Case Study: Bridging The Gap With Healthcare Providers

One of our health care clients wished to enhance medical services and care coordination provided in the region as health care providers who both cooperate and compete in respective health care services, how could we help the client bridge the differences and build on the common regional vision?

In support of the client’s regional vision, we helped identify a range of legal structures and relationships that would permit the client to work with other health care providers to build the common vision without violating anti-trust laws and health care regulatory fraud and abuse laws in particular. There were many reasons why the collaboration might not work or would pose legal challenges, which would have made “no” the easy answer. However, we focused on how to say “yes, you can do that” but in a way that was legally compliant, practically achievable, and complementary to the client’s mission. How to say “yes but do it in this way” is much more challenging than simply identifying the road blocks to justify “no”. The process involved extensive interactive efforts with the client’s management team, governing board, and health care consultants to create a multi-pronged strategy and then equally extensive interactions with other health care providers who might be interested in participating in some aspect of that strategy.

With our advice, the client developed and executed on the multi-pronged strategy that included (a) development of loose affiliations with health care providers interested in exploring opportunities to work together and/or share services but not yet ready to become formally aligned, (b) creation of a clinically integrated network for providers who were prepared to cooperate more closely and formally but continue to remain independent entities, and (c) acquisitions of other health care providers who decided joining our client organically would achieve the best results for their businesses and missions.