Accountable Care Organizations and Health Reform

Accountable Care Organizations and Health Reform

Providing Forward-Thinking Solutions in a Rapidly Changing Health Care Marketplace

Today's health care providers face change that is breathtaking in pace and scope. Providers must make critical business decisions now, even though many details of federal health care reform are still being defined and debated. Of particular concern are the issues surrounding the creation of accountable care organizations (ACOs), a transformative payment and delivery approach that is the backbone of the Medicare Shared Savings Program (the "Program") established by the Patient Protection and Affordable Care Act of 2010 (PPACA). In the effort to establish ACOs, health care organizations cannot afford to be left behind; nor can they rush headlong into unexplored territory.

The health care lawyers of Hunton & Williams have the insight and in-depth knowledge to help clients balance the opportunities and challenges associated with the creation and implementation of ACOs. With decades of experience in the highly regulated health care industry, we have worked closely with clients to monitor and comment upon emerging legislation and agency rules, and to implement statutes and regulations after they have gone into effect. Our lawyers have authored numerous articles and reports published in legal and business journals, all designed to help health care companies keep their footing in a rapidly changing landscape.

We advise large health systems, hospitals, academic medical centers, physician groups and other participants on all aspects of the ACO model, including the following:

  • Formation of ACOs, including recruitment of provider panels and creation of administrative and clinical leadership and management structures
  • Compliance with ACO antitrust requirements and safety nets as proposed by the Federal Trade Commission and the Department of Justice, including preparation of applications for agency reviews
  • Establishment of provider reimbursement and payment distribution structures that meet the requirements of the Program
  • Creation of strategic cost, quality and care goals and initiatives
  • Development of ACO performance measurement and reporting tools
  • Compliance with the Stark, anti-kickback and other Medicare and Medicaid fraud and abuse laws