The healthcare sector began 2025 facing a challenging environment shaped by extraordinary events from the previous year.
According to Forrester’s recent report, ‘Predictions 2025: Healthcare Tackles Tough Terrain To Reach New Horizons’, the sector is still facing "the largest cybersecurity attacks ever recorded, historically low Customer Experience Index (CX Index™) scores, and widespread disruptions in relationships between health systems and insurers that drove the spread of medical deserts."
What the experts predict
Industry priorities
Forrester identifies "growing concentration risk, regulatory uncertainties stemming from the overturning of the Chevron doctrine, and the impact of [the] election," as major factors influencing the healthcare industry in 2025.
In response to these challenges, healthcare organizations are expected to turn their attention to preventative measures like "prioritizing cybersecurity enhancements and investing in generative AI (genAI) technologies to improve customer experiences and manage rising costs."
If a regional hospital network faces financial strain but wants to improve its cyber security, it can invest in an AI-powered risk assessment tool that helps identify potential compliance issues before they become costly violations.
AI-driven advocacy for health insurers
While millions of dollars were spent on digital experiences, these haven't met anticipated adoption rates. Consequently, Forrester predicts that "half of the top 10 US health insurers will use AI to bolster member advocacy."
With "call volumes to health insurers continuing to soar" and government scrutiny increasing, insurers will now look to "embrace the human experience to drive down costs and bolster wavering member trust."
For example, when an insurer rolls out an AI-powered virtual assistant that helps customer service representatives provide personalized assistance to policyholders, reducing call handling times and increasing customer satisfaction.
Reducing reliance on prior authorizations
Although AI was first used to process prior authorizations (PAs) faster and cheaper, its overuse has resulted in "increased administrative burden for providers and care delays."
Furthermore, "PA-fueled bureaucracy and payment delays have led some health systems to exit payers’ networks during a plan year, accelerating the spread of medical deserts."
As such, Forrester predicts that "one-third of leading health insurers will decrease reliance on PAs.
Ultimately, eliminating PA requirements for routine procedures like diagnostic tests will allow providers to perform necessary procedures without delays, resulting in faster diagnoses and treatments.
Strengthening healthcare cybersecurity
Cybersecurity is a top priority in 2025, with Forrester forecasting that "three more states will pass legislation to fortify hospital cybersecurity requirements." The industry is still recovering from attacks like the Change Healthcare data breach, which "left devastation in their wake."
Taking the lead, "New York is implementing new cybersecurity program requirements that bolster security controls and mandate more stringent risk assessments and better incident response." The program also extends protections "beyond HIPAA to cover hospitals’ confidential business information."
Massachusetts and California are among the other states that are anticipated to follow, while Illinois, Texas, Florida, and Washington are also strengthening cybersecurity and healthcare privacy regulations.
Additionally, the newly proposed Health Infrastructure Security and Accountability Act aims to introduce "mandatory and enforceable" cybersecurity controls. However, Forrester warns that "the bill has a long legislative road ahead of it, and the industry is unlikely to meet its standards."
Looking ahead
Despite these major challenges, 2025 could be an opportunity-rich year for healthcare organizations, creating chances for innovation and better patient care through AI-driven member advocacy, PA re-evaluation procedures, and improved cybersecurity defenses.
Ultimately, healthcare organizations must figure out how they will handle challenges to improve staff and patient outcomes.
FAQs
What is concentration risk in healthcare?
Concentration risk happens when healthcare services are controlled by a few large organizations, reducing competition and limiting patient choices.
How will AI improve customer experience in healthcare?
AI will enhance customer service through virtual assistants, predictive analytics, and automation of administrative tasks.
Can AI be integrated into HIPAA compliant emails?
Yes, AI-powered features can be integrated with HIPAA compliant emailing platforms, like Paubox, to automate processes like patient consent management and sending personalized emails while maintaining HIPAA compliance.
Read also: HIPAA compliant email API
