Pumpkin spice lattes have given way to turkey and stuffing, which in turn has given way to ugly sweaters and pop star Christmas albums and specials.
For working professionals, it’s a time for prognostications about what might change in their industry in the new year.
End of year predictions make timely reads in part because they come at a time when people are winding down for the year and getting ready to take their mind off of their day to day work.
Yet while they may give us a broad and varied view into expectations (or hopes and dreams), the vast majority of predictions about how healthcare will change in 2025 are likely to be wrong. Not because prognosticators are foolish, but because our modern healthcare system has evolved over 80+ years, and any major change over the course of any twelve month period is unlikely; add the enormous complexity of healthcare and its myriad special interests, and forecasting a specific change is that much more difficult.
Given this, and perhaps sprinkling a bit of Grinch spirit onto the season, below are six things that experts view as unlikely to change in healthcare in 2025, followed by a dash of optimism.
1. GLP-1 Access Issues Will Take Time To Solve
GLP-1s have been hailed as miracle drugs in recent years. Clinical studies are producing findings that support the enthusiasm. The class of drugs has been a miracle for the pharmaceutical firms that manufacture them, as spending has increased by more than 400% from 2019 to 2023 in Medicaid populations alone.
Add to these developments the recent announcement that the Biden Administration is seeking to expand access to GLP-1 drugs among Medicaid and Medicare beneficiaries (essentially by relaxing strict indications of use solely for diabetes), and there is palpable excitement about the continued use and healthcare system implications of these drugs.
Yet thorny problems remain. First and foremost, the rapid increase in demand for these drugs has resulted in dramatic shortages, which in turn has led some pharmacies and virtual care companies to produce non-FDA approved (but legal) GLP-1 drugs via compounded generic ingredients.
“We must first figure out the basics: how can we help more people access GLP-1s and achieve the best possible outcomes. Solving those problems means lowering the cost of treatment, through things like drug price competition and expanded insurance coverage, and overcoming barriers to access, through solutions like telehealth,” explains Zach Reitano of Ro, a virtual care company that offers access to FDA-approved and compounded GLP-1 drugs.
Others point to the fact that while the drugs are promising, their impact may be transitory. “They’re not a silver bullet,” says Sean Duffy of Omada, a digital health company that focuses on helping consumers manage chronic diseases through lifestyle changes. Duffy argues that to have a lasting impact at scale, GLP-1s must be, “appropriately paired with proper nutrition, exercise, and other lifestyle improvements that have been proven over decades of research.”
2. Provider Consolidation And Desire For Scale And Efficiency Won’t Stop
Horizontal mergers. Vertical acquisitions. Cross-market mergers.
Between 2005 and 2022, the share of community hospitals that were part of a multi-hospital system increased from 53% to 68%. Related, the share of physicians practicing in hospital-owned practices increased to 41% in 2021 (up from 29% a decade earlier).
The multitude of factors driving provider consolidation are many: administrative and operational challenges, increasing competition from private equity, and revenue uncertainty with shifting patient populations and preferences, among others.
Given the industry’s inertia and the number of drivers, it seems unlikely that provider consolidation slows down in 2025.
Scott Barclay, Managing Director of Insight Partners, a global venture capital and growth equity firm, sees relationship dynamics with health plans driving hospital self-interest and self-preservation. “We believe large providers will continue trying to buy market share and raise prices, and insurance companies will continue to raise premiums and fight with providers,” Barclay explains. (Disclosure: the author’s consulting firm works with Insight Partners).
Where Barclay focuses on hospital relationships with health plans, others see continued strain on relationships with consumers. “The pressure on health systems to acquire new commercially-insured patients will only increase as more and more people age into Medicare. Ensuring that these patients are able to access the system will be a critical challenge for organizations already operating at 100% capacity,” says Graham Gardner, MD and CEO of Kyruus Health, a technology platform helping providers better connect with and improve access to consumers.
3. Hype Around Generative AI In Healthcare Remains Mostly That: Hype
A Flare Capital report suggests $30 billion has been invested into healthcare AI in the past five years. The report highlights opportunities for AI to transform areas ranging from financial and back office functions to patient engagement to clinical care, among others. An Andreesen Horowitz analysis suggests that AI can help unlock $314 billion through more efficient healthcare operations.
The numbers suggest massive investor enthusiasm in the technology. And certainly, the application of generative AI to certain use cases, most notably ambient scribe technology, seems to be finding the elusive product-market fit in healthcare.
Yet for all of the excitement, there is a fair amount of skepticism around the actual application of AI within real world healthcare environments, or the ability to scale successful AI-first businesses in healthcare.
“Generative AI has been proven useful in certain instances, but it is not the answer to everything in the healthcare industry,” says David Schweppe, Chief Analytics Officer of MedeAnalytics, an analytics and (ironically) AI company.
Gardner of Kyruuus Health is skeptical that companies building AI-first solutions can stand out in a crowded field. “Point solutions — particularly new entrants leveraging AI — will struggle to differentiate themselves and risk having their features subsumed by incumbent vendors building these capabilities into their core offerings,” Gardner explains.
Perhaps the most important insight relates to how AI should be used in the future: to build upon, rather than replace, the human connection that is (or should be) at the center of health. “True personalization will come from a people-centered approach… We’re losing sight of how powerful it can be to simply ask patients, “How are you doing?”,” notes Robin Glass of Included Health, a comprehensive virtual care provider.
4. Neither Retail Nor Tech Is Coming To The Rescue (But Won’t Stay Away Entirely)
When Tim Cook announced in January 2019 that he thought that Apple’s lasting impact would be about health, it set the healthcare industry afire with speculation: what direction would Apple’s healthcare strategy take, and how would it impact healthcare stakeholders?
More than five years later, it seems Apple has not made much progress toward achieving the impact its CEO hoped for. Judging by its own assessment, neither Apple’s own efforts nor its results are material enough to mention. This hasn’t prevented Cook from recently recommitting to his vision.
Color industry insiders are skeptical, if still supportive. But the skepticism is not just reserved for Apple: after dozens of failed high profile initiatives and investment from big tech (e.g., Amazon’s Haven partnership) and big retailers (e.g., Walmart and Walgreen), even Harvard Business Review is doubtful about disruption from corporate outsiders.
“It’ll be definitive in 2025 that Amazon will be the only major corporation in “FAANG” (Facebook, Apple, Amazon, Netflix, and Google) that is truly committed to transforming care delivery,” expects Duffy of Omada, who points to Amazon’s long term thinking and focus on pharmacy and care delivery (via its Oneedical acquisition).
5. Progress On Data Interoperability Continues, But Painfully Slowly
“The politics of access to healthcare data will continue as if it’s a 6th grade student council election,” says Jonathan Bush, industry luminary and CEO of health data platform Zus Health.
Bush could be referring to many things here: the ongoing difficulties in consumer access to their own data (or even awareness this is possible), the public feud between Oracle Health and Epic Systems regarding which company is the true enabler (or laggard) of data interoperability, whether federal efforts to support interoperability via standards are too heavy handed or not enough, or the dispute and subsequent antitrust lawsuit between startup Particle Health and Epic Systems regarding data accessibility.
Alon Joffe, Cofounder and CEO of Eleos Health, agrees, noting that while virtually all stakeholders want interoperability between their systems, we’re unlikely to see robust progress in 2025. “Legacy systems are too complex and lack the right incentives,” he explains.
Despite the complexity and incentives, there is a sense of movement, if it feels plodding. That may be okay, given the implications. “Privacy concerns, regulatory uncertainty from a new administration, and the rapid emergence of new data producers complicate the landscape,” describes Nick Stepro, Chief Product and Technology Officer at Arcadia, an analytics and data platform enabling healthcare organizations to pivot to value-based models of care. (Disclosure: the author’s consulting firm works with Arcadia.)
Bush is optimistic, if for no other reason than emerging financial incentives. “There’s too much economic force profiting from the liberated data, and that economic force is reducing the cost of care. Once the genie gets out of the bottle, he is very hard to squeeze back in,” he notes.
6. Antitrust in Healthcare Scrutiny Remains, Especially On the Highest Profile Cases
One area of the incoming Trump Administration that seems clear, with respect to its posture toward how the private sector functions and antitrust policy in particular, is that it intends to ensure it is getting a fair shake from traditional and social media companies. Hence what may have contributed to ABC News’ recent settlement offer of $15 million and Meta’s (Facebook’s) $1 million contribution to the Trump inauguration fund, among others.
Outside of that, speculation abounds: will the administration return to a more traditionally Republican-held laissez-faire view of private sector competition, or hue towards J.D. Vance’s advocacy of Lina Khan, who has worked to expand Federal Trade Commission’s remit and scope?
It is worth noting that the Department of Justice’s (DOJ) antitrust case against Google, which a judge found guilty of anticompetitive practices in August, was initiated under the previous Trump Administration. As were many other cases. A review of the DOJ’s website suggests an average of ~42 antitrust case filings during the first Trump Administration versus ~32 antitrust filings per year during the Biden Administration.
Based on the data and previous experience, as well as the current political and public climate facing healthcare, it seems reasonable to expect continued focus at a minimum on single firm conduct among dominant firms.
Within healthcare, that suggests the DOJ’s investigation into UnitedHealth Group is likely to continue. So too with the FTC’s ongoing feud with pharmacy benefit managers (PBMs), who also face bipartisan policymaker pressure.
Related to health technology, Stepro of Arcadia points to the issues affecting health data interoperability as creating barriers to innovation and improved insights in healthcare. “There’s growing friction between new and innovative entrants and incumbent organizations that threaten to slow momentum without sufficient incentives to embrace true openness.”
While they may be on their way out, current top antitrust enforcers seem to be aware of the interoperability issues, and the extent to which they may be exacerbated by large technology incumbents.
When recently asked about the Particle Health lawsuit alleging anticompetitive conduct by Epic, FTC Chairperson Lina Khan acknowledged awareness of the issue. “We’re not involved in that litigation, which is brought by a private company, but it’s actually something I had heard concerns about, especially among entrepreneurs and startups that were trying to enter the healthcare space,” Khan said.
Assistant Attorney General Jonathan Kanter recently echoed the awareness of technology platforms. “Using the outdated… approach, antitrust enforcement and policy missed opportunities to assess how broader changes in business, such as the rise of platform business models, health care technology and regulatory incentives, impacted competition.”
A Case For Rational Optimism
So if relatively little is likely to change writ large in 2025, and we have a healthcare system that produces below-average outcomes for exceptionally high spend, why be optimistic? Adjusting the aperture can be helpful.
A Bill Gates quote comes to mind: “’Most people overestimate what they can do in one year and underestimate what they can do in ten years.”
Specific to healthcare, Alon Joffe, Cofounder and CEO of Eleos Healthcare thinks we live in the best time ever to impact the system. “We finally have the technological tools to best the cost curve. It will still take time and be an uphill battle, but at least we have the tools to fight it,” he explains.
Likewise, Barclay of Insight Partners advises taking a longer term view of progress. “There are many negatives in our current moment, but in the long run, they are only a moment in time,” he says.
Working to improve healthcare can at times feel like a Sisyphean task. It also can be difficult to recognize progress in the moment. With this in mind, perhaps the wisest prediction (or just insight) comes from an unlikely source: a media and public relations executive, not normally known for their desire to keep things low key.
“Healthcare takes a minute,” advises and predicts Darren Brandt of Sloane PR.
Amidst a prediction season that touts all the ways the world might change in the next 12 months, sometimes the diligence to keep one’s head down and patience to see things through is the reminder we all need.
