Alternative Payment Models and Related Regulatory Issues: Stark Law, Anti-Kickback Statute, Gainsharing, PIP, MLR

Healthcare payors and providers are working to align financial incentives and allocate financial risk. As a result, providers managing patient care are absorbing more exposure to financial burden in exchange for greater potential financial gains. The healthcare industry continues to transition from a fee-for-service model to APMs.

Among the legal and regulatory issues relating to value-based contracting are state insurance laws, medical loss ratio (MLR) requirements, Medicare physician incentive plan (PIP) rules, the Anti-Kickback Statute (AKS), the Stark law, and the gainsharing portion of the Civil Monetary Penalties law.

Healthcare providers and their counsel need to understand the different options available along with the related regulatory issues for a health system to ensure compliance while shifting to a value-based model.

Listen as our authoritative panel discusses different payment models and the associated risks of the models. The panel will examine the related regulatory issues, including Stark and AKS compliance, as well as valuation, and provide insight for ensuring compliance.

1. Different payment model options
2. Associated risks of the models
3. Legal issues and regulatory concerns
4. Valuation issues

The panel will review these and other principal issues:

• What different APM options do healthcare providers and payors have?
• What are the risks of each option? What are the regulatory issues for APMs?
• What hurdles do healthcare providers and payors face while shifting from a fee-for-service model to APMs?