The health care landscape is vast and and health care costs seem like a never-ending battle for benefits pros, employers and employees. However, benefits pros continue to fight back to tame the rising tide of health care costs.
Industry leaders share their thoughts and concerns about the health care landscape and how it will affect their 2025.
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Retail health giants are failing when it comes to primary care
In 2025, we’ll continue to see more of these larger players exit portions or the health care industry entirely due to lack of aligned incentives. Retail health care might be convenient, but a real primary care experience can’t be replicated in a store. While companies like Walmart and Walgreens once had stars in their eyes and believed they could “fix” health care, 2024 has been the story of pharmacy giants rapidly jumping ship from the primary care business after investing billions and concluding that “health care isn’t a sustainable business model.”
What’s missing from the equation for retail health today is that incentives are not clearly aligned for key stakeholders. Many large retail companies rely on being able to see a high number of patients in order to be profitable. In contrast, the whole premise of a value-based care model makes sure that providers, employers and members all stay engaged with care, by prioritizing patient outcomes and high-quality care over volume of patients seen. In 2025, we’ll see more large retail players exit the health care industry and start to see other primary care innovators come to the forefront instead.
Dr. Kevin Wang, chief medical officer, apree health
A battle over weight loss drug coverage brews
As GLP-1 medications reshape obesity treatment, mounting demand is forcing health plans and employers to reevaluate their coverage policies. While more payers might add GLP-1s to their list of covered obesity medications, everyone is looking for better solutions—such as nutrition co-therapy—to control the total cost of these drugs. DTC companies offering GLP-1s will race to the bottom on price, and many won’t survive until the end of the year. In this environment, payers and patients alike will be eager to find proven, sustainable solutions for weight loss at a lower cost.
Sami Inkinen, CEO and co-founder, Virta Health
How would a Trump-Vance administration affect clients in your practice?
A Trump-Vance administration would cut back on many of the Affordable Care Act’s insurance reforms, which would result in the proliferation of substandard insurance products. While some cohorts of employers might embrace these products in an effort to reduce costs, they would result in broad gaps in coverage, with rank-and-file employees (among others) incurring substantial unreimbursed expenses.
Alden Bianchi, partner, McDermott Will & Emery
AI agents across the value stack of health care
The trend to watch is the application of AI agents across the value stack of health care. AI Agents are increasingly seen as creating disproportionate value for health care businesses as providers look to move beyond their highly manual, inefficient processes and decades-old legacy tech.
Naimish Patel, president, health care practice, Red Cell Partners
HR in the health care landscape
In 2025, HR teams will increasingly focus on cost-saving and spend optimization initiatives to navigate economic pressures while enhancing employee satisfaction. As it relates to health care benefits, we will see an internationalization of specialty prescription benefits, allowing organizations to source medications globally to reduce costs and drive down prices for employees.
Amy Mosher, CPO, isolved
Health systems & their workforce
Health systems need to focus on reimagining their workforce strategies by focusing on recruits and individuals from diverse, nonclinical backgrounds, building a more inclusive and resilient foundation for the clinical workforce. The current talent pool in health care is limited in size, creating an urgent need for innovative strategies to attract, develop and retain a strong workforce for the long-term.
Initiatives bringing new talent into health care support worker positions, such as Certified Nursing Assistant and Medical Assistant training programs, are not only making clinical roles more accessible but also providing clear career pathways. This enables new talent to grow into advanced positions, encouraging staff mobility and aiding the effort to address workforce shortages. This approach builds both a sustainable talent pipeline and a strong base of the clinical pyramid, ensuring the health care system is better prepared for future demands.
Andrew Malley, CEO, OpusVi
Increased focus on metabolic health and fertility
I anticipate a growing emphasis on optimizing health and improving fertility even before actively trying to get pregnant. I think we will see a greater investment in addressing lifestyle, nutrition, and overall wellbeing to support fertility even before fertility treatment is initiated, and in some cases, this will result in improved success rates for less costly and less invasive treatments.
An emphasis will be placed on prioritizing nutrient-rich foods and avoiding highly processed items to support overall health. Maintaining a healthy weight and having good metabolic health will be another factor focused on when it comes to fertility for both men and women. Both being underweight and overweight can affect hormone levels, and impact ovulation and sperm production and quality. Continuing to focus on these areas throughout pregnancy can also lead to improved outcomes for the pregnant person and baby.
While medical interventions are necessary for some people, they don’t always have to be the first option, and I’d like to see more focus, education, and efforts placed on enhancing fertility as well as pregnancy through nutrition and lifestyle modifications.
Dr. Asima Ahmad, co-founder and chief medical officer, Carrot Fertility
Health care AI gets personal
While health care AI has focused primarily on diagnosis and automating back office and support tasks, 2025 will mark a pivot toward AI-powered care, such as behavioral modification platforms that deliver personalized, adaptive lifestyle interventions. Evolving far beyond simple health tracking, new AI systems will leverage broader data sets to drive predictive, proactive interventions. This technology will drive behavior change at scale, making lifestyle approaches the most successful and scalable treatments for chronic illnesses.
Sami Inkinen, CEO and co-founder, Virta Health
Simplify benefits with AI
To tackle barriers to benefit access, streamlining processes and improving communication are essential. Simplified enrollment, supported by automated data entry and interactive tutorials, minimizes friction for both HR teams and employees. Tools like cost estimators and price comparison calculators empower employees to make budget-conscious decisions, alleviating financial stress. Simplified claims processes—including mobile claims submission and direct deposit options—further enhance the user experience, ensuring employees can quickly access the care they need. AI-powered chatbots and targeted communication campaigns inform employees about deadlines and benefit options, driving engagement and reducing confusion.
Makesh Bhardwaj, CEO of Healthcare, MedTech & Life Sciences, Sutherland
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