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Payers, Providers, and Downstream Global Risk: What Health Plans Need to Know

Event Date: 2/6/2019

Event Overview

Wednesday, February, 06, 2019
11:00 AM CT – 12:30 PM CT (90 minutes)
Discussion Lead by: Sheppard Mullin
This event is hosted on our ReadyTalk platform


As Alliance members are evaluating the implications of partnering with other entities in downstream global risk as part of their overarching strategy to transition toward value and risk-based reimbursement, they may discover that these arrangements, if not done properly, are tricky and full of minefields. 

Sheppard Mullin has done more of these arrangements in the past two years than any other firm in the country.  They will lead a discussion on downstream global risk (where the payor delegates a percent of premium downstream for professional, institutional and facility, and pharmacy to a risk-bearing entity and delegates core functions such as utilization management, care management, claims payment, customer service and credentialing.  Downstream global risk-bearing structures can be used with Medicare Advantage, managed Medicaid and commercial risk arrangements.

These joint ventures are taking a variety of forms and structure and may involve a range of types of entities including payors, physician groups, clinical providers and private equity-backed management companies.  Investor-owned national carriers are aggressively pursuing these arrangements.  Many states are rapidly evolving their regulatory stance and there are interesting federal regulatory issues as well. 

This webinar will get you up-to-speed on the many aspects of a quickly evolving strategic imperative.



Eric Klein is a partner and the leader of Sheppard Mullin's National Healthcare Team, Based in Century City/Los Angeles, California.  He regularly advises health plans and providers on joint ventures, mergers and acquisitions, contracting risk adjustment programs and physician alignment strategies.

Christine Clements, a partner in the Washington, DC. office, advises on Medicare and Medicaid matters and pharmacy benefit management issues under Part D.  Christine works closely with CMS and previously was Chief Medicare Counsel for Aetna, Inc.

Matthew Goldman, an associate in the Century City/Los Angeles office, advises health plans and providers regularly on value and risk-based arrangements, has structured multiple global risk arrangements and is experienced in working with state insurance regulators.



Executives driving strategic change especially in the area of risk arrangements, value reimbursement, strategic alliances and partnerships, managing and mitigating risk, will want to attend this webinar. 

Ask your peers a question or share a resource anytime through the Alliance discussion forum

You can visit the discussion forum and post a question anytime. It's only available to Alliance members, so you question is private and secure. When submitting a question, you can select which topics your question is related to, such as "risk adjustment" or "coding". Individuals who have indicated in their Alliance profile they are interested in those topics and are opted in to discussion forum emails will receive your question. You can also add an attachment to your question or reply, making this tool another great resource for sharing best practices with your peers.



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Below is a list of all delegates registered to date for this event

  • Renee Kimm
  • Compliance at Central Health Plan of California
  • Rachel Abramson
  • Program Manager of Strategic Planning at Community Health Plan of Washington
  • Joseph Dicks
  • Director, Network Contracting at MetroPlus Health Plan
  • Irita Matthews
  • Associate General Counsel at Health Alliance Plan (HAP)
  • Larry Pliskin
  • VP, Compliance and Governance at Mount Carmel Health Plan (MediGold)