Antitrust Compliance and Clinical Integration: Recent Developments, FTC and DOJ Scrutiny

While talk of change on Capitol Hill continues on healthcare, one consistency is that healthcare providers around the country still seek out ways to better collaborate and coordinate care. Accountable care organizations and other forms of clinical and financial integration are the most common types of collaborations other than mergers and acquisitions. However, competitor collaborations can raise antitrust concerns. The FTC, DOJ, state attorneys general, and other market participants are scrutinizing these arrangements to ensure compliance with antitrust laws.

The speakers will describe how the FTC investigates collaborations among providers such as ACOs and clinically integrated networks. They will discuss collaborative activities that are unlikely to raise antitrust concerns and the types of situations that are likely to prompt an investigation. They will address how to reduce antitrust risks in forming and operating a physician network, joint venture, or ACO, and how best to respond to an antitrust investigation if one occurs.

Listen as our authoritative speakers provide practical guidance on how to assess the antitrust risks of provider collaborations and how to reduce the likelihood of an antitrust investigation or challenge.

1. Antitrust overview
2. Antitrust assessment of provider collaborations
   1. Is there sufficient financial or clinical integration?
   2. Will the network have market power--how does one go about determining product and geographic markets, or is that even necessary?
   3. Exclusive vs. non-exclusive networks
   4. How to document potential cost and quality efficiencies
   5. What conduct creates "red flags"?
3. Addressing some common questions
   1. How does the network know that it is sufficiently integrated?
   2. When can joint negotiations begin?
   3. Should the network work with health plans--and if so, how?
   4. How relevant is evidence of cost or quality gains?
   5. Does working with a hospital raise or lower the antitrust risks?
   6. What if prices go up?
   7. Should the network seek an advisory opinion?
   8. And more

The speakers will review these and other noteworthy issues:

• What are the lessons from the FTC's advisory opinions regarding clinical integration programs?
• What are the elements to include in a clinically integrated provider network within the meaning of antitrust law?
• What are best practices for effective clinical integration and avoiding antitrust problems?