October 9, 2023

Last week, APMA entered into a memorandum of understanding (MOU) with The Epiphany Group (TEG), a Chicago-based consulting firm that advises health-care providers on economic and operational matters. Collaborating with TEG allows APMA members access to services that extend beyond what APMA’s Center for Professional Advocacy (CPA) can provide, such as opportunities for litigation. 

TEG offers decades of relevant health-care industry experience from a business perspective and aims to help providers “level the playing field” when dealing with health insurers. Under the agreement, TEG is available to consult with APMA members and will offer its services to APMA members at a 10-percent discounted rate. TEG’s services include, but are not limited to, advice, recommendations, and assistance such as contract review, quantifying and challenging egregious health plan practices, and providing dispute resolution services. Members can reach out directly to TEG for a direct engagement agreement.

TEG is also positioned to evaluate the following services for members to address the current and future financial and operational business risks:

• Denial management analysis and enhancements
• End to end revenue cycle management support
• Evaluation of technology tool utilization, including robotic process automation (RPA) and offer enhancements, as appropriate

BCBS Opportunity

A federal court sitting in the US District Court for the Northern District of Alabama (the “Alabama Court”) has ruled recently that the 36 Blue Cross/Blue Shield Plans operating in the United States have violated US antitrust law, namely Section 1 of the Sherman Act, which prohibits contracts, combinations, and conspiracies in restraint of trade. The litigation, captioned as In re: Blue Cross Blue Shield Litigation (MDL No: 2406) (the “Antitrust Litigation”), was brought on behalf of BCBS subscribers and providers that had contracted with Blues Plans. TEG, in collaboration with antitrust class-action lawyers at Scott + Scott in New York City and Lynch Carpenter in Pittsburgh, will work with you and an antitrust-damages expert both to estimate your potential antitrust damages (your “potential damages”) and to compare those to the claim value amount your organization might receive by joining in a Provider Class settlement, which could well be less. In this way, you can make an informed judgment about whether it would make economic and operational sense for your organization to participate in the Provider Class litigation or opt-out of any proposed Provider Class settlement to pursue your larger individual damages claim directly.

TEG will also cohost a webinar with APMA in the near future to introduce APMA members to TEG's service offerings. Continue following the APMA Weekly Focus for an update on the timing and registration for that webinar.

For more information, contact Partners John Grese, Jgrese@theepiphanygrp.com, 724-316-3111; or Louis Longo, LLongo@theepiphanygrp.com, 412-855-8495.

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