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Overview

Health plans must exercise great care to ensure provider contracts are optimally protective and preventive. Every ‘i’ must be dotted and ‘t’ crossed to meet regulatory requirements, minimize legal exposure and promote good working relationships. In addition to understanding the legal considerations for drafting provider contracts, plans must also have a command of various payment mechanisms and their implications.

Join us for the series as DSR Health Law partners Mike Daponde and Megan Rowe discuss common legal issues health plans face in provider contracting. Participants will also hear from local plan leaders who will discuss the different payment mechanisms plans often employ and share their experiences in provider contracting, including pitfalls and lessons learned, and how to get ahead of potential issues.

Who should participate:
Local health plan CEOs, CFOs, plan counsel, provider contracting and finance staff

Session 1 Agenda

Legal Issues in Medi-Cal Provider Contracting
May 11, 2021 | 1:30 – 3:00 p.m. 

Learn from DSR Health Law’s Mike Daponde and Megan Rowe as they discuss key legal contract provisions plans should review and fortify to avoid litigation, including:

• Utilization management
• Offsetting overpayments
• Government Claims Act
• Dispute resolution
• Indemnification
• Regulatory requirements
• Compensation terms
• Eligibility

Sessions 2 & 3 Agendas

Dr. Bradley Gilbert, former CEO of Inland Empire Health Plan, will offer introductory insights and perspectives around provider contracting. Participants will also hear from local health plan leaders who will explain some of the pros and cons of commonly used payment mechanisms, share challenges they have encountered in provider contracting and discuss strategies used to mitigate potential issues.

Practical Issues In Medi-Cal Provider Contracting —​ Part I
May 12, 2021 | 1:30 – 3:00 p.m.

Agenda

• Context & Overview
  • Philosophy of provider contracting 
  • Network adequacy considerations 
• Hospital Contracting
  • Overview of APR-DRGs
  • Per diem contracting and exclusions
  • Provider payment models — pros and cons 
  • Outpatient services
  • Tertiary and quaternary

Practical Issues In Medi-Cal Provider Contracting —​ Part II
May 13, 2021 | 1:30 – 3:00 p.m.

Agenda

• Risk-Based Contracting
  • Dual capitation — hospital and IPA
  • Global risk through restricted Knox-Keene license (RKK)
  • IPA-only contracting
  • Monitoring and oversight

• Physician Contracting
  • Capitation model agreement 
  • Pros and cons of capitation vs. fee-for-service
• Miscellaneous Services — dialysis, home health, durable medical equipment

Faculty

Edward Calles
Sr. Director, Provider Network Management
L.A. Care Health Plan

Michael J. Daponde
President
DSR Health Law

Steve Davila
Director, Provider Contracting
Inland Empire Health Plan

Bradley Gilbert, MD, MPP
Consultant & Former CEO of Inland Empire Health Plan

Kurt Hubler
Chief Network Officer
Inland Empire Health Plan

Megan A. Rowe
Partner
DSR Health Law

Registration

NOTE: Health plan staff interested in participating should adhere to their respective plan’s process for LHPC Institute event registration where applicable.

Fees* (per connection)
Session 1 only                       $30
Sessions 2 & 3 only               $60
Full Series                              $75
Plan Series Registration^     $175
*Special pricing is offered while health plan staff are working remotely. Standard pricing will resume when staff return to work on-site.
^ Select this option if plan staff will view the webinars communally on-site. Plans with multiple sites must register each site separately and identify whom at each site should receive the webinar access information upon registering. When registering, please enter unique email addresses for each additional site as the system may not allow duplicate logins.​​

Registration closes May 6 at 5:00 p.m.

Registration Confirmation: Registrants will receive an email notification confirming their registration.

Participating in the Webinar: You will only need a computer with a web browser (Google Chrome, Microsoft Edge or Mozilla Firefox is recommended; Internet Explorer may not be supported) and a telephone. Audio for the program will be available via toll-free number or by using your computer speakers. 

Cancellation and No-Show Policy: Cancellation notification must be submitted in writing to institute@lhpc.org seven or more days prior to the course date. Refunds will not be given after that date. Substitutions are encouraged. Payment will be due for registered individuals that do not attend the event and for which a cancellation notice is not received.