2025 State of Healthcare
As we move into the new year, with a (kind of) new President and a new way of operating in Washington, what is in store for healthcare? These are the top 10 items we are watching out for:
Delayed Payer Fee Schedule Updates: With all of the uncertainty at CMS, we expects payers to concentrate more on the state MCO market and push contract negotiations into next year when there is a little more stability in the market.
Improved Vertical Integrations: With UHC/Optum buying up assets and provider networks over the past few years, the majority of stakeholder gains were seen in in-network referrals, Now, the hard work of integrating the full vertical should begin. That means independent practices are going to have to be on top of their game to see margin gains of any real significance.
Home health will step up their ACO game. Accountable Care Organizations have already eaten the low hanging fruit. Now, they have to solve for quality of care at significantly greater scale and lower costs. That means outsourcing care to home health agencies, which means they need rapid care coordination capabilities.
Medication administration is going to be in the spotlight. Everyone’s been talking about PBMs, but we can’t solve the middleman problem until we have clarify into actual medication usage. The biggest problem in healthcare right now is a lack of standardized medication and treatment planning across the continuum of care. We expect ACOs lead the charge there (see item #3), but payers will soon follow.
Facility-level CEOs will see their salaries rise as the big players realize just how valuable good operators are. While we still don’t have confidence that health system leaders are paying enough attention to facility-level leadership, we don’t think they’ll have that luxury much longer. Some facilities are seeing great financial and clinical outcomes; some are closing their doors. The differentiator is usually local leadership.
AI will take a back seat. This is a crazy prediction and the headlines won’t support it. You’ll still hear a ton of hype about AI, but the actual decision-makers are realizing it will be years before the technology provides real ROI. Expect augmented intelligence (computers automating tasks based on if/then logic provided by humans) to be in big demand behind the scenes.
Nurses will be overworked and underpaid. At least in the first half of the year, that part of the labor market is still going to see difficulty. Too many nurses have realized they can make more money at home doing QA, chart reviews, or TikTok videos to want to work in a facility.
Which means, big system recruiters will work harder for fewer results. Small practices should be okay, as long as the main boss isn’t a dick. If nurses like the office culture and feel appreciated, they’ll stick around. That stability is one of the only advantages left for independent practices. Expect all office staff to ask for a $1 or $2 raise this year though, and you should give it to them.
Compliance finally gets standardized. We just released our Oversight & Protection Platform for this very reason. The industry is now stable enough to have real best practices, but the workforce is chaotic enough to need a tech platform to manage them.
CIOs need personal liability insurance. Health systems have been pushing their IT risks down the chain, forcing CIOs to accept those risks as part of their job requirements. Many have papered that in the CIO employment agreements, leaving CIOs very exposed - personally. We expect a big uptick in the number of IT personnel requiring the company to foot the bill for personal liability and indemnity policies.
Need help navigating the future of healthcare? Reach out to one of our Business Advisors here.