The need for change in healthcare covering the U.S. is apparent, both digitally and culturally. The change process is set against a backdrop of rapid and widespread change transition across health and care services.
As to how healthcare will continue to evolve in the U.S., the firm CipherHealth has undertaken a review of key trends within the sector. The report has been shared with Digital Journal together with comments from two key personnel working within the firm.
Health financial strain: “Something has to give”
The U.S. has a healthcare spending problem. As a share of Gross Domestic Product, healthcare spending stands at over 17 percent—almost $14,000 per year for every person in the country.
Yet the system is not very efficient. This includes reimbursements being under strain and rising costs across the board, particularly in staffing.
Technology and standardized pathways could be the answer to sustaining quality care amidst these financial constraints.
According to Nate Perry-Thistle, Chief Product & Technology Officer: “Those who can adapt by embracing efficiency and support tools will find themselves better equipped for the road ahead. In 2025, systems that adapt by maximizing efficiency through standardized care pathways and AI-backed decision support will be best positioned to maintain high-quality care under intense financial pressures.”
AI’s Role: Measured, strategic integration over hype
Perry-Thistle looks at the application of artificial intelligence in healthcare and the solutions this offers: “Despite AI’s potential, healthcare organizations remain cautious about its widespread deployment, especially for patient-facing roles. In 2025, we anticipate a “measured adoption,” aimed at demystifying AI, that will focus on supporting healthcare operations without compromising care quality. This means AI will be embraced incrementally—first to assist in data processing, workflow automation, and patient outreach—laying the groundwork for eventual clinical applications. This gradual, strategic approach helps systems build trust and confidence in AI’s role as a supportive force in healthcare.”
Value-based care adoption across the maturity spectrum
Value-based healthcare is the equitable, sustainable and transparent use of available resources to achieve better outcomes and experiences for every person.
Considering ‘value’ within healthcare, Jake Pyles, CEO finds: “While traditionally led by progressive health systems, value-based care (VBC) is now being embraced by more “middle-of-the-pack” organizations, catalyzed by CMS and initiatives like the TEAM payment model. In 2025, expect this trend to grow as healthcare providers across the board, regardless of their previous VBC readiness, recognize the need to move beyond fee-for-service models. This shift signals that VBC is no longer an optional pathway but a requisite for sustainable, quality care across healthcare settings.”
The Rise of Employer Direct Models
A direct contracting arrangement essentially cuts out the traditional insurance carrier by allowing employers and health systems to work together directly.
Pyles continues his analysis to consider the value employers add to the process: “Employer direct care models, championed by organizations like Transcarent and Collective Health, are creating a new healthcare landscape where quality and cost-effectiveness are prioritized directly at the employer level. In 2025, as more employers recognize the need to ensure value-driven care for their employees, health systems will face growing competition from these employer-oriented networks. This trend will press providers to match quality and cost metrics, rethinking how they engage with employers as key stakeholders in population health.”
