Eileen M. Considine

Eileen clerked for the Honorable James T. Foley, United States District Court for the Northern District of New York.  

Provider Alignment and Accountable Care

In the emerging health reform marketplace, Eileen advises clients on creating mechanisms for provider alignment and participation in commercial and Medicare shared-savings initiatives, commercial accountable care arrangements, bundled payments, patient-centered medical homes, financial and clinical integration models, and population health strategies.

Representative Experience

• Provide general counsel services for providers and integrated delivery and financing systems
• Serve as managed care counsel for several large health systems, including academic health systems (hospital, physicians and ancillary providers) and have held these positions for more than 20 years
• Serve as a member of a managed care strategic advisory group for a large academic health system engaged in formulating transformative strategies
• Serve as counsel to a provider sponsored managed care plan that is as part of the defense military health system of the United States Department of Defense with respect to matters relating to its Department of Defense contract and managed care issues
• Counseled an academic health system in the formation of its clinically integrated network and continue to be involved in its operations and contracting efforts
• Represented an academic health system client in its collaboration with a large national HMO that is intended to be a national model for transformation in care, affordability, research, prevention and health outcomes. The transaction included a long-term managed care agreement, as well as a care model agreement between the academic health care system, including its clinically integrated network, and the HMO. The relationship includes the development of infrastructure and joint capacity planning, and the implementation of collaborative processes on physician staffing, enhanced technology, care coordination, active engagement of patients and families, and ongoing evaluation of performance measures
• Represented a large health system in structuring a narrow network health plan joint venture with a nationally known insurer
• Represented an academic medical center in structuring direct-to-employer accountable care health plan options for one of the country’s largest retailers
• Represented a large academic health system in its termination and transition to non-participating provider status with the dominant payor in its service area
• Negotiated and drafted complex reimbursement arrangements for providers and provider networks, including global capitation and shared savings and risk arrangements
• Interfaced with regulators from insurance and health departments in various states relating to all types of managed care and health insurance issues
• Acted as health care/health insurance advisor in many types of litigation, including class actions challenging the calculation of usual and customary rates, reimbursement of emergency services to nonparticipating providers, downcoding and sequestration recovery
• Counseled clients on issues involving network adequacy requirements under federal and state laws