Managed Care Organization Representation

Members of the Practice Area have represented MCOs of every variety and size, including HMOs, insurance companies, preferred provider organizations ("PPOs"), and provider-sponsored or owned network organizations.  Our broad experience in representing the diverse segments of the health care delivery field in connection with managed care issues enables the Practice Area to efficiently and creatively assist in the resolution of legal issues, development of appropriate structures, and maintenance of legal compliance.

Practice Area members have had significant extensive experience in structuring MCOs and in resolving the numerous issues surrounding the creation, implementation, and ongoing operation of these entities.  Representative projects include:

• Forming licensed HMOs, including provider-sponsored organizations.
• Forming national, statewide and regional provider network, targeted commercial and/or Medicare/Medicaid markets.
• Counseling health care trade associations on managed care issues.
• Reviewing and negotiating managed care contracts on behalf of various clients, including a large multispecialty group practice and an academic medical center.
• Creating regional networks of physician/hospital providers under contract with various MCOs.
• Creating new MCOs as joint ventures between an existing MCO company and a regional provider system.
• Organizing primary care providers into an independent practice association to coordinate managed care contracting and facilitate risk assumption and management.
• Representing specialty providers in the creation of fully integrated entities capable of accepting full capitation and providing a network of service to MCOs.

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