The Centers for Medicare & Medicaid Services and the Office of Inspector General recently finalized new regulations designed to accelerate the transformation of the healthcare industry to a system that better pays for value and promotes care coordination. As a result, there are now exciting new opportunities for providers to partner in ways not possible in the past.

Our healthcare team at Nelson Mullins has been carefully examining these regulations. Over the next few weeks, we will be publishing a five-part series of summaries to help you understand these concepts, and to begin to see the increased potential in value-based care. We are also looking forward to helping our clients create innovative ways to best take advantage of these opportunities, including through direct contracting entities.

Attached to each summary will be a relevant part of an article on the subject, written by Nelson Mullins partner Ed White.

Part 1: New Opportunities for Provider Collaboration - Stark and Anti-Kickback Statute Standards for Value-Based Care

  • The New Stark Law Exceptions for Value-Based Arrangements
  • The New Anti-Kickback Statute Safe Harbors for Value-Based Arrangements

Part 2: Creating a Value-Based Enterprise - The Foundation for the Stark Exceptions and Anti-Kickback Statute Safe Harbors

  • The Value-Based Enterprise for Stark Exceptions
  • The Value-Based Enterprise for the Anti-Kickback Statute Safe Harbors

Part 3: How to Create a Care Coordination Value-Based Enterprise

  • The Stark Model: Value-Based Arrangement
  • The Anti-Kickback Statute Safe Harbor Model: Care Coordination Arrangement

Part 4: How to Create a Partial Risk Value-Based Enterprise

  • The Stark Model: Meaningful Downside Financial Risk Arrangement
  • The Anti-Kickback Statute Safe Harbor Model: Substantial Downside Financial Risk Arrangement

Part 5: How to Create a Full Financial Risk Value-Based Enterprise

  • The Stark Model: Full Financial Risk Arrangement
  • The Anti-Kickback Statute Safe Harbor Model: Full Financial Risk Arrangement