Carolyn Jacoby Gabbay represents providers of health care services and senior living options (such as hospitals, physicians, life care and continuing care retirement communities, long-term care and home health providers) before state and federal regulatory agencies and in their strategic transactions, in payment matters (including sophisticated managed care risk contracting and ACO development) and in their ongoing business operations.
What do you focus on?
My current practice focus is on three key areas, leveraging my 35+ years of experience representing health care and senior living/post-acute providers to add value in their sophisticated transactions.
I advise health care systems in their strategic affiliations and transactions representing hospitals forming regional health systems with community hospitals and academic medical centers; IPAs creating affiliated, regional contracting networks; and senior living, post-acute and home health providers aligning to reposition as part of accountable care organizations. For example, recently, my team successfully represented a health care system that was the “stalking horse” bidder in a state court receivership on the acquisition of the assets and operations of a community hospital in a neighboring state. The transaction was named “Deal of the Year – Healthcare/Life Sciences Sector” by M&A Advisor.
I counsel providers on internal investigation of compliance issues; represent them in the self-disclosure of Stark, Anti-Kickback and billing compliance matters; and negotiate resolutions with the Office of Inspector General (OIG) and the United States Department of Justice. For example, I have worked with the OIG before filing a formal self-disclosure to assure the investigative plan and random sampling would be accepted under the new Voluntary Disclosure Protocol.
Managed Care Risk Arrangements
I have extensive experience with a wide array of managed care risk and incentive arrangements, including percentage of premium, global capitation, budgeted capitation, bundled payments, P4P, quality incentives and shared savings arrangements with third-party payors for commercial and Medicare Advantage products as well as the Medicare ACO population management program (including Pioneer ACOs). I helped a state-wide integrated delivery system develop a cutting-edge economic partnership with a commercial insurer to issue a new signature, system-centric health insurance product for the small employer and individual market. I am also helping clients inform state regulatory agencies as they wrestle with addressing the growing prominence of risk-bearing organizations.
What do you see on the horizon?
Providers will face tremendous pressure to accept constantly increasing amounts of economic performance risk and to create collaborations and partnerships across the continuum of care in a wide variety of healthcare and living settings. I am working with forward-thinking health care organizations on creative risk-bearing strategies to embrace this challenge and realize on its opportunities.
- Moderator, “Disruptive Innovation: Creating the Healthcare Systems of the Future,” American Academy of Healthcare Executives—Massachusetts, May 2013