Health care providers who contract with payors through provider-controlled contracting organizations generally are paid either a risk-based fee or a fee for services rendered. As payor interest in risk contracting has diminished, many contracting organizations have turned to fee-for-service...
Health care providers who contract with payors through provider-controlled contracting organizations generally are paid either a risk-based fee or a fee for services rendered. As payor interest in risk contracting has diminished, many contracting organizations have turned to fee-for-service contracts. To avoid the antitrust prohibition against agreements among competing providers with respect to the price of their individually provided services, many organizations have turned to the use of the messenger model. This handbook is intended to provide guidance on the legal analysis applied to messenger models utilized by health care provider networks when they contract with health care payors.
This book provides the necessary predicate for understanding these issues by exploring the relevant history of managed care in the United States, trends in the formation of provider networks and their negotiations with managed care, and the genesis and evolution of messenger models themselves. The book then details the treatment of messenger arrangements by the federal antitrust agencies and the courts, and concludes with an analysis of specific antitrust concerns and risks relating to messenger models. It's a perfect resource for those who either want to know more about the concept or simply want to properly implement a messenger model.
The Appendices of this handbook include a number of useful resources, including the applicable Statements of Antitrust Enforcement Policy in Health Care, Department of Justice business review letters, Federal Trade Commission advisory opinion letters, speeches of antitrust enforcers, and sample antitrust guidelines for messenger models.
Summary of Contents
Chapter I - Introduction
Chapter II - Methods of Provider Contracting
Chapter III - The Legal Genesis of Messenger Arrangements
Chapter IV- Treatment of Messenger Models by Antitrust Agencies and Courts.
Chapter V - Managing the Antitrust Risks of Messenger Models
Appendix A - Statements of Antitrust Enforcement Policy in Health Care
Appendix B - Messenger Model Business Review Letters
Appendix C - Messenger Model Advisory Opinion Letters
Appendix D - Speeches and Documents Submitted to the Agencies
Appendix E - Sample Antitrust Guidelines for Messenger Models
Table of Cases