Managed care will completely replace today's healthcare payment system by 2025, former White House adviser says

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Healthcare providers should expect that they will be paid exclusively through managed care systems by 2025, a former White House adviser said Tuesday.

Already, the Affordable Care Act has laid the groundwork for this transformation by creating large provider systems that cover the whole care continuum, Ezekiel Emanuel, M.D., said in an interview with Reuters. Emanuel, who worked with the Obama administration on crafting the ACA, spoke on camera at Aspen Ideas Week in Colorado.

Accountable care organizations and other large provider systems “are really now grown enough to provide … primary care to specialty care to hospital care to post-hospital care, whether it's physical therapy or nursing facility or rehabilitation services,” he said. Once they also have “the insurance function” — which he believes “they're going to get” — these provider groups will be complete “integrated delivery systems.”

Insurers have various options for how to align with these provider groups, but they will create affiliations that likely will resemble the current Kaiser Permanente managed care model, Ezekiel predicted. By 2025, premium-based insurance through private employers will be totally eclipsed by this type of managed care, he proposed.

Ezekiel believes this transformation will increase care quality while bringing costs down.

Some prominent figures in long-term care, including LeadingAge CEO and President Larry Minnix, also have said that the shift to managed care is inevitable and could be positive for the sector. 

However, some providers have expressed concern that managed care contracts are extremely complex, and some states recently have delayed shifts to Medicaid managed care systems.

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