The health care landscape is undergoing a significant transformation as we begin 2025. With advancements in technology, the shifting demands of patients, and the ever-evolving complexities of medical treatments, the industry is poised for a series of profound changes.

And the pressure is on for U.S. employers, whose health care spending is projected to jump by nearly 8% in 2025 – the largest annual increase in more than a decade.

In response to rising health care costs, plan sponsors will focus on improving efficiency and eliminating waste in 2025. We will see greater focus on increasing member engagement, maximizing utilization of benefits and well-being programs, and creating impactful partnerships to help lower their cost trend.

Let’s take a look at some of the biggest health care trends for 2025 and how they will impact U.S. employers.

Trend No. 1: Unprecedented focus on customer experience in health care will improve benefit utilization and outcomes

The emphasis on enhancing the customer experience in health care will be paramount in 2025. Companies like Apple, Netflix, Amazon, and others have conditioned consumers to expect personalized and seamless experiences. This expectation includes health care, where patients demand convenience, customization, and ease of use.

Research shows that a significant majority of people want personalized health care and services – and that they find those aspects lacking. A Bain & Co. study found that 65% of health care consumers expect a more convenient experience, while the American Academy of Physician Associates found that the same percentage of consumers say coordinating and managing health care is overwhelming and time-consuming.

The focus in 2025 will be on delivering reliably simple health care experiences that align with individual needs and preferences to guide people to the right care at the right time, on their terms. One of the primary ways to achieve this is through personalized navigation and resources – and by using demographic data to offer dynamic choices unique to each person.

Digital technology plays a crucial role in this transformation. The first phase of digital transformation in health care saw a rise in adoption of technology that helps streamline the health care process by enabling patients to schedule appointments, receive medication reminders, access personal health information, and get care virtually while being monitored remotely.

The next evolution in health care experiences will involve integrating advanced AI and machine-learning algorithms to predict patients’ needs and recommend preventive measures. Furthermore, these platforms will facilitate seamless communication between patients and their care teams, enhancing the overall patient experience in areas such as medication adherence, proactive preventive scheduling suggestions, and necessary follow-ups/screenings.

This year we’ll also see improvements in health insurance experiences. Driving health insurance literacy will become paramount, as higher health insurance literacy is linked to higher vitality, better health care experiences, and greater utilization. According to research from Evernorth, 75% of adults who have high health insurance literacy – defined as confidence in understanding health insurance benefits and how to use them – are satisfied with their health benefits. Additionally, the research found that 94% of people with high health insurance literacy are satisfied with their health insurer.

Consumers want to engage with their health plans using their preferred digital channels and to receive effortless communications on plan updates and choices that are personalized to their health needs and past behaviors. We’ll see a rise in digital assistants that deliver curated topics based on individual needs, with AI-powered tools offering quick answers, personalized content, and real-time best actions. Ultimately, this phase of technological disruption in health care will lead to improved health outcomes by ensuring that patients can engage easily with their health plans to find the care they need and then remain engaged and proactive in managing their health throughout their care journey.

Programs and resources aimed at keeping people healthy will continue to grow, including digital coaching, social connections, device/app connections, and digital well-being challenges and incentives.  

Trend No. 2: Clinical excellence in women’s health and condition-specific care to reduce costs, eliminate waste, and increase patient satisfaction

In 2025, clinical excellence will be emphasized through benefits that offer whole-person support, clinical guidance, and end-to-end integrated care models and solutions in areas such as women’s health and condition-specific care. Integrated care models that focus on holistic patient care will become of utmost importance. A review of 34 studies published in the National Library of Medicine found that integrated care models reduce costs, help eliminate waste, improve health outcomes, and increase patient satisfaction. Employers who facilitate access to these services will see a healthier, more engaged workforce.

Improvements in women’s health

The term "women’s health" has historically been associated with a limited range of health concerns unique to women, like pregnancy. Today, however, those involved in health care and policymaking are acknowledging that the scope of women’s health extends far beyond obstetrics and gynecology. An Evernorth analysis of 7.4 million commercially insured people ages 13 to 64 found that while women accounted for 50% of that population, they represented 53% of the patients utilizing health care and 57% of the total costs of care. Only 7% of the health conditions evaluated were unique to women, yet 69% of the conditions represented in claims data were more common or costlier in women, or both.

We’ll see a greater push this year to make substantial improvements in the realm of women's health, with empathetic guidance for women that looks at the entire person versus just symptoms. This will include a comprehensive understanding of the disproportionate impacts faced by women, the underlying causes of variations in their health care experiences, and the ways in which health care service delivery and benefit design can be enhanced to better address women’s specific needs.

Wraparound care for people with musculoskeletal conditions

Additionally, we will see a move toward condition-specific care programs developed to guide members to the right care at the right time and with the correct provider. This approach will be most prevalent in treating high-cost conditions such as musculoskeletal (MSK) conditions and within oncology and cardiodiabesity. MSK conditions, which include arthritis, low back pain, and neck pain, affect more than half of American adults and are a top driver of health care expenditures in the U.S., costing an estimated $420 billion annually. Back conditions alone account for 29% of those costs and are the top reason for sick days and disability leave, leading to productivity losses of up to $40 billion a year. 

The MSK care journey can be fragmented, and interventions may reach customers too late, causing a ripple effect of inflated costs, ineffective treatments, and unnecessary surgeries. To curb these costs, we will see personalized treatment programs for people with spine, knee, hip, and shoulder conditions aimed at guiding people to the right path for care. Early identification through predictive models will be paramount, as will digital guidance and engagement through personalized activities, assessments, content, treatment guidance support, care navigation tools that steer patients to high-performing providers, and more. In addition, dedicated care teams will be a key component of these programs.

A guided, personalized, and evidence-based approach to cancer care

A 2024 study by the Business Group on Health found that cancer ranked as the most expensive condition to treat for the third year in a row. That’s precisely why employers who offer health insurance to their workers must prioritize end-to-end cancer care, including a greater focus on prevention and early detection, specialty drug management, seamless navigation and experience, and condition-specific resources and tools.

In one recent pilot, a guided, personalized, and evidence-based approach to cancer care improved outcomes and cut costs. Over an 18-month period, the program increased the use of recommended treatment plans by 5.2%, leading to $24 million in savings in a large commercial population.

Over the year, we will see a shift to a more guided and holistic approach to cancer care focused on:

• Value-based care models that help patients navigate the care delivery system and their health plan benefits
• Building care plans for each member (and their caregivers) based on their specific needs
• Identifying resources to help with financial needs or other support available within the community, such as child care, transportation, and meal delivery
• Providing care coordination to help patients better understand treatment plans and coordinate their care across various resources
• Offering distress screening and behavioral health access and support, which are critical and often improve outcomes for cancer patients while lowering costs

Proactive management of cardiodiabesity

Medical and pharmacy costs for obesity, diabetes, and heart disease will continue to increase in 2025. The complexity of these conditions necessitates a tailored, data-driven, innovative approach to decrease health care spending and save lives.

   

The utilization of GLP-1 drugs, primarily for treating obesity, diabetes, and heart disease, is expected to rise significantly. Research shows that 79% of employers said they saw a heightened interest in obesity medications, including GLP-1s, among their covered members in 2024. While these medications are a standard treatment for diabetes (covered by 96% of employers in 2024), eligibility has broadened to include obesity (covered by 67% of employers in 2024), and cardiac conditions (covered by 34% of employers in 2024). It is therefore no surprise that 97% of employers expressed concern about the long-term cost implications of GLP-1s.

Proactive management of chronic conditions is essential to control rising health care costs. In 2025, expect more employers to implement wellness programs focused on preventing obesity, diabetes, and heart disease. We’ll see a bigger push toward encouraging regular health screenings to detect and manage chronic conditions early and to find cost-effective medication management strategies. Additionally, employers and health plans will look for ways to better manage GLP-1 spend through evidence-based prevention, identifying at-risk patients early and acting with urgency to reduce patients’ progression to worse health.

Trend No. 3: An evolution in behavioral health care with greater focus on navigation, personalization, and measurement

Currently, 30 countries around the globe report mental health and well-being as their No. 1 health issue. In the United States, statistics show that 1 in 4 people are dealing with mental health challenges. On average, Americans take 11 years to seek help for mental health issues, which can worsen a person’s condition, leading to more severe symptoms and ultimately increasing the cost of care. Research has found that outpatient behavioral health treatment is associated with medical and pharmacy savings of up to $2,565 in the 15 months after diagnosis. The greatest savings were observed for patients who had at least three sessions with a therapist – referred to as therapeutic alliance.

Access to behavioral health care has improved greatly over the last 5 to 10 years, yet it remains an issue for many Americans. In 2025, we will see a bigger shift toward integrating mental health into primary care to improve access, as well as advances in behavioral care navigation through personalized assistance, identifying the right methods of care, helping people find appointments, and providing 24/7 real-time clinical support. Adoption of virtual behavioral care will continue to grow, and we expect to see greater uptake of predictive data models for earlier identification, provider matching, faster appointment times, and 100% follow-up. 

The field of behavioral health care also must evolve to focus on better addressing the mental health crisis among America’s youth and supporting their entire family unit. Diagnosed or undiagnosed, millions of young people are struggling, and many parents feel ill-equipped to manage the many related challenges impacting life at home and work.

Soaring human and economic costs make the ongoing behavioral health care crisis and the ripple effect on parents, families, communities, and workplaces untenable for a thriving society. U.S. employers spend more than $200 billion annually on behavioral health costs for employees and their dependents, a figure that excludes indirect costs such as lost productivity and missed work.

An evolution in behavioral measurement-based care will take place, as research shows standardized metrics are key to delivering quality treatments and better outcomes for patients. “Standardized metrics ensure that we can measure the success and outcome of treatments broadly, to support a more standardized definition of quality in the industry. This data-driven approach, alongside the development of family support and clear industry outcomes specific to autism treatments, will be game changers in behavioral care over the next 12 to 18 months,” Holgerson said.

Trend No. 4: Generative AI shaping strategy and growth in health care

Health care is experiencing a massive transformation driven by an increase in the adoption of generative AI.

Among U.S. health care leaders surveyed by McKinsey, 59% are currently partnering with third-party vendors to develop customized health care solutions, 24% are planning to build solutions in-house, and 17% expect to buy off-the-shelf generative AI products.

Additionally, generative AI will play a pivotal role in shaping strategy and growth within the health care industry. A study published in the Journal of the American Medical Association indicates that AI-driven models can improve health diagnostic accuracy by 30%.

As the use of generative AI continues to grow, we’ll see a bigger focus on data security to protect member and patient privacy. We will also see organizations thinking more strategically about the risk and legal frameworks that govern the use of generative AI. A study by Deloitte found that 82% of heath care organizations have or plan to implement governance and oversight structures for generative AI. This same research found that leaders see promise in generative AI for improving efficiencies (92%) and enabling quicker decision-making (65%).

Given that generative AI doesn’t always serve up accurate answers – at least not yet – keeping humans in the loop will remain a critical component.

As we begin 2025, the health care industry is poised for significant changes driven by these key trends. From enhancing customer experiences and prioritizing women’s health to managing the rising costs of GLP-1 drugs, evolving behavioral health care, and adopting generative AI, the future of health care promises to be dynamic and transformative. Employers must stay informed and adaptable to capitalize on these trends and improve the overall health care landscape and outcomes for their workforces.

This article was created with the assistance of AI tools. It was reviewed, edited, and fact-checked by Cigna Healthcare’s editorial team and subject matter experts.