Global law firm Reed Smith launched Managed Care Outlook 2025, the firm’s third annual report analyzing significant trends, the evolving regulatory landscape and legal risks facing managed care organizations in the coming year.
The 2025 report provides incisive details on a broad range of legal and regulatory topics impacting managed care organizations. The report serves as a comprehensive resource, providing strategies and information that help MCOs navigate compliance challenges, manage legal risks and adapt to technological changes.
Managed Care Outlook 2025 addresses these key topic areas:
- Business and management – MCOs continue to address a wide range of business challenges arising from changes in technology, federal and state policies and regulations, and the legal landscape. Issues on the forefront include the increasing use of technological advances such as artificial intelligence (AI) and third-party tracking technologies, the impact of diversity, equity and inclusion policies in health care, pay transparency laws, cybersecurity and privacy risks, and federal antitrust enforcement impacting business transactions and mergers.
- Legal and regulatory – MCOs will grapple with recent regulatory upheaval and anticipated policy shifts by the incoming Trump administration. Issues on the horizon include mental health parity, abortion-law problems, gender-affirming care, drug pricing reforms, the future of emerging therapies, and legal changes impacting ERISA regulations.
- Litigation and trends – Recent litigation has sparked elevated risks for MCOs, with wide-ranging implications on how they operate and conduct their businesses. Companies may face critical challenges related to the Medicare Advantage program, antitrust enforcement, and numerous ERISA developments impacting preemption, bad faith litigation and health benefit disputes.
- Risk management – With regulatory scrutiny on the rise, managed care companies will have to navigate new and evolving risks. Key issues on the horizon include growing threats of litigation related to independent dispute resolution processes under the No Surprises Act; fraud, waste and abuse issues; increased focus on denial letters; management of third-party vendor processes; and cyber-breach response.
“Managed care organizations will face a dynamic and multifaceted regulatory and legal landscape in 2025,” said Marty Bishop, leader of Reed Smith’s managed care practice. “MCOs will encounter continued challenges and risks, on both the federal and state level. Our team of 60 dedicated attorneys has a comprehensive and deep knowledge of the complexities in the industry and works to stay ahead of the issues. Managed Care Outlook 2025 is a valuable resource for managed care leaders, managers and investors, and provides a toolkit and roadmap to help manage their businesses in today’s complex regulatory and compliance environment.”
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