AGRiP Governance & Leadership Conference March 6 – 9, 2016 Nashville, TN EMPLOYER HEALTH CLINICS: KEY ASPECTS OF THE MANAGEMENT SERVICES AGREEMENT 1111
THE DELAWARE VALLEY HEALTH TRUST CENTER Last December the Delaware Valley Health Trust opened a Health and Wellness Center which is managed by CareHere Management PLLC in accordance with a Medical Professional and Medical Services Agreement The Health Center is a employer-sponsored “near-site” facility established exclusively for the employees and retirees (and their dependents) of the Health Trust’s public employer participants. All Health Trust plan enrollees obtain primary care and wellness-related services without the payment of any co-pays or other fees 2
THE DELAWARE VALLEY HEALTH TRUST CENTER (Cont.) The RFP process was developed and overseen by Stephen J. Fallon, the Director of the Employee Benefits Practice at Insurance Buyers’ Council It is expected that the Health Center will primarily service eligible enrollees who live or work within a 10 mile radius of the Center 3
KEY ASPECTS OF THE MANAGEMENT SERVICES AGREEMENT Separation of Church and State: Insulate the Trust and its participants from any liability arising from the management of the Center: -Delineation of the parties’ duties and responsibilities such that the Trust has no responsibility for the Center’s healthcare providers; -Strong indemnity and insurance requirements; and -A well crafted dispute resolution/arbitration provision 4
KEY ASPECTS OF THE MANAGEMENT SERVICES AGREEMENT (Cont.) Detailed description of the services to be provided by the management company, including: -The medical and wellness program services; -Recruitment, screening and employment of medical professionals and medical assistants; -The employment of wellness program professionals and support staff; 5
KEY ASPECTS OF THE MANAGEMENT SERVICES AGREEMENT (Cont.) - Regulatory compliance, credentialing and insurance of medical professionals; -Set-up/implementation services; -Ongoing procurement and management services; -Marketing and communications services; -Utilization and financial reporting; and -The option to offer other services, including occupational medicine and physical therapy 6
KEY ASPECTS OF THE MANAGEMENT SERVICES AGREEMENT (Cont.) The Trust’s responsibilities: -Construction, maintenance and security of the Center; -Funding the purchase of equipment and supplies by the management company; -Maintenance and provision of de-identified claims data; -Insurance; and -Payment of fees and expenses (set-up fee, management fee and ongoing operational expenses) 7
KEY ASPECTS OF THE MANAGEMENT SERVICES AGREEMENT (Cont.) The right to audit the management company’s performance Term and termination clauses with provision for return of proprietary information and claims data The retention of ownership of certain equipment and supplies Strong confidentiality provisions, especially as respects medical records and claims data so as to protect proprietary interests of the management company and patient privacy 8