During the Thanksgiving break, I prepared myself for my annual healthcare industry predictions. I adorned myself with my bedazzled wizardly robes and picked up my trans-luminescent crystal bowl. I truly believe that my vision this time around is exceptionally clear and sharp. Only time will reveal if these visions are accurate or just early Yuletide hallucinations. What is certain is that the upcoming year in American healthcare will be unlike any other in recent memory.

Unveiling the Shifts in American Healthcare in 2025

Wellness at the Forefront: The RFK Jr. Effect

The impact of Robert F. Kennedy Jr. on US healthcare discourse will be significant. People will start questioning why we accepted overeating processed foods and consuming excessive amounts of neurotoxic alcohol and marijuana. Previously marginal ideas about wellness and disease causation and medications will gain mainstream acceptance. Traditional allopathic medicine and public health will constantly be on the defensive. Doctors, nurse practitioners, and pharmacists will need to work harder than ever to encourage patients to adhere to medications that they will be more skeptical about (except for Ozempic and other GLP1s!). The average American will increasingly view traditional healthcare as part of a corrupt medical industrial complex. However, when they have a genuine healthcare need, this "corrupt" complex will once again prove to be heroic for a short while.

Wellness is no longer a niche concept but is now at the center of healthcare discussions. People are realizing the importance of a holistic approach to health and are seeking alternatives to traditional medicine. This shift will have a profound impact on the healthcare industry and will require healthcare providers to adapt and evolve.

Worsening Misinformation: The X Dilemma

After the pandemic, a significant portion of American society has lost trust in the medical profession. Rebuilding this trust will be a challenging task that requires a grassroots effort involving frontline staff and leaders from various sectors such as pharma, managed care, medical specialty societies, hospitals, and medical groups. They need to establish and adhere to trust-building principles and behaviors to restore confidence in health science and healthcare professionals. Logging onto X (formerly known as Twitter), one gets the impression that everyone is an expert with the confidence to make claims without proper clinical experience and data analysis.

The spread of misinformation on social media platforms like X has become a major concern. It is crucial for healthcare organizations and professionals to take a proactive approach in combating misinformation and providing accurate information to the public. This will require a collaborative effort between different stakeholders to ensure that the public has access to reliable healthcare information.

Medicare Advantage's Comeback: Under the Trump Administration

The past few years have been challenging for Medicare Advantage. The new risk model, V28, has slashed revenues for plans. Achieving high STAR ratings, which are tied to bonus payments, has become increasingly difficult. Base rates have also increased less than expected in a cost-inflationary environment. Additionally, there has been unprecedented scrutiny of utilization management and sales and marketing practices. All these factors have led to a retreat from Medicare Advantage in some parts of the country.

With the incoming Trump administration and Dr. Mehmet Oz as the likely new administrator of CMS, there is hope for a turnaround in Medicare Advantage. Dr. Oz has been a strong advocate for Medicare Advantage, and with a Republican-controlled House and Senate, there is a possibility of easing regulatory burdens and making Medicare Advantage an even more attractive alternative to traditional Medicare. However, it remains to be seen how far these changes will go.

Obscure Government Deputies: The Power Behind the Scenes

With Robert F. Kennedy Jr. expected to be the Secretary of Health and Human Services and Dr. Mehmet Oz as the CMS Administrator, President-elect Trump has shown that he values star power over policy and bureaucratic expertise in healthcare. This does not mean that Kennedy or Oz will not drive policy change. Both have strong views on health and healthcare that will influence US healthcare policymaking. However, they will rely on seasoned deputies to manage large and complex agencies where seemingly insignificant details can have a significant impact on healthcare.

The role of government deputies in shaping healthcare policy cannot be underestimated. These deputies will have the power to make important decisions and influence the direction of healthcare. It is essential for them to have a deep understanding of the healthcare industry and be able to navigate the complex bureaucratic landscape.

The End of the Health Equity Field as We Know It

After the murder of George Floyd, healthcare organizations announced health equity initiatives, and many appointed chief health equity officers. The Biden administration's healthcare initiatives also focused on health equity. However, with the creation of the Department of Government Efficiency and Vivek Ramaswamy's stance on health equity, there is a possibility of a significant shift.

Health equity efforts may face challenges in the new political environment. It is important for healthcare organizations to adapt and find new ways to address health disparities and improve health equity. This may require a reevaluation of existing strategies and a focus on innovative solutions.

More Turnover at the Top: A Changing Landscape

The year 2024 saw major leadership changes in some of the healthcare industry's biggest companies. Bruce Broussard left Humana and was replaced by Jim Rechtin. David Joyner took over at CVS. In 2025, we can expect more such changes in other healthcare companies, both big and small. Long-tenured CEOs may receive golden parachutes as the industry faces multiple headwinds, and boards look for fresh faces to solve old problems.

Leadership turnover is a common occurrence in the healthcare industry, and 2025 is likely to be no exception. These changes can bring new perspectives and ideas to the industry, but they also require careful management to ensure a smooth transition.

Big Transactions Return: A New Era in Healthcare

Almost a decade ago, US healthcare was focused on mergers like Humana-Aetna and Cigna-Anthem, but both failed. CVS-Aetna was later completed. Since then, United Health Group has continued to make acquisitions, but big transactions have slowed down due to concerns about regulatory approval. With the incoming administration likely to be more friendly to big transactions, we can expect to see a resurgence of bold moves in 2025.

Merger and acquisition activities in healthcare are expected to pick up in 2025. This will have a significant impact on the industry, as it will lead to the consolidation of companies and the emergence of new players. It will also require careful regulatory oversight to ensure that these transactions do not harm consumers or the healthcare system.

The AI Revolution Accelerates: Transforming Healthcare

Artificial intelligence is finally ready to make a significant impact on healthcare. AI scribes are now widely used, and they are saving doctors time on administrative tasks. AI is also assisting with the interpretation of diagnostic tests and providing decision support to physicians. Mainstream EMR vendors like EPIC and Cerner are integrating AI into their systems, and biopharma companies like Vertex Pharmaceuticals are using AI and data science to improve their operations.

The AI revolution is transforming healthcare in ways that were once thought impossible. It has the potential to improve patient care, increase efficiency, and reduce costs. However, it also raises concerns about data privacy and security, and healthcare providers need to address these issues to ensure the safe and effective use of AI.

Regulators Scrutinize Private Equity: Protecting Healthcare

The collapse of Steward, owned by Cerberus Capital, has raised questions about the role of private equity in healthcare. There is a growing concern that private equity's focus on profit may lead to rising prices and eroding service quality. States like Oregon and California have established healthcare transaction review boards to regulate private equity's role in healthcare.

Regulators will continue to closely monitor private equity's activities in healthcare to ensure that they do not harm patients or the healthcare system. This will require a collaborative effort between regulators, healthcare providers, and industry stakeholders to establish clear guidelines and regulations.

Digital Health's Continued Spin: Bridging the Gap

In the past, many digital health companies were valued based on their potential, but many have failed to deliver on those expectations. The fundamental problem with digital health is its inability to connect effectively with the traditional healthcare system. However, winning digital health companies in 2025 will be those that can seamlessly integrate with traditional healthcare when needed.

Digital health has the potential to revolutionize healthcare, but it needs to find a way to bridge the gap between the digital and analog worlds. This will require collaboration between digital health companies and traditional healthcare providers to develop innovative solutions that meet the needs of patients.

The crystal ball may not always be accurate, but these are the predictions for the future of American healthcare in 2025. Only time will tell if these predictions hold true.