Healthcare Leadership Trends for 2025
Insurance Reimbursement Changes Threaten Economics Trends in health insurance could portend volume and margin declines. Four merit highlighting: Shift to lower-margin reimbursement. The aging population will bring the percentage of enrollees in commercial plans to 55% by 2030, down from 59% pre-pandemic. 1 That represents millions of patients generating lower Medicare reimbursement for providers. Affordable Care Act (ACA) marketplace risk. The enhanced premium subsidies program that boosted enrollment substantially in recent years terminates at the close of 2025. Government forecasts see a resulting direct-purchase enrollment decrease of 7.3 million people. 2 Any lost coverage could lead to deferral or avoidance of care. Medicare Advantage (MA) difficulties. Almost 33 million people were enrolled in MA in 2024. Carriers seek improved margins on these policies and could request higher premiums that prompt enrollment decreases. Moreover, MA has been administratively burdensome to providers due to high volume of prior authorizations and denials. A number of health systems have terminated MA agreements. Medicaid enrollment decline. Medicaid enrollment also benefited from the federal continuous enrollment requirement instituted during the COVID crisis. That program has now expired and is projected to reduce participation to 79.4 million people in 2025 from over 90 million in 2023. 3 Many anticipate further reductions. Workforce Management Continues to Demand Attention Healthcare’s workforce disruptions have receded, but significant flash points remain. One study projects a shortfall of 100,000 critical healthcare workers and 73,000 nurse assistants by 2028. 4 Another analysis predicts a gap of about 300,000 registered nurses (RNs) in 2027 and over 200,000 by 2037, assuming that historical labor patterns persist. 5 Turnover permeates the industry. The nursing rate is 18.4% nationally. 6 Medical practices face “rampant turnover,” notes a leading association. 7 Over half of nursing homes annually replace 50% or more of staff. 8 The myriad workforce issues make staffing management paramount. Organizations are using technology to manage their needs and find an optimal blend of permanent and temporary staff.
1 Oliver Wyman, “5 Ways Hospitals Can Cut Costs, Achieve Long-Term Stability,” April 2024. 2 Centers for Medicare and Medicaid Services, “National Health Expenditure Projections 2023-2032 Forecast Summary,” June 2024. 3 Ibid. 4 American Hospital Association, “5 Health Care Workforce Shortage Takeaways for 2028,” September 10, 2024. 5 National Center for Health Workforce Analysis, “Nurse Workforce Projections, 2022-2037,” November 2024. 6 Nursing Solutions, Inc., 2024 NSI National Health Care Retention & RN Staffing Report, March 2024. 7 R. Payerchin, “MGMA Analyzes Pay for Administrative, Nursing Staff,” Medical Economics, June 26, 2024. 8 The National Consumer Voice for Quality Long-Term Care, “High Staff Turnover: A Job Quality Crisis in Nursing Homes,” September 8, 2022.
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