Five focus areas for healthcare leaders in 2025

As we reflect on insights from last week’s JP Morgan Healthcare Conference and imminent policy shifts with the new administration at CMS and HHS, there are several key takeaways that will shape the healthcare industry. Here are 5 near-term essential focus areas for healthcare leaders:

1. Value-Based Care: Resurgent and Refined Value-based care is back, with renewed focus on moving more quickly away from fee-for-service. Reinstating the Geographic mode of the Global and Professional Direct Contracting Model would aim to reduce costs and improve outcomes across a region. Look out for more specialty care models as well.
2. Medicare Advantage (MA): Positioned for Expansion MA is set for growth as regulatory hurdles ease. Key strategies include refining risk adjustment, using AI to mitigate staffing shortages (super staffing), and increasingly using AI-generated predictive data analytics to drive towards better outcomes and lower enrollment costs. Health systems will need to leverage technology to improve their efficiency to succeed with MA contracts, especially where quality plateaued.
3. Medicaid's Future: Innovation Needed Proposed funding cuts threaten Medicaid’s sustainability, shifting the burden to health systems and FQHCs. To mitigate this, healthcare leaders must invest in low-cost care management to prevent escalating acute spending and protect vulnerable populations. A change in payments could include more block grant funding and ‘all-payer’ models. ?
4. Tech-Enabled Services: Expanding Potential The repeal of the 2023 Executive Order on AI is opening doors for broader AI applications in healthcare. Generative AI is moving from hype to reality, improving decision-making, streamlining workflows, and driving efficiencies. Seamless EHR integration and interoperability will be crucial to realize AI’s full potential. Healthcare organizations are looking to find trusted partners to efficiently implement AI solutions.
5. Employers and Consolidation: Innovating Under Pressure Employers are recalibrating their healthcare benefits strategies as costs rise without improvements in outcomes. With pressure to meet fiduciary duties under ERISA and the CAA, more self-insured employers are issuing RFPs to demonstrate better value for their healthcare spend. Broker relationships are shifting as procurement departments take a larger role in selecting vendors. Simplification and consolidation are top priorities, as companies seek integrated platforms for navigation, prevention, and administrative services. Health systems and medical groups also seek to regain control from insurers and generate new revenue streams, further driving innovation in direct-to-employer and care models.

Implications for 2025 Healthcare is entering a transformative era driven by reduced regulation, greater accountability, innovation, and cost management. Organizations embracing scalable solutions, cutting-edge tech, and meaningful partnerships will lead the way, delivering care that balances increased revenues, efficiency, but shift sooner from fee-for-service payment models.

About the authors:

Marion Couch is the CEO of Intovalue. She previously served as Senior Medical Advisor in the Office of the Administrator at the Centers for Medicare & Medicaid Services. Prior to CMS she held senior leadership roles at several academic health systems including serving as chair of two surgical departments, Surgeon-in-Chief at an academic medical center, and President of two national professional medical societies.

Robert Alterman is the Chief Performance Officer of Guidehealth. He previously held senior roles at McKinsey, serving as associate partner in the Philadelphia office, with leadership in private equity and value-based care.

Sanjay Doddamani is the founder and CEO of Guidehealth. He previously served as Senior Medical Advisor at the CMS Innovation Center. Prior to CMS, he was a senior physician leader at large integrated health delivery system networks and has spent two decades in various roles leading healthcare innovation.