The beginning of a new year means it's time to take a step back and assess the state of things. HealthCare Business News went around the healthcare industry to find out what executive leaders had to say about the lessons from 2024 and what we can expect in 2025.

Here are some of the responses we received.

In 2025, health systems will increasingly embrace generative AI (GenAI) as a cornerstone of revenue cycle transformation. The days of fragmented tools and siloed processes are finally giving way to a more unified approach, where AI models trained on clinical data provide a consistent foundation across coding, denials, and prior authorizations. This shift isn’t just incremental — it’s revolutionary, akin to the introduction of the internet or the PC. GenAI is unlocking the patient record, offering revenue cycle teams a powerful clinical assistant that enables them to work smarter and more effectively, addressing long-standing challenges like denials, missed reimbursements, and cost to collect.

Healthcare has long been a late adopter of technology, but this time is different. Already, health systems are piloting or deploying GenAI tools, signaling an accelerated adoption curve that will spike in 2025. Leaders are realizing that this technology doesn’t replace their workforce; it gives them superpowers. By automating complex, repetitive tasks and providing actionable insights, generative AI alleviates workforce shortages and reduces burnout, all while improving financial outcomes. The focus in 2025 will increasingly be on strategic partnerships with vendors capable of scaling AI applications across the revenue cycle, building trust in these solutions as integral to operational success.

In 2025, we’ll see health systems harness GenAI to not only reduce costs but also to enhance team productivity and drive revenue capture. The ability to deploy a single, scalable AI model across multiple revenue cycle functions will unify operations and unlock efficiencies previously thought impossible. This integration of AI will ultimately transform healthcare finance, resulting in both improved financial performance and better patient experiences.

- Amy Raymond, SVP of Revenue Cycle Operations and Deployments, AKASA


In 2025, GenAI will move forward as a critical component in helping clinicians and payers wholistically understand individuals’ health circumstances. There will be a greater focus on GenAI’s applications towards proactive insights for health management, personalized member engagement initiatives, and improving member/client service. For example, GenAI framework will provide deeper visibility into a person’s social determinants of health (SDOH) needs using data insights. Healthcare organizations know that not all members tell their care teams every past and present detail of their health challenges, and that’s where AI will fill in the gaps. Beyond providing a detailed picture of the member’s environmental conditions that affect their ability to heal, AI will also give precise downstream care actions for the member and/or greater cohort.

GenAI will also be a big player in member engagement. It will take the content from the engagement journey and yield insights about areas the members should focus on, what the clinical team should do, and what the future may look like for all involved. It will simplify communication between the members, clinicians, and payers, giving easy-to-understand and precise next best actions. Documentation will be more efficient and accurate because of it.

Regarding risk, GenAI’s ability to consume and analyze complex data from different sources to make key predictions is something the healthcare industry has never seen before. I believe that next year, GenAI will be in full swing, analyzing big data sets and offering a new context of care with deeper clarity and granularity, leading to more positive outcomes. The number of actions it can tackle simultaneously is astonishing, leading me to believe that GenAI is the ultimate pathway to supporting the value-based care model. Like no other advances in medical history, GenAI will quickly and drastically improve member satisfaction, lower costs, enhance the quality of care, and reduce care team burnout.

- Pravin Pant, Vice President of Advanced Analytics, ZeOmega


Since the 2010 Affordable Care Act, it seems every year in healthcare has been full of change. With a new administration but a narrowly divided Congress we can expect to see a number of experiments and approaches on the perennial topics of PBMs, prior authorization, 340B, and telehealth payments. But the big dollars and the big growth are centered in Medicare Advantage and its somewhat similarly capitated Managed Medicaid programs.

The heavy action will be in how we incent capitated payers (MA plans) to provide appropriate levels of care given the fundamental incentive to spend less and arguably do less. Today, one pivot point of those incentives is the HCC (Hierarchical Condition Codes), used to prospectively assess how sick insured populations are and therefore how much the plan should get paid. The other pivot point of the MA payment puzzle focuses on retrospectively looking at plan performance on clinical quality and level of service measures - the Star Ratings. Multiple major payers have sued CMS, often successfully, over their Star Ratings. Ultimately payment levels are a data play, and that data will increasingly include rich clinical data. Successful plans will leverage modern big data computing.

What makes these payment tools the point of controversy are varying beliefs on whether MA plans are paid too much or too little. In July, MedPAC, the Congressional CMS oversight agency, stated that MA plans were overpaid by 22%. Recently we’ve seen multiple plans stop paying commissions to brokers who are bringing them high-expense patients in effect saying CMS is not paying enough for these patients. Managed Medicaid, though run by the states, has similar concerns. MA plan payment rules will almost certainly materially change in 2025. Expect to hear a lot about MA plan spend and the underlying performance data in 2025!

- Dr. Don Rucker, Chief Strategy Officer, 1upHealth


As we move into 2025, healthcare will continue to evolve as it always does, presenting both opportunities and challenges for physicians. As we transition to a new presidential administration, novel healthcare legislation will no doubt become a hot topic for a demanding healthcare ecosystem.

In this time of change, online communities will stand out as a vital support system for physicians navigating shifting policies and regulations. For years, online provider communities have served a key role for physicians seeking to connect, collaborate and have informed conversations with their peers across the country in real time. I believe these safe spaces will become even more important to physicians and the broader healthcare industry in 2025 and beyond.

- John Theobald, Founder & CEO, Healthcasts

Healthcare’s high costs and consumer unhappiness with the industry will likely reach a flash point in 2025. Healthcare insurance premiums and overall industry costs are projected to rise yet again. Yet the U.S. continues to lag in outcome quality. Member and patient experiences generally remain fragmented and far less digital than they could be. Regulators, employers and consumers will push back.

AI can help the industry address its cost, quality and efficiency issues. AI, which includes generative AI, machine learning and natural language processing, can record and summarize data in a few minutes. Healthcare organizations can save hours every day when AI captures patient data at the point of care, in medical records, during call center interactions, and so on. Generative AI delivers comprehensive data about patients and clinical guidelines in seconds so providers and care managers can make better decisions. AI streamlines operations, with AI agents embedded in systems handing off data to other AI agents. All of this adds up to substantial productivity gains and potential cost savings.

Cost improvements visible to consumers haven’t materialized yet. But in this next year, healthcare organizations will zero in on translating AI’s efficiencies into reducing care and coverage costs. Watch for them to be focused about how and where they deploy AI. The key metrics will be whether an AI initiative clearly reduces costs while enabling better service and health outcomes.

- Venkatgiri (Giri) Vandali, President of Healthcare and Life Sciences, Firstsource


The utilization of drug-gene testing, also known as pharmacogenomics (PGx), has gained significant traction over the past year and will remain a revolutionizing tool that is shaping the future of precise medication prescribing. We can now confidently transform experimental PGx programs into comprehensive PGx hubs for larger patient communities. We will see amplification in the use of PGx test results by healthcare providers to elevate their therapeutic decisions and select effective interventions sooner.

PGx test insights enable ongoing care monitoring over time and care teams will build confidence in relying on them daily in their decision-making. An aging population is increasing the demand for healthcare. The transformative role of proactive PGx-informed medication management for complex and aging patients, along with other clinical and lifestyle variables, will be evident in specialized and primary care settings.

Organizations will be transitioning their siloed and often nascent PGx initiatives toward a model that leverages cohesive delivery platforms. They will equip their care teams with scalable and operationally efficient genomics solutions, allowing healthcare providers to focus on delivering quality care. Efficient solutions will be needed to help care providers address clinical relevance, workflow, and operational challenges while reducing cognitive burdens.

As we gain further real-world evidence on the performance of PGx programs, especially in chronic disease management, organizations will establish PGx testing as a cost-effective standard of care. There will be an increase in the use of real-world evidence to explore AI’s potential in accelerating the discovery of novel drug targets and facilitating the repurposing of treatment modalities for chronic and costly disorders. The ability of AI to make sense of large amounts of patient records is well-positioned to help organizations screen patient cohorts and unlock opportunities to improve care with genomic insights.

- Houda Hachad, PharmD, M. Res, Vice President of Clinical Operations, Aranscia


Looking ahead to 2025, providers and health plans must prepare for a future where personalization, prevention, and empathy form the cornerstones of care delivery. With nearly two-thirds of consumers delaying care until it's urgent, meeting growing expectations for transparency, proactive health management, and personalized care is more critical than ever. Coupled with a heavier regulatory emphasis on health equity, the healthcare industry needs pre-emptive and accessible solutions that prioritize early and continuous engagement.

Convenience and cost-effectiveness remain top priorities as consumers seek on-demand, affordable care options. Members, for instance, are increasingly seeking tailored recommendations for care management, benefit utilization, and wellness initiatives, often powered by real-time insights from wearable devices and integrated digital tools. These growing expectations, combined with administrative/operational hurdles and the shift to a value-based care model, require providers and health plans to better understand nuanced consumer needs and align their customer journey strategies with desired outcomes.

For healthcare organizations to capitalize on these changes, the integration of advanced technologies will be essential. In the CX space, AI-driven solutions will play an outsized role in helping healthcare organizations better guide patients and members through complex processes and answer their questions about benefits, in-network providers, etc. More health plans will turn to platforms powered by AI – particularly Gen AI and Agentic AI – to provide omnichannel campaigns and real-time interactions that offer culturally relevant communication strategies and multilingual support options. These hyper-personalized experiences will allow health plans to build stronger, more inclusive relationships with their members.

To thrive in this new year’s evolving healthcare landscape, providers and payers must balance identifying and capitalizing on emerging growth opportunities with delivering high-quality, equitable care to an increasingly diverse consumer base. When strategically integrated with an empathetic human touch, advanced technologies like AI, automation, and analytics are the key to empowering healthcare leaders to improve patient/member satisfaction and drive sustainable, value-driven solutions for all.

- Rajesh Subramaniam, Chief Executive Officer, ResultsCX