Healthcare predictions 2025: The power of pragmatic change

Employers brace for the same grim ritual every January: calculating how much more healthcare will cost in the coming year. Will it be 8%? 10%? More? For decades, these increases have felt unavoidable, like a rising tide. But 2025 could be the year that changes.

Not because of artificial intelligence or the latest Silicon Valley promises. Not because of sweeping policy changes or government intervention. And certainly not because healthcare has suddenly become simpler.

This analysis explores five key predictions for 2025 - not wishful thinking about what could be, but practical forecasts based on new approaches already showing results. These predictions outline a path forward that doesn't require reinventing healthcare overnight. Instead, they show how today's successful solutions could become tomorrow's standard practice.

1. Mid-size employers will become healthcare’s unlikely heroes

Facing rising costs, these businesses will drive the adoption of local solutions that deliver better care at lower costs.

Conventional wisdom has long pointed to corporate giants or big tech disruptors as the ones most likely to fix healthcare. Major retailers like Walmart and Walgreens tried to make a difference with retail clinics yet faced significant roadblocks—Walmart recently shuttered all 51 of its health centers. Even Amazon, with its focus on virtual care and prescription delivery, has struggled to gain traction. Surprisingly, meaningful change is emerging from an unlikely source: mid-sized and family-owned businesses that can no longer afford to sustain the status quo.

The challenge

The traditional strategies for managing healthcare costs are falling short. For decades, employers have relied on the same playbook: absorb annual increases, shift costs to employees through higher premiums and deductibles, or cut benefits. Large corporations can often weather these increases, while smaller businesses tend to scale back benefits. Mid-sized employers, however, find themselves caught in the middle—too large to ignore the problem but too small to absorb the cost hikes. As a result, they are being driven to find a new path forward.

Early signs of change

This shift is already emerging in places like Michigan, where mid-sized businesses are partnering with new healthcare networks that contract directly with providers. These aren't massive corporations with unlimited resources. They're often second and third-generation family businesses - the backbone of their communities - who have found they can save significantly while offering richer benefits through direct-to-provider networks.

Proof in numbers

"I've built tech forever, but I came to realize that tech alone won't solve healthcare. You need a different business model enabled by technology," says Amy Wykoff, Nomi Health Chief Product Officer. "That's what we're seeing in West Michigan, where mid-sized employers control $2.8 billion in annual healthcare spend."

These businesses are achieving what Fortune 500 companies couldn't—20-40% savings while maintaining or even improving care quality. Perhaps most telling, stop-loss insurers—often the toughest critics of new models—are validating these approaches with significant premium discounts.

Human impact

This isn't just about cost savings. These are businesses where CEOs know their employees by name. When healthcare decisions affect people you see every day, the need for change becomes personal. Mid-sized employers are proving that you can both reduce costs and improve benefits—by offering programs like zero-deductible plans that larger companies often dismiss as impossible.

2025 Prediction

In 2025, mid-sized employers will be one of healthcare's most effective drivers of innovation. While headlines focus on big tech and corporate giants, these pragmatic businesses will demonstrate that local, collaborative approaches can create meaningful, lasting change. Their success will prove that local action can drive national change.

2. The black box of healthcare costs will open

Chief Financial Officers will demand visibility—and finally get it.

For decades, CFOs have tracked and optimized every business expense except one: healthcare spending. Despite being their second-largest cost after payroll, healthcare spending has remained a mystery, hidden behind layers of complexity that obscure its true drivers.

The challenge

Healthcare's "black box" persists because the industry has made complexity a feature, not a bug. "Every CFO looks at healthcare costs the same way," says Nomi Health Co-Founder and CEO Mark Newman. "They build an 8% increase into next year's budget because that's just what healthcare does - it goes up. When you can't see inside the black box, you can't do anything about it."  

Accepting inevitable increases isn't just a business problem - recent lawsuits against major employers show it's becoming a legal liability.

Early signs of change

Real-time analytics and data transparency are shining a long-overdue light on healthcare spending patterns. CFOs are beginning to ask the same questions of healthcare that they ask about every other business expense: Where exactly is the money going? What value are we getting? How can we optimize this investment? With new tools and visibility, employers are moving from passive acceptance to active management of their healthcare spending.

Proof in numbers

The power of transparency is already evident. For example, employers using transparent pharmacy programs are saving up to 30% on medication costs by leveraging better pricing and clinical programs. With a clearer picture of their total healthcare spending, employers can uncover inefficiencies and misaligned incentives that were previously invisible.

Human impact

When employers understand their healthcare spending, everything improves. Human resource teams can design benefits that match their workforce's actual needs. Benefits administrators become advisors rather than gatekeepers. Data-driven decisions replace guesswork, ensuring healthcare dollars are spent where they matter most.

2025 Prediction

By 2025, scrutiny of healthcare spending will intensify, driven by rising costs and legal pressures. Employers won’t just access their data—they’ll use it to improve outcomes, manage costs more effectively, and mitigate legal risks. Those who embrace transparency will lead the way, proving that smarter spending can deliver better benefits for everyone.

3. Healthcare’s fintech moment will arrive

Just as banking modernized a decade ago, healthcare will finally adopt faster, digital payment solutions.

Remember the last time you visited a bank branch? For most people, it’s rare—banks have become digital-first, with branches now mainly used for special tasks like notarizing documents or accessing safe deposit boxes. It's hard to believe that just a decade ago, we structured our lives around bank hours and physical locations. This shift didn’t happen by chance.

"The Digital Wallet Wars of 2011-2013 happened because fintech companies proved there was a better way," says Boe Hartman, Nomi Health Co-Founder and Chief Technology Officer. "They showed that payments could be instant, simple, and digital. Banks had to adapt or become irrelevant. Healthcare is now facing that same moment."

The challenge

While other industries have modernized their payment infrastructure, healthcare remains tethered to paper checks, manual processing, and disconnected systems. These outdated methods don’t just slow things down—they create vulnerabilities as transaction volumes increase and cyber threats grow more sophisticated.

Early signs of change

Just like banking changed with digital tools, healthcare payments are getting faster. New digital payment platforms can complete healthcare transactions in real-time, replacing the slow, paper-based systems that typically take months to clear.

Proof in numbers

The inefficiency of current healthcare payments is undeniable. Each year, billions of transactions are handled through outdated systems that demand significant manual effort and reconciliation. New digital platforms are already replacing these outdated methods, delivering payments faster and reducing administrative burdens

Human impact

Modern payment systems simplify healthcare for everyone. Providers spend less time chasing payments and more time on patient care. Administrators process claims faster and more accurately. Patients can focus on their health without the stress of financial confusion. When payment complexity disappears, the entire healthcare experience improves.

2025 Prediction

In 2025, healthcare payments will enter their fintech era. Just as we rarely visit bank branches today, the slow, paper-based payment processes in healthcare will give way to digital-first approaches. The winners will be those who can make healthcare payments as simple as other everyday transactions.

4. Real-time provider payments will gain traction

The new math of healthcare: Why providers will take less to earn more.

Consider a typical healthcare provider's revenue cycle: deliver care today, bill insurance, wait months for payment, follow up on denials, and possibly receive just 60-70 cents on the dollar. Now imagine instead: providing care and getting paid what you're owed within 48 hours. This shift fundamentally changes how healthcare works.

The challenge

Today’s payment system forces providers to juggle two roles: caregiver and banker. Practices must maintain extensive billing teams, dedicate countless hours to chasing payments, and often limit which insurance plans they accept. Some providers require upfront payments or even turn patients away, reducing access to care for those who need it most.

Early signs of change

"Our value proposition to providers is simple," says Nomi Health Co-Founder and CEO Mark Newman. "For a dollar that you're owed, you're getting 70 cents after months of waiting. What if we paid you what you are owed, right now?"  

New payment models are proving that providers can earn more by accepting guaranteed 48-hour payments at slightly reduced rates. The trade-off works: providers eliminate billing overhead, reduce collection expenses, and avoid revenue losses from unpaid claims. This model replaces the traditional "bill high and hope" approach with predictable, sustainable revenue.

Proof in numbers

Administrative costs account for 15-25% of a provider’s revenue—dollars spent on managing billing operations instead of delivering care. Under the traditional system, providers often charge higher rates but lose a significant portion to unpaid claims and collection expenses. Real-time payments reduce this overhead, ensure faster cash flow, and create financial stability. Even with slightly lower reimbursement rates, providers come out ahead by eliminating the costly inefficiencies of the current system.

Human impact

Guaranteed payments allow providers to shift their attention from chasing invoices to serving patients. With reliable cash flow, they can make strategic investments in their practice, hire additional staff, invest in better equipment, and enhance access to care in their communities. Without the burden of payment delays or denials, providers can focus on delivering high-quality care and meeting the needs of their patients.

2025 Prediction

In 2025, providers will increasingly prioritize payment models that offer certainty over higher but unreliable rates. This shift will not only improve financial stability for providers but also expand access to care and elevate the patient experience. When providers are freed from the burden of managing complex billing systems, everyone benefits.

5. Protecting healthcare payments will become a national priority

Mounting vulnerabilities will force policymakers to classify medical payments as critical financial infrastructure.

Healthcare payments are one of the largest financial systems in the U.S., handling billions of transactions annually. Yet they don’t receive the same protection or oversight as banking systems or securities markets despite being essential to both patient care and provider operations.

The challenge

The February 2024 cyberattack on Change Healthcare showed just how vulnerable the system is. The breach delayed payments to providers and exposed sensitive medical and financial data of 130 million Americans.

Despite healthcare representing nearly 20% of the U.S. economy, the payment infrastructure remains fragmented and outdated, relying on systems that are both inefficient and unprepared for modern cybersecurity threats. The status quo isn’t just inefficient—it’s dangerous.

Early signs of change

The conversation is beginning to shift. There is growing recognition among policymakers that healthcare payments should be treated as critical infrastructure, much like banking. “If these systems fail, it’s not just a business problem—it’s a public health issue,” says Boe Hartman, Nomi Health Co-Founder and Chief Technology Officer. "Designating healthcare payments as national critical infrastructure would fundamentally alter the landscape. It would change the conversation about healthcare in the United States, opening up competition in ways this industry hasn't seen in 50 years."

Proof in numbers

• Healthcare data breaches cost $9.8 million per incident, more than double the average cost in other industries.

• 18% of U.S. GDP is tied to healthcare spending, yet its payment systems operate with minimal regulatory oversight.

• The average payment delay caused by a breach or system failure can stretch into months, disrupting care and provider operations.

Human impact

When payment systems fail, patients experience delays in care; providers struggle with cash flow and sensitive data is exposed. These disruptions impact trust and access at every level of the system. Protecting healthcare payments isn’t just about financial security—it’s about ensuring continuity of care.

2025 Prediction

In 2025, healthcare payments will see increased examination and initial steps toward being classified as critical infrastructure. This change will take time, but early action will lay the foundation for stronger safeguards, more efficient systems, and better protection for both providers and patients.

Looking ahead

For decades, healthcare has been caught between big, sweeping reforms and small, incremental changes, with little to show for it. But the trends shaping 2025 are different. They’re grounded in necessity and built on proven approaches.

Change isn’t coming from bold, untested ideas or radical disruption. It’s coming from organizations and individuals who can no longer accept the current state of healthcare. Employers are pushing for transparency. Providers are rethinking how they get paid. Policymakers are starting to recognize the risks of outdated infrastructure.

The tools are available. The models are already working. And most importantly, the math finally makes sense. The story of 2025 will be one of practical, measurable progress—driven by those taking action to make healthcare work better for everyone.

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