Alexis Bortniker strategically advises health care providers, payers, private equity companies, and technology companies on joint ventures, mergers and acquisitions, payment structures, and complex business transactions. She is a sought-after health care transactional lawyer in the firm’s San Diego office and chair of the Health Care Transaction Group. She also co-chairs the Health Care & Life Sciences Sector’s Payor Provider Convergence Area of Focus.
Alexis has extensive experience in alternative payment models, population health management, risk-based reimbursement systems, and payer/provider alignment. She also advises emerging companies in navigating the move away from direct-to-consumer payment models to third party payment strategies, including commercial payment, direct to employer, centers of excellence and more.
Alexis works regularly with investors, entrepreneurs, and startup businesses in the health care arena, and she advises on a variety of developing legal areas, including risk and outcomes-based payment models and joint ventures.
- Alternative Payment Models and Risk Contracting
- Represents risk-based providers participating in CMMI demonstration models, including the Realizing Equity, Access, and Community Health (REACH) ACO model in matters related to provider formation and structure, joint ventures, provider participation, and CMS compliance.
- Advised health care providers across the health care continuum in negotiations of participation agreements with over 250 insurers and third-party payers across the country.
- Represents entities looking to purchase or establish Knox Keene plans in California.
- Represented oncology practices in their affiliation with national oncology MSOs across the country.
- Advised oncology practices in movement to value-based care models.
- Advised oncology practices nationally on hospital/physician alignment.
- Telemedicine Managed Care Contracting
- Assisted numerous telemedicine companies in managed care contracting strategy and negotiations across all 50 states. The work allows companies to successfully become in-network providers, no longer relying only on direct-to-consumer model.
- Assisted telemedicine companies in negotiating direct-to-employer contracts and networks, and other strategies for coverage and payment.
- Telebehavioral Health
- Assisted numerous telebehavioral health companies in structural compliance, payer contracting strategies, and care compliance guidance to build national platform for delivery of adult and pediatric telebehavioral health.
- PACE Programs
- Advised not-for-profit PACE Program in a sale to a for-profit company, advising on regulatory and corporate compliance issues, resulting in a for-profit PACE program fully capitalized and position to expand the program to seniors in multiple states.
- Advised organization and establishment of new PACE Programs in multiple states.
- The Best Lawyers in America© in the field of Health Care Law (2018-2024)
- Super Lawyers® – San Diego Rising Stars, 2022
- Co-author, “California: Proposed Regulations Impacting the M&A Market in California,” Health Care Law Today (August 28, 2023)
- Speaker, “The Unique Nuances of Determining FMV for Value-Based Care,” Pinnacle Best Practices Symposium (May 10, 2023)
- Speaker, “Providers Who are a Risk Bearing Entity,” What you Should Know About Payor/Provider Convergence (January 26, 2023)
- Panelist, “Precision Medicine vs. Value-Based Payment,” ACCC 48th Annual Meeting & Cancer Center Business Summit (March 4, 2022)
- Panelist, “Cancer Care is Different: The Oncology Patients’ Bill of Rights,” ACCC 48th Annual Meeting & Cancer Center Business Summit (March 4, 2022)
- Panelist, “Provider Relief Fund: Reporting Requirements and Compliance Concerns,” Let’s Talk Compliance (July 16, 2021)
- Cancer Business Forum – Advisory Board
- American Health Lawyers Association
- California Society for Health Care Attorneys
- JD, Duke University School of Law (2007)
Notes Editor, Duke Journal of Comparative and International Law
- BA, Harvard University, cum laude (2004)