While patients have historically been conditioned to stay in-network, they still have some uncertainty when it comes to their out-of-pocket costs. At the same time, they are starting to view health care more as a consumer-driven category, and as that happens, we will see more niche cash pay services take off.

Oliver Kharraz, founder & CEO, Zocdoc

Health care affordability crisis

The U.S. health care affordability crisis can be solved by 2030 if we can improve access to primary care. There’s truly a crisis of affordability in US health care today: 1 in 3 Americans have medical debt, and 1 in 5 don’t think they’ll ever pay it off. Primary care has been proven to play a key role in helping drive down health care costs and is the single biggest lever we have to address the affordability crisis. The U.S. could save $67 billion in health costs if every American used a primary care physician as their go-to, usual source of care.

The challenge is that access to quality care isn’t always easy to come by, with appointments often booked out for months. What’s more, the health care industry faces a primary care physician shortage that makes it even more difficult for patients to be seen.

In 2025, we’ll begin to see a renewed focus on reimagining primary care through more effective policies implemented to remove barriers to care and address the physician shortage the industry currently faces, as well as tax incentives to encourage employers to drive down health costs by prioritizing primary care.

Dr. Kevin Wang, chief medical officer, apree health

Keeping costs under control

During the tight labor market following the pandemic, enhancing benefits to improve attraction and retention jumped to the top of the list. This year, however, the top two strategies we saw unfold that I predict will be prioritized even more in 2025 both address the need for employers to manage cost: (1) managing high-cost claimants and (2) getting specialty drug spend under control. Spending on prescription drugs remains the fastest-growing component of health benefit cost — employers reported that drug benefit cost per employee rose 7.2% in 2024.

The ongoing introduction of very high-cost gene and cellular therapies, including biologics for autoimmune disease patients, is contributing to this exponentially growing spend. Given this trend, I anticipate we’re going to see a larger shift away from retention-oriented benefits to cost-savings benefits for employers.

Ellen Rudolph, co-founder & CEO, WellTheory

SMBs: Most innovative health care buyers?

Health care premiums in workplace benefits plans are expected to rise 7% to 8%, on average, in 2025. Given this increase, and based on our conversations with brokers and employers, we believe small—to medium-sized businesses (SMBs) will continue to lead the way as the country’s most innovative health care buyers.

As business owners struggle to handle the steep renewal increases from traditional carriers, we expect them to take the lead in exploring new solutions that help control costs for their businesses and employees. As an alternative to traditional insurance, we are well-positioned to assist those businesses looking to break free from the vicious cycle of rising costs.

Ashok Subramanian, co-founder & CEO, Centivo

Medical cost trends

Health care costs continue to climb year after year, driven by factors including expensive specialty care and high-cost drugs, the ongoing repercussions of the pandemic, and the growing costs associated with complex care. Most employers offer high-deductible health plans in response to rising costs, but the ability to pass costs on to employees is limited.

Today, according to the Commonwealth Fund survey, 23% of working adults with health insurance are underinsured, meaning in part, that they are unable to afford their out-of-pocket costs. In light of this, employers will seek to provide access to support and resources to help employees navigate the complexities of the health care system. By ensuring they are engaged in their health and wellbeing, employers and their partners can leverage this strategy to effectively manage costs and improve outcomes.

Arthur “Abbie” Leibowitz, M.D., F.A.A.P., co-founder & chief medical officer, Health Advocate