Experience
ProMedica sells Paramount Health to Medical MutualJones Day advised ProMedica in the sale of Paramount Health to Medical Mutual. Inova Health System Foundation sells 50% interest in Innovation Health to AetnaJones Day represented Inova Health System Foundation in the sale of its 50% interest in Innovation Health Holdings, LLC and its insurance company and HMO subsidiaries (collectively, "Innovation Health") to Aetna ACO Holdings, Inc., a subsidiary of Aetna Inc. and CVS Health Corporation. PWNHealth and Home Access Health Corporation sold to Everlywell, forming Everly HealthJones Day advised PWNHealth LLC and Home Access Health Corporation in its sale to Everlywell, a leading digital health company, and forming Everly Health. Academic medical center considers multi-state second opinion servicesJones Day provided strategic health regulatory guidance to a preeminent academic medical center in connection with their multi-state second opinion and telehealth programs. ProMedica Health System implements extraterritorial health care policies in all 50 states and District of ColumbiaJones Day advised ProMedica Health System on implementation of extraterritorial health care policies in all 50-states and the District of Columbia. Aetna attempts acquisition of HumanaJones Day represented Aetna Inc. as antitrust counsel in its attempted $37 billion acquisition of fellow health insurer Humana Inc. Spirit AeroSystems enters into "accountable care" arrangement with clinically integrated networkJones Day advised Spirit Aerosystems Holdings Inc. ("Spirit") in connection with the development and negotiation of an "accountable care" arrangement pursuant to which Via Christi Health Alliance in Accountable Care, Inc., a clinically integrated network of hospitals, multi-specialty physician groups, and other health care providers will manage and coordinate the delivery of health care services to employees enrolled in Spirit's self-funded health benefit plans and assume financial accountability for managing the cost and quality of health care services furnished to its employees and their dependents. Henry Ford Health System and Health Alliance Plan of Michigan sell Medicaid business in multiple Michigan countiesJones Day represented Henry Ford Health System and Health Alliance Plan of Michigan in the sale to Molina Healthcare of Michigan of certain assets of HAP Midwest Health Plan related to the Medicaid and MIChild business in five Michigan counties. The following represents experience acquired prior to joining Jones Day.
Represented Inova Health System in negotiating a joint venture transaction with Aetna, a publicly traded insurer, for purposes of setting up jointly owned regional managed care plans and a clinically integrated delivery network.
Represented major health systems in establishing provider-owned health plans for self-funded and fully insured market, including applying for a Certificate of Authority and insurance license.
Represented health insurance clients on offering qualified health plans for health insurance exchange.
Advised employers and employer organizations on implications of employee health plan under Affordable Care Act, essential health benefits, employer mandate, and compliance strategies.
Advised clients on a variety of issues under health care reform including formation of patient centered medical homes and Accountable Care Organizations (ACO), regulatory concerns arising from these new models, and impact of exchange on providers and health plans.
Provided counsel on formation and operation of integrated delivery systems consisting of multiple hospitals, major physician groups, and other health care providers.
Represented provider-owned or affiliated health plans on a wide variety of corporate, operational, and regulatory issues, ranging from structuring financing arrangements among providers and affiliated payers (e.g., revolving loan), establishing management services and other shared services organizations, to advising on Anti-Kickback, Stark, and antitrust issues.
Provided counsel in the acquisition, sale, restructuring, and expansion of managed care plans and approvals from federal and state regulatory authorities.
Provided counsel on formation and operation of life and health, property and casualty insurance companies, and various types of managed care plans such as PPOs, HMOs, and rental and fronting arrangements.
Provided legislative support and expert witness testimony on a variety of provider/payer issues including mandated benefits, credentialing, rental network, and most-favored nation provisions.
Advised clients on programs with federal and state governments such as Medicare Advantage/Prescription Drug Programs, Medicaid managed care plans, and federal employee health care programs.
Provided counsel in negotiating major reimbursement agreements between providers and payers and in the successful resolution of disputes over audits and recovery.
Provided counsel on the formation of health insurance purchasing groups including health insurance alliances and co-ops.
