AAMC Produces Landmark Report on Academic Health Systems for the Future
For the Association of American Medical Colleges (AAMC), Manatt advised on and coauthored the landmark 2014 report "Advancing the Academic Health System for the Future," which articulated a vision and recommendations for academic health centers as they seek to transform into systems responsive to the changing clinical environment and able to continue to invest in teaching and research missions. Manatt worked closely with the AAMC Healthcare Affairs Advisory Panel of Deans, CEOs and Practice Plans to assess the landscape for academic medicine, complete in-depth profiles of leading organizations, prepare the panel report, and develop a companion self-assessment tool.
Continuum Health Partners Merges with Mt. Sinai
Manatt advised Continuum Health Partners, a New York City nonprofit health system composed of three hospitals (Beth Israel, St. Luke's Roosevelt and NY Eye and Ear Infirmary) in the formation of a new, integrated health system with Mt. Sinai Hospital and the Icahn School of Medicine at Mt. Sinai. The combined entity—called the Mount Sinai Health System—is now one of the nation's largest nonprofit health systems.
Blue Shield of California and Anthem Blue Cross Fund Integrated Data Exchange
Manatt represented Blue Shield of California in the formation of a joint venture with WellPoint Inc.'s Anthem Blue Cross to fund California Integrated Data Exchange, better known as Cal INDEX, projected to be one of the nation's largest health information exchanges. Together, Blue Shield and Anthem Blue Cross are spending $80 million on the nonprofit.
The Commonwealth Fund Examines States' Efforts to Promote Integrated Care
Manatt authored a white paper for The Commonwealth Fund that examines states' efforts to promote integrated care delivery as part of their efforts to deliver high-quality, cost-effective care to Medicaid beneficiaries with comorbid physical and behavioral health conditions ("State Strategies for Integrating Physical and Behavioral Health Services in a Changing Medicaid Environment"). The Medicaid expansion authorized by the Affordable Care Act (ACA) brings greater import to these efforts, as millions of uninsured low-income adults, many at increased risk for behavioral health conditions, gain coverage and states are required to provide behavioral health services and meet federal parity laws. State efforts to ensure that Medicaid beneficiaries have access to integrated care, however, are hindered by a fragmented behavioral health system that is administered and regulated by multiple state agencies and levels of government, and by purchasing models that segregate behavioral health services from other Medicaid-covered services. Drawing on a review of the literature and interviews with diverse stakeholders, this report explores strategies states are deploying to address or eliminate system-level barriers to integrated care for this medically complex and high-cost Medicaid population.
Regional Collaborative of Healthcare Providers and Plans Advised on HIPAA Issues
Manatt led the development of a regional collaborative of healthcare providers and plans for the purpose of implementing the HIPAA Administrative Simplification transactions. The project included developing detailed ROI analyses for each of the seven provider and payer member organizations, a consortium governance and funding model, the technical architecture design for transaction integration and real-time transfer of HIPAA transactions between consortium members, and a detailed project plan and cost estimates for implementation.
Medical Device Manufacturer Executes Reimbursement Strategies to Support Launch
Manatt is assisting a medical device manufacturer with execution of reimbursement strategies to support the launch of its recently FDA-approved radiopharmaceutical. Reimbursement support includes analysis of clinical evidence to guide development of coverage policies, preparation of New Technology applications to receive Medicare reimbursement in hospital outpatient departments, and identification of reimbursement challenges and opportunities under the Affordable Care Act.
Hoag and St. Joseph Health Advised on Merger
Manatt advised Hoag Memorial Hospital Presbyterian and St. Joseph Health, two of the most prominent healthcare systems on the West Coast, on an innovative affiliation that seeks to significantly improve the delivery of healthcare in the local communities served by these long-standing institutions. The organizations have formed an integrated regional health system that includes six Southern California hospitals, an expansive physician network, and numerous outpatient and urgent care facilities in Orange County and the High Desert. Their shared vision includes taking action to fix fragmented systems of care, greatly improve access for the underserved, and deliver on the goal of making the region among the healthiest in the country. Manatt represented the parties with respect to state and federal regulatory and antitrust matters and advised on key corporate and governance provisions for the members of the affiliated group.
National Health Insurer Forms Multiple JVs to Create ACOs
Manatt's healthcare team has structured multiple joint ventures between a national managed care health insurer client and leading healthcare systems throughout the United States. The purpose of the JVs is to create accountable care organizations (characterized by a payment-and-care delivery model) through which our client can employ its insurance and IT capabilities to help providers better manage the cost and quality of care.
Kaiser Commission on Medicaid and the Uninsured Prepares Issue Brief on DSRIP
Manatt and The Kaiser Commission on Medicaid and the Uninsured prepared an issue brief on Delivery System Reform Incentive Payment (DSRIP) programs, which are increasingly being used by state governments across the country to promote sweeping payment and delivery system reforms. Part of broader Section 1115 Waiver programs, DSRIP initiatives provide states with significant funding that can be used to support efforts by hospitals and other providers to change how they provide care to Medicaid beneficiaries. Titled "An Overview of Delivery System Reform Incentive Payment (DSRIP) Waivers," the brief examines the similarities and differences among California, Texas, Kansas, New Jersey, Massachusetts and New York across key elements of DSRIP waivers, including the goals and objectives of DSRIP initiatives; eligible providers, projects and organizations; allocation of funds; data collection and evaluation/reporting; and financing of DSRIP waivers.
Academic Health System Develops Health IT Strategy
Manatt advised a large academic health system on its health information technology strategy, including the design of a new portfolio-based IT organization model to improve resource alignment and focus, an application plan that consolidated systems and prioritized investments in new capabilities, a technology plan to improve systems' performance and availability, and a five-year capital and operating budget.
Long-Term Care Coalition Advised on Legislative and Regulatory Strategy
Manatt founded and provides legislative and regulatory advocacy services to the New York State Coalition of Managed Long-Term Care and PACE Plans, a consortium of 18 nonprofit, provider-sponsored managed care organizations that coordinate care of chronically ill, nursing home-eligible New Yorkers. As part of our engagement, we obtained approval of a proposed rule to mandate their enrollment, if they require more than 120 days of community-based long-term care services. The rule immediately became the centerpiece of the state's Medicaid Redesign of long-term care services. We also assisted with the implementation of the new initiative, as well as the development of a new, capitated model for managing the care of dual eligibles.
Hartford HealthCare Counseled on Antitrust Issues
Manatt served as antitrust counsel to Hartford HealthCare, which includes Hartford Hospital (an 867-bed regional referral center that is one of the largest teaching hospitals and tertiary care centers in New England) and three community hospitals, with respect to its affiliations with the Hospital of Central Connecticut and with Backus Healthcare System, also based in Connecticut. In the midst of sweeping change in healthcare, these affiliations created a fully integrated healthcare delivery system for the region.
New Hampshire Assesses Basic Health Plan Options
On behalf of the Endowment for Health/Health Strategies of New Hampshire, Manatt partnered with Mercer Government Human Services Consulting to publish an assessment of the Basic Health Plan (BHP) option for the state of New Hampshire. The team was tasked with presenting a suite of options for state policymakers and stakeholders to consider as New Hampshire contemplates whether to implement the BHP. The report includes an evaluation of the financial feasibility of the BHP option in the state and an analysis of policy options for the use of federal subsidies above the cost of the BHP. It also examines the implications of adopting a BHP for a state health benefit exchange.
Major Pharmaceutical and Device Manufacturer Analyzes Alternative Pricing Models
Manatt was engaged by a large pharmaceutical and medical device manufacturer to conduct comprehensive research and analysis of alternative pricing models used by pharmaceutical manufacturers in their contracts with health plans and delivery systems. Manatt identified alternative pricing options, worked with the client's leadership to consider how the options might become a component of its commercial plans, and provided lead pricing options and strategic recommendations to the company.
California HealthCare Foundation Highlights Efforts to "Free the Data"
Recognizing the significant role that publicly accessible and usable data can play in improving the quality and efficiency of the healthcare system, the U.S. Department of Health and Human Services (HHS) and certain states have launched initiatives to increase the amount of new healthcare data available in the public domain. Manatt Health Solutions—together with the Center for Democracy & Technology—prepared an issue brief titled "Strategies for Safeguarding Patient-Generated Health Information Created or Shared Through Mobile Health Devices" for the California HealthCare Foundation highlighting efforts by HHS and states to "free the data" and outlining the benefits to California should the state follow suit.