AHLA Health Plans Contracting Handbook: A Guide for Payers and Providers (AHLA Members)

Robert M. Keenan, III (Editor, Project Chair, and author of Chapter 1, Introduction: Basics of Contracting and Negotiating) is a partner with King & Spalding and advises health systems, hospitals, home health companies, pharmacy benefit management companies, pharmaceutical and medical device companies, physician organizations and managed care companies on a wide variety of federal and state regulatory matters, including health information privacy, fraud and abuse, certificate of need, licensure and managed care/insurance issues. Mr. Keenan also represents health industry clients in various transactional matters, including healthcare regulatory due diligence in connection with mergers and acquisitions, joint ventures between healthcare providers, managed care contracting, and general contracting. He has specialized experience dealing with health information privacy issues for HIPAA covered entities and business associates, as well as for device and pharmaceutical companies.

Mr. Keenan also has a particular focus advising hospitals and health systems on regulatory and structuring issues applicable to physician practice acquisitions and employment. Mr. Keenan is included in the most recent editions of The Best Lawyers In America, the Chambers USA Client's Guide to American's Leading Lawyers for Business, and Guide to the World's Leading Healthcare Lawyers. Mr. Keenan is a member of the American Health Law Association (AHLA) (Health Information & Technology, Fraud and Abuse, HMOs and Health Plans, and Life Sciences subcommittees), the Health Law Section of the American Bar Association, and the State Bar of Georgia, and is a member and past President of the Georgia Academy of Healthcare Attorneys. He writes and speaks frequently on health law issues and is the Co-Editor of the AHLA's Health Plans Contracting Handbook, 6th ed. (2011).

Mr. Keenan graduated from the University of Illinois in 1985 and from the University of Georgia School of Law in 1988 where he was Executive Editor of The Georgia Law Review. Mr. Keenan served as law clerk to the Honorable Bobby R. Baldock, United States Court of Appeals for the Tenth Circuit, in Roswell, New Mexico. He began his legal career at King & Spalding, served for four years as Assistant General Counsel with Prudential HealthCare in Atlanta, and then returned to King & Spalding in 1999. He is a partner in the firm's Healthcare Practice Group.

Anne W. Hance (Co-Editor and Project Vice Chair) is a partner in the law firm of McDermott Will & Emery LLP and is based in the Firm's Washington, D.C. office. She is a member of the Health Industry Advisory Practice Group and co-chair of the Firm's Insurance/Payers Affinity Group. Anne focuses her practice on advising health insurers, health maintenance organizations, pharmacy benefit managers and other industry stakeholders on federal and state regulatory matters. She counsels clients on a broad range of issues, including health insurance market reforms enacted under the Affordable Care Act; federal health care programs, including the Medicare managed care (Medicare Advantage) Program, the Medicare prescription drug benefit (Medicare Part D), and the Medicaid Program; state insurance regulatory issues; provider and administrative service contracting; HIPAA privacy and security matters; federal fraud and abuse and compliance issues; as well as general legal and health policy issues. She has worked with health plans and pharmacy benefit managers on pharmacy benefit management contracts and related regulatory issues involving pharmaceutical pricing and benefit design and administration.

Anne frequently presents and authors articles on issues relating to Health Care Reform, Medicare Advantage, and Medicare Part D, including legislative and regulatory developments, compliance matters, and Medicare risk adjusters. She served for six years as vice-chair in charge of publications for the American Health Law Association's (AHLA's) Payers, Plans and Managed Care Practice Group, and currently is serving as co-chair for the planning committee for AHLA's 2015 Institute for Health Plan Counsel and also serves on the editorial advisory board for BNA's Health Insurance Report. This is Anne's second time serving as a co-editor for the AHLA Managed Care Contracting Handbook, having worked with the authors and editors on the 6th Edition as well.

Leah B. Stewart (Co-Editor and Project Vice Chair) is a shareholder at Beatty Bangle Strama, PC in Austin, Texas, and practices in several areas of healthcare and regulatory law, with an emphasis on managed care. She represents hospitals, provider-affiliated plans, pharmacies, and other healthcare entities on a wide range of matters, including healthcare and managed care contract arrangements; regulation of healthcare providers, health plans, insurance and workers' compensation carriers; federal and state privacy issues (HIPAA); Texas legislative and rulemaking initiatives; federal and state fraud and abuse laws; Medicare Parts C and D; licensure and certification by the Texas Department of Insurance; and health care transactions. Leah is actively involved in AHLA and has served as a Vice Chair in the Payers, Plans and Managed Care Practice Group since 2011. Leah is an alum of the University of Virginia School of Law and Texas A&M University.

Matthew P. Amodeo (Chapter 2, Accountability and Collaboration-The New Paradigm in Payer-Provider Relationships) is a partner with Drinker Biddle & Reath LLP in their Albany, New York office. He focuses his practice on hospital physician Affiliation transactions, managed care contracting, accountable care arrangements and New York healthcare regulatory matters. He advises healthcare providers, ACOs and population health management companies concerning structural, operational and payment issues involved in shared savings and other types of risk arrangements with third party payers. Matthew also advises health systems regarding Federal and state Exchange related matters, the Medicare Shared Savings Program and other Medicare payment reform initiatives under the Affordable Care Act.

Adam C. Aseron (Chapter 4, Key Contract Definitions) is a founding member of Giles Aseron PLLC. Adam's principal area of practice is healthcare law, with an emphasis on transactional and regulatory matters. Adam represents physicians, hospitals, and other healthcare entities, as well as healthcare industry investors, in connection with business transactions and ventures, federal and state regulatory matters, and day-to-day operations and compliance issues. Adam regularly advises clients on managed care contracting issues. Before co-founding Giles Aseron PLLC, Adam worked for several years as a healthcare attorney with the Austin office of Vinson & Elkins L.L.P. Previously, Adam served as a judicial clerk for The Honorable Thomas B. Bennett, U.S. Bankruptcy Court for the Northern District of Alabama. Adam obtained his law degree from the University of Texas School of Law in 2006, where he graduated with high honors, was a member of the Order of the Coif, and an Associate Editor of the Texas Law Review. He also received the Robert S. Strauss Endowed Presidential Scholarship in Law, the David J. Beck Endowed Presidential Scholarship in Law, and Dean's Achievement Awards in both Civil Procedure and U.S. Law and National Security. Before law school, he received his B.B.A. with honors in banking and finance at the University of Georgia. Adam is licensed to practice law in Texas and New York.

James W. Boswell (Chapter 10, Dispute Resolution) is a litigation partner practicing in King & Spalding's Healthcare Practice Group. His practice is devoted to handling litigation and investigations on behalf of healthcare industry clients. Mr. Boswell has represented healthcare entities in administrative matters, False Claims Act lawsuits, civil litigation proceedings, and government investigations. Mr. Boswell regularly handles jury trials, administrative hearings, arbitrations and appellate arguments involving specialized healthcare issues, including managed care specifically. He received his law degree, magna cum laude, from Harvard University in 1991. Mr. Boswell joined King & Spalding in 1992 after clerking on the United States Court of Appeals for the Fifth Circuit. Mr. Boswell is a member of the Board of Directors of the American Health Law Association. From 2009 to 2012, he served as Chair of the Healthcare Liability and Litigation Practice Group of the American Health Law Association. In 2008, Nightingale’s Healthcare News recognized him as one of twelve "Outstanding Healthcare Litigators" nationally. Mr. Boswell is listed in Chambers USA, Super Lawyers, Best Lawyers in America, and Georgia Trend's Legal Elite.

Robin Fisk, Editor in Chief and co-author of Chapter 17, Considerations in the Absence of a Contract Between Provider and Payer, is a health lawyer focusing on managed care and business transactions. She has represented providers, practitioners, and managed care organizations. Robin has functioned as in-house counsel for managed care companies in metro New York, Texas, and Massachusetts, served as lead counsel for four insurer start-ups, several service line and service area expansions, and as contract counsel to national providers. Pursuing a longstanding interest in improving the way services are delivered, she recently completed her Master’s of Health Care Delivery Science, a program jointly sponsored by the Tuck School and the Dartmouth Institute. Robin has also taught health law at the Master’s level. She graduated from Boston University School of Law and the University of Pittsburgh a very long time ago.

Lisa G. Han (Chapter 12, Medicare Managed Care Contracting) is a partner at Jones Day. Lisa represents a wide variety of health care organizations and provides strategic and transactional and regulatory counseling with respect to their managed care operations. Lisa has significant experience in mergers, acquisitions, and restructurings of insurance companies and managed care plans; insurance holding company transactions and related regulatory filings; state insurance law, including license, products filings and insurance marketplace compliance; Medicare Advantage and Medicaid managed care plan compliance and operation; formation of ACOs and clinically integrated network and other types of network development; value-based purchasing strategies, including bundled payment, P4P, gain sharing, consumer directed health plan and other risk based programs; Health Reform Law.

Richard J. King (Chapter 6, Payment Methodologies, Including Risk-Based Payment) is a Shareholder with Stevens & Lee, P.C. He concentrates his practice in health law with emphasis on federal and state regulatory compliance and third party reimbursement, including Medicare, Medicaid and nongovernmental commercial payers. He has represented more than 100 hospitals, nursing homes and personal care facilities in state and regulatory proceedings, including survey, certification and certificate of need matters. He has appealed Medicaid and Medicare disputes and has defended clients in insurance, health care, commercial and franchise law matters. Mr. King frequently writes and speaks on a wide range of health law and policy topics and has presented before numerous professional organizations, including the Delaware Health Care Facilities Association, the Healthcare Financial Management Association, and the Pennsylvania Bar Institute. He is a former Chair of the Health Law Section of the Delaware Bar Association. Mr. King received an M.P.H., with a concentration in Health Policy and Management, from the Harvard University School of Public Health, a J.D. from the University of North Carolina School of Law, and was an Echols Scholar at the University of Virginia, where he earned his B.A. with distinction.

John M. Kirsner (Chapter 3, Antitrust Issues in Payer/Provider Contracting) is a partner in the healthcare practice group at Jones Day, resident in Columbus, Ohio. Mr. Kirsner's practice focuses on provider integration strategies, including development and ongoing legal and regulatory advice for accountable care organizations, clinically integrated networks and other provider network strategies. He also has led several engagements forming sophisticated integrated provider organizations, including establishing foundation models, professional service agreement models and loose affiliation models involving large multispecialty group practices and hospital systems. He has extensive experience with commercial ACO shared savings arrangements, assisting in the negotiation of such models with payers, as well as establishing internal distribution mechanisms. Mr. Kirsner has many years of experience with payer/provider contracting issues as well. He has written book chapters for other AHLA publications, is a co-author of a book on payer/provider contracting issues, and is a frequent national speaker and author on healthcare issues. He is a past chair of the Ohio State Bar Association Health Care Law Committee, and has been named to the Best Lawyers in America for both healthcare and insurance law since 2007, and an Ohio Super Lawyer since 2006. He is a 1992 graduate of The Ohio State University Moritz College of Law, and has two wonderful children, Eleanor (7) and Ariel (5), with his wife Lisa.