Value-Based Care

Value-based care is reshaping how the U.S. health care system delivers and pays for care. As payment moves from volume to outcomes and expense management, organizations need strategies that align clinical performance with financial results. Hall Render’s Value-Based Care team helps providers design and govern models that reward quality, coordination and cost stewardship.

Our attorneys and advisors work across the full spectrum of models, including Accountable Care Organizations (“ACOs”), clinically integrated networks, value-based enterprises, provider-sponsored health plans, patient-centered medical homes, bundled payments, gainsharing and capitation. We form new entities and partnerships, negotiate value-based payer contracts and advise on corporate restructuring, antitrust, tax and governance questions that arise as organizations assume risk and share savings. We also help clients build fair methodologies for distributing shared savings and allocating shared losses that promote alignment and physician engagement.

The regulatory landscape is complex and evolving. Our Firm has deep experience with the Value-Based Enterprise framework under the Stark Law and Anti-Kickback Statute, as well as waivers and program rules tied to CMS Innovation Center models and commercial arrangements. We translate these requirements into practical guardrails and documentation that support day-to-day operations, compliance program integration and board oversight.

Our scope and scale set us apart. We represent approximately 60 ACOs in 32 states on formation, network development, value-based contracting, shared savings distribution and compliance. For systems preparing to take on risk, we deliver readiness assessments that examine sources of value-based revenue, physician leadership and care management infrastructure. In a recent multi-hospital engagement, our roadmap identified immediate opportunities in Medicare Advantage quality bonuses and rural clinic strategies, along with 180-day implementation plans to build data governance, modernize physician compensation and strengthen care coordination.

Because outcomes are shaped by factors beyond the clinic, we help clients address social determinants of health. Our work includes designing patient assistance programs, developing beneficiary engagement strategies, establishing data use and ownership policies and building networks for transportation, food security and housing support.

Whether you are joining the Medicare Shared Savings Program or refining a commercial risk portfolio, we provide the legal and operational support you need to perform well, stay compliant and improve care.