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All health care providers are facing significant change as a result of health care reform. While the health care industry is constantly changing, the Affordable Care Act accentuates the pace of evolution. All health care providers face many new concepts and challenges:

  • Quality and Risk-Based Payment/Managed Care
  • Health care Exchanges
  • Accountable Care Organizations
  • Medicaid Expansion
  • Increased and Novel Fraud and Abuse and Antitrust Compliance Risk

Academic Medical Centers (AMCs) are not immune to these changes and challenges. And while they continue to serve their unique missions of education, research and training in order to survive, many of them still must compete in the health care marketplace as health care providers.  AMCs possess attributes that bodes well for their success while simultaneously making them more vulnerable:

  • Strong reputations as regional tertiary care centers providing highly specialized services.
  • Sophisticated clinically-integrated care between hospitals and physicians to treat complex disease.
  • Academic mission focused on population health but may not always be aligned with cost savings.
  • Complex governance structure between AMC, medical schools and their university that may not be aligned to the purpose and mission of AMC. 

Many AMCs already are responding to health care reform by forming new alliances and comprehensive clinically-integrated networks. Some are affiliating with or acquiring community hospitals that complement their academic mission. And they are incorporating primary care physicians into the networks, so that patients can receive efficient and coordinated care. Others are entering into risk-based payment arrangements with managed care entities.

We counsel and guide our health care provider clients, including AMCs, so that they can thrive in this new era of health care reform. 

  • Formation of Integrated Delivery Systems.
    • Strategic advice on structure of integrated health systems
    • ACO formation and regulatory compliance
    • Counsel on risk-based payment arrangements
    • Advise on Center for Medicare & Medicaid Innovation initiatives
    • Corporate counsel on health transactions including mergers and joint ventures
    • Antitrust review
    • Fraud & Abuse Compliance
  • Connection to regulatory agencies and Congress to assist clients in understanding underlying policy objectives as well as provide access to decision-makers when necessary.
  • Extensive experience in fraud and abuse enforcement to mitigate risk while also providing vigorous representation during government investigations.

Click here to view representative engagements.

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Crowell & Moring LLP is an international law firm with approximately 550 lawyers representing clients in litigation and arbitration, regulatory and policy, and transactional matters. The firm is internationally recognized for its representation of Fortune 500 companies in high-stakes litigation, as well as its ongoing commitment to pro bono service and diversity, equity and inclusion. The firm has offices in Brussels, Doha, London, Los Angeles, New York, Orange County, San Francisco, Shanghai, and Washington, D.C.

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