Top 10 Healthcare Industry Predictions for 2025

Over the Thanksgiving holiday, I donned my magical robe and dusted off my semi-luminous crystal bowl in preparation for my annual healthcare industry forecast.

I mean…balls.

My vision has never been so clear and clear.

Only time will tell if these visions are accurate or just early Christmas hallucinations.

What I definitely see is that the American healthcare industry is going to be unlike any other in recent memory in the year ahead.

1) Wellness is the focus

The RFK Jr. effect is going to be real. People will begin to wonder why we have become so accustomed to overeating processed foods and consuming large amounts of neurotoxic alcohol and marijuana. Previously fringe ideas about the causal relationship between health and disease and drug treatments will continue to become mainstream. Traditional allopathic medicine and public health remain in constant defense. Doctors, nurses, and pharmacists will have to work harder than ever to continue to promote compliance with medicines that the public is becoming ever more skeptical of (with the exception of Ozempic and other GLP1 drugs, of course). is!). Until the average American citizen gets the real medical needs they deserve, they will come to see all parts of traditional medicine as part of the corrupt medical-industrial complex. Then, and only then, the “corrupt” medical-industrial complex will, from time to time, become “heroic” again.

2) Misinformation is (much) worse.

In the wake of the pandemic, American society as a whole has disenfranchised doctors. And there is no easy path back to a place where the knowledge and, more importantly, the judgment of doctors and other health care professionals is fully trusted. Log on to social media site I feel like it has become. Rebuilding trust in health care institutions requires a grassroots, Manhattan Project-style effort that involves front-line staff and leaders from a variety of sectors, including pharmaceutical companies, managed care, medical professional societies, hospitals, and medical groups. is. They must articulate and, more importantly, adhere to a set of trust-building principles and actions aimed at restoring trust in health science and the medical profession. Unfortunately, given the focus on the presidential transition, I think the chances of that happening in 2025 are slim to none, but I'm optimistic about the future.

3) Medicare Advantage will make an incredible comeback.

The past few years have been dark for Medicare Advantage (Disclosure: I lead SCAN Health Plan, a California-based Medicare Advantage plan with more than 280,000 members). The new risk model, affectionately known as V28, resulted in a significant drop in returns versus plan. Achieving high STAR ratings related to bonus payments is becoming increasingly difficult. Additionally, the rate of increase in the base interest rate was lower than expected in an environment of significant cost inflation. Needless to say, there has been unprecedented scrutiny of utilization management and sales and marketing practices. All of this has led to some parts of the country retreating from Medicare Advantage. Enter the incoming Trump administration and Dr. Mehmet Oz, who is likely to become the new administrator of the Centers for Medicare and Medicaid Services (CMS). He has been an unabashed supporter of Medicare Advantage until his appointment. Now that we have a Republican House, Senate, and president, they will go so far as to push for Medicare Advantage for All (as Oz has done before, and for that matter, as I have done). I wonder if it is? Will “repeal and replace” take the form of an expansion of the Medicare Advantage program? I doubt it. Nevertheless, I believe that the regulatory environment surrounding Medicare Advantage will ease and that traditional Medicare (oddly enough, still lacks dental, vision, and hearing coverage, which is often standard in Medicare Advantage plans) will begin next year. We hope that this will provide a more attractive alternative to 4 years.

4) Unknown government members become more important than ever

With Robert F. Kennedy Jr. expected to take on the role of Secretary of Health and Human Services and Dr. Mehmet Oz the role of CMS administrator, President-elect Trump is pinning his hopes on stars over policy and bureaucratic expertise. He made it clear that he values ​​power. Top Managed Care Jobs. This is not to say that Kennedy and Oz don't push for policy change. Both men have strong and well-known perspectives on health and health care that will certainly permeate U.S. health care policymaking. It just means relying on experienced lawmakers to wrestle with government agencies that are large and complex, and where even the smallest detail can have a disproportionate impact on health care. And along with agency leaders whose natural orientation is outward-looking, those lawmakers (HHS's Jim O'Neill and CMS's TBA) are shaping the shape of government departments that powerfully shape and define the contours of health care in the United States. will wield truly unprecedented power over the United States.

5) The health equity field (as we know it) is coming to an end.

In the wake of George Floyd's killing, health care organizations announced health equity initiatives (some bold, some weak), and many appointed chief health equity officers. The Biden administration's signature health care approach over the past four years has centered on health equity. And every CEO from every sector of the industry was equipped with talking points about what their companies were doing to reduce healthcare disparities and improve health equity. Days after the creation of the Ministry of Government Efficiency was announced, Vivek Ramaswamy suggested that health equity is firmly in the focus of the new ministry. He wrote in a post on did. An efficient government has no room for DEI bloat. It's time to stop doing that. ” Health equity efforts will either take a major step back in the new political environment, or, more optimistically, be completely reshaped.

6) There will be more turnover at the top.

2024 saw major leadership changes at the top of some of the largest companies in the healthcare industry. Bruce Broussard left Humana and was replaced by Jim Rechtin. David Joyner replaced Karen Lynch at the helm of CVS. Expect to see more changes like this in 2025, along with other healthcare companies large and small. With a bizarre confluence of multiple industry headwinds making the jobs of these tops more difficult than ever, a few long-tenured CEOs are likely to be given golden parachutes, and boards will be left with old problems. They will start looking for new people to solve the problem. This trend applies to managed care companies, health systems, and startups alike. There may also be early changes in government leadership. Healthcare search consultants, or rightfully so, are going to have a great year.

7) Big deals come back.

Almost a decade ago, the U.S. healthcare industry was fascinated by the mergers of Humana and Aetna and Cigna and Anthem. Both failed, and CVS-Aetna was created in the aftermath. Since then, United Health Group has continued its acquisition gambit (Change Healthcare and Amedisys being recent examples), but fears that the deal would be blocked by the FTC or the Department of Justice have led to big-game hunting. has slowed down significantly. The next administration is likely to be much friendlier to this “big deal”, at least from some industry insiders, and I expect all sorts of big, bold moves to return. are. In 2025, we're going to see a ton of mergers (CigMana too?), dissolutions, and going private. Look for Kaiser Permanente's Risant to complete another health system acquisition in 2025. Healthcare investment bankers will be busy.

8) The AI ​​revolution will accelerate

Artificial intelligence (AI) is finally ready for prime time. AI scribes are now everywhere, and will soon be in places where they don't currently exist. Physicians save time on administrative tasks in real time. AI is now helping interpret diagnostic tests and providing doctors with meaningful decision support. Mainstream EMR vendors such as EPIC and Cerner are undertaking large-scale AI integration efforts. Biopharmaceutical companies like Vertex Pharmaceuticals are undertaking breakthrough AI and data science initiatives that extend to every aspect of their business. And as competition increases, the price of AI is plummeting. All of this means that the AI ​​revolution has begun in earnest. Heck, even the bluest of institutions, the New England Journal of Medicine, has its own AI-focused journal led by Harvard visionary Zach Keohane. There is no turning back now, and critical aspects of patient care should immediately improve, not to mention the serious administrative bloat in healthcare institutions.

9) Regulators will scrutinize (even more) the role of private equity in healthcare

The collapse of Steward, owned by Cerberus Capital, has Republicans and Democrats alike questioning whether private equity's role in health care has gone too far. It's another story when clinics are acquired by profit-driven health care private equity firms, raising prices and lowering the quality of service. When a local hospital collapses, access to health care for the entire region is threatened. States such as Oregon and California have established Health Care Transaction Review Boards to regulate the role of private equity and health care. Many of the public (now more than ever aware of the presence of private equity in healthcare) support these deals, and these review committees need to take a more aggressive stance on these deals. Expect to take it.

10) Digital health continues to revolve

In the halcyon days of Teladoc Livongo, many digital health companies were valued. In the years since then, many companies have tried and failed to grow revenues to match their frothy valuations. A fundamental problem with digital health is its inability to meaningfully connect to analog healthcare systems. The winners in 2025 and beyond will be those that can not only compete with conventional medicine, but also seamlessly bridge traditional medicine when needed, and continue to do so. It's a tough trick to pull off, but in 2025 some gems will announce partnerships that will do just that.

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A crystal ball never fails…until, of course, it fails. Only then do we turn to the dark arts of astrology and tarot.

For now, my healthcare industry predictions are complete…until next year!