Messenger Model Agreement

By | April 10, 2021

Given the active review of messenger-type agreements by the DOJ and the FTC, it is essential that IPAs and other entities using these networks review their activities to ensure that they comply with the guidelines. If there are issues or if the network in question controls a significant part of a market, the PPI may request legal review and legal assistance. It is clear that the DOJ will actively enforce cartel and abuse legislation if “messaging model” activities are used as a shield for collusive illicit behaviour or used as shields. Affirmation 9 of the statements of antitrust policy in health care describes the use of the Messenger model: The main advantage of a messaging model is a single-point communication channel for providers and payers. By moving towards MPA, our medical service providers enjoy a methodical reputation in the community and a reputation for quality health care. By working with the MPA, payers are able to communicate with more than 1,000 doctors via a unique and familiar channel. So unless you`re comfortable with a toothless miracle, I strongly suggest you go on the extra mile and develop clinical integration into your network rather than creating an IPA messaging model. You will discover that you can really offer better care, and then you can negotiate with payers who are happy (or perhaps reluctantly) to pay for this increased quality. IPAs and PHOs have often sought legitimate ways to negotiate with payers a joint venture that is not an illegal activity. Many multi-supplier networks have attempted to avoid illegal activities by encouraging the joint venture to provide services based on significant financial risks, which are shared in the form of large head tax rates or tax rates, which are distributed only if cost reduction targets are met.

These key models of financial risk have become unpopular over time, and as an alternative, phos and other multi-supplier networks have begun to create clinical integration through um/QS activities. The FTC and the Department of Justice have acknowledged in recent staff advisories that there may be sufficient clinical integration (including through web-based electronic medical records) to allow multi-provider networks to negotiate with payers and not to allow illegal pricing agreements per se. In addition, as part of Stark II, CMS created exceptions and shelters under the anti-kickback law to allow hospitals to provide certain non-monetary subsidies to electronic medical record creation software. The CMS and the FTC encourage the integration of hospitals and physicians through various regulations and expertise to improve quality and promote improved health care. I`ve seen more interest lately in training IPAs of messaging models. I never understood the fascination with these animals. However, antitrust authorities caution that suppliers must also exercise caution in using a messaging model when the courier coordinates supplier responses, acts as an intermediary for collective bargaining, or otherwise facilitates collusive activities between suppliers. The key aspect of the Messenger model is therefore that there should be no explicit or de facto agreement between suppliers on price. The guidelines also provide a following example of a “messaging model” function, which the DOJ and FTC consider to be an “illegal price agreement in itself”: other provisions of the guidelines warn against disclosing royalty information between participants.

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