Managed Care Contracts & Network Development

Overview

Having a deep understanding of the intricacies involved in managed healthcare, we are well-equipped to assist clients in establishing successful managed healthcare arrangements. This includes navigating the various practical and operational considerations that arise, whether it's in the context of traditional fee-for-service to risk-based, bundled payment models. We routinely advise providers and managed healthcare organizations on pay-for-performance programs, quality bonuses, gain sharing programs, fee-for-service arrangements, value-based contracting models, and clinical integration initiatives. Our team members also have extensive experience with payor-provider litigation, managed care litigation and arbitration. Our role is to maximize your expertise and bring our breadth of real time contracting knowledge to your managed care contracts and negotiations.

Representative experience

• Five-hospital health system: Represented in the formation of a physician joint-venture with over 800 physicians for purposes of creating a managed healthcare narrow network, system-wide co-management and a framework for clinical integration
• Licensed health plan: Advised on the creation of and launch of its special dual-eligible, Medicare-Medi-Cal Health plan (D-SNP) and related support services
• Large health plan: Counseled on in several matters, including advice regarding the development of plan-sponsored incentive payment programs with contracting providers
• Managed healthcare insurance plan that contracts with various providers: Represented in connection with their structuring of quality improvement programs and incentive payments to provide value-based care to beneficiaries
• Represented numerous clinically integrated networks with respect to network formation, governance, and contracting in connection with the creation of a narrow network product with shared risk with a commercial health plan and employer self-funded plans
• Represented several hospital systems, health plans, IPAs, and medical groups with respect to their managed care contracting strategy, including managed care contracts, joint contracting, the establishment of narrow networks, risk pools, and delegated services arrangements

Recognition

• Nixon Peabody has been named a Tier 1 National firm for Health Care Law in the 2025 edition of Best Law Firms® and in consecutive years prior; named “Law Firm of the Year” in Healthcare Law by Best Law Firms in 2016
• Named as a leading firm in Healthcare by Chambers USA in 2021; 31 healthcare lawyers ranked
• Recognized as a top law firm in Healthcare by the American Bar Association’s Health Law Section
• Ranked nationally as one of the largest healthcare firms by Modern Healthcare