Practice Areas & Industries: Baker, Donelson, Bearman, Caldwell & Berkowitz, PC

Practice/Industry Group Overview

Disease management initiatives are playing an increasingly important role in the way that government programs, private health plans and employers cope with the challenges of managing chronic health conditions in a health care system that has historically been oriented to treat acute illnesses.

Baker Donelson attorneys have been at the forefront of disease management analysis, from early "gainsharing" trends that focused on controlling costs to the more recent generations of disease management solutions that have included incentives for meeting quality benchmarks. Baker Donelson attorneys also have significant experience in the formation and operation of specialty providers who focus on particular health care conditions and who can accomplish significant disease management objectives. The clients our attorneys have counseled in this continually evolving area include disease management companies, trade organizations, institutional health care providers and physician organizations. Specifically, Baker Donelson's attorneys and public policy advisors have:

• Secured the federal public policy representation of the Disease Management Association of America, one of the largest trade organizations for the disease management community;
• Authored and updated the American Health Lawyers Association Monograph entitled Disease Management and Gainsharing: The Next Generation of Managed Care;
• Advised disease management companies and other health care clients on a comprehensive range of legal issues relevant to disease management initiatives, including issues related to ERISA, liability for medical treatment decisions, federal and state fraud and abuse laws, state insurance regulations and HIPAA and state law privacy statutes;
• Submitted advisory opinion requests on gainsharing to both the OIG and the Centers for Medicare and Medicaid Services (CMS, formerly HCFA);
• Advised clients on permissible alternative gainsharing structures in the wake of the OIG Special Advisory Bulletin; and
• Structured specialty carve-outs for hospitals, physician groups, and other health care facilities and companies, including:
  • ambulatory surgery center joint ventures;
  • cath lab joint ventures;
  • heart hospitals; and
  • other cardiovascular services.