Contracting

We help health plans use their leverage with vendors and providers to negotiate key agreements. We also craft straightforward, up-to-date contract templates that your employees can easily understand and put to use.

Contracts for Health Plans, including Medicare Advantage and Part D Prescription Drug Plans, Medicaid Managed Care Plans, and Qualified Health Plans

  • Pharmacy Benefit Manager (PBM) agreements
  • Provider agreements – health system, hospital, physician group, and other providers of ancillary services such as hospice and durable medical equipment
  • Outsourcing agreements for administrative plan functions such as claims processing, utilization management and appeals, or customer service
  • Sales channel agreements, including Field Marketing Organizations (FMOs), general agencies, agents and brokers
  • Behavioral health management, vision benefits administration, dental benefit administration agreements
  • Risk adjustment services for Medicare Advantage and Qualified Health Plans

We also assist health plans transitioning their provider agreements to value-based payment arrangements, including bundled payments, shared savings arrangements, and capitation arrangements.