care clients. He is past chair of the Ohio State Bar Association Health Care Committee and also served as the business development partner for the Columbus Office of Jones Day from 2015 to 2018.


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