By Joe Spinelli, chief strategy officer, Aranscia.
2024 left us with raw emotions, sentiments, and uncertainty around how the US healthcare system will support both the commercial and political promises of excellence and value in care for all.
Faced with ever-escalating costs, and rate-limited access to effective care for an increasingly greying population, we are left with no choice but to embrace novel approaches to identifying, facilitating, and incentivizing proactive care improvement and efficiencies. The only thing certain about 2025 is that it will not be business as usual.
Initiatives to further the personalization of health care extend beyond embracing best practices for high-risk and high-cost cohorts – they also empower the broader population of patients and clinicians with access to evidence-based insights to drive both proactive and preventive benefits. The field of personalized medication management and the utilization of drug-gene testing (also known as pharmacogenomics, or PGx) can truly support a trifecta of improving access, efficiency, and economics.
What problems can personalized medication management solve?
Adverse drug events are the fourth leading cause of preventable death in the US, and downstream issues related to ineffective medications or unwanted side effects create a significant cost and care burden on our healthcare system. In contrast to one-sized-fits-all prescribing, which has traditionally aligned care providers and pharmacy benefits with a “standard” regimen irrespective of its assessed compatibility with the patient, personalized medication management programs use a combination of tactical diagnostic testing and high-evidence clinical insights to assist providers in optimizing therapeutic decisions.
How are biomarker programs like PGx being embraced nationally?
Widespread state and federal initiatives have recognized the value and benefit of improving the accessibility of PGx testing. Over half of the US states now have legislation in force or introduced to enhance coverage for biomarker testing programs like PGx, and they have overwhelmingly received bipartisan support.
While the federal legislative priorities for 2025 and beyond remain uncertain, key thematic elements of personalized care, use of evidence-based science, and operational efficiency are highly compatible with the key tenets of PGx programs at scale.
When it comes to providing comprehensive preventive care, more than annual checkups are required. A patient-facing approach is needed to support the establishment of a health-forward routine comprised of proper nutrition and exercise, mental and emotional health, and chronic condition management.
Numerous studies back this preventive care model, which produces wide-ranging benefits, from improved health outcomes to lower care utilization to lower healthcare costs.
Unfortunately, despite its known benefits, the US healthcare system has been slow in its uptake of preventive care for many patients; just 8% of Americans currently undergo routine preventive screenings and care. As a result, the US loses about $55 billion annually due to missed prevention opportunities. That’s about $0.30 for every dollar spent on healthcare services.
Reversing these trends is the driving force behind the growing interest in lifestyle or preventive medicine and the adoption of technology tools to support physicians and patients in this approach.
Emergence of Lifestyle Medicine
Lifestyle medicine uses evidence-based, whole-person, prescriptive behavioral, and therapeutic lifestyle interventions to prevent, treat, and manage chronic diseases such as cardiovascular diseases, type 2 diabetes, and obesity. By integrating the six pillars of lifestyle medicine—nutrition, physical activity, stress management, restorative sleep, social connection, and avoidance of risky substances—into patient care, lifestyle medicine helps patients improve their health and well-being.
A lifestyle or preventive approach to medicine can address up to 80% of chronic diseases and potentially reverse the decades-long rise in the prevalence of chronic conditions and associated costs. It can also improve both patient and provider satisfaction. This aligns with the Quintuple Aim of better health outcomes, lower cost, improved patient satisfaction, improved provider well-being, and advancement of health equity.
By Grace Nam, Strategic Solutions Manager, Laserfiche.
As the healthcare industry continues to grapple with the dual challenges of rising costs and evolving patient expectations, the urgency to modernize and automate has never been greater.
A recent Deloitte report reveals that 75% of life sciences executives have a positive to cautiously positive outlook for 2025, signaling optimism despite ongoing challenges.
This optimism is rooted in the sector’s ability to innovate, leveraging technology to drive operational efficiency and improve patient outcomes.
With aging populations and increased demand for digital healthcare solutions, organizations must adapt quickly to remain competitive in a rapidly changing landscape. From integrating automated data processes to centralizing patient records, modernization is no longer a luxury—it is a necessity. These technological advancements not only streamline administrative tasks but also set the foundation for a more patient-centric approach to care. As we move into 2025, the industry stands at a critical crossroads, where the adoption of cutting-edge solutions will determine its trajectory for years to come.
Modernizing Legacy Systems
The modernization of legacy systems will be a cornerstone of healthcare innovation in 2025. Many institutions are shifting toward centralized and structured document management through integrated solutions. This approach streamlines operations, reduces manual processes, and lays the foundation for scalable automation. Tools that auto-extract and auto-populate healthcare data are increasingly becoming the norm, driving operational efficiency and improving data accessibility for healthcare staff.
These advancements not only reduce administrative burdens but also enhance the patient experience. Automation plays a critical role in managing patient information and streamlining tasks, such as appointment scheduling, billing, and record management. Younger generations, in particular, are pushing for rapid, digital-first engagement, favoring seamless interactions over traditional methods. By investing in these technologies, healthcare providers can better meet these expectations, creating a more responsive and patient-centric system.
By Ryan Chapin, executive director of strategic solutions, and Vijaya Krishna Veeravalli, senior vice president of cloud engineering, AGS Health.
Ryan chapin
As we head into 2025, several key trends are expected to significantly shape the future of healthcare revenue cycle management (RCM). From managing surging denial rates and evolving workforce dynamics to mitigating rising cybersecurity risks and integrating cutting-edge technologies, healthcare organizations are entering the new year while navigating a complex—often contentious—environment to enhance patient care and operational efficiency.
Navigating an Adverse RCM Environment
Denials, evolving payer relationships, and greater administrative burdens have come together to create what may best be described as an adverse RCM environment for healthcare organizations.
Climbing denial rates, prior authorization requirements, and the costs associated with managing both are among the most significant challenges confronting healthcare organizations going into 2025. According to an American Medical Association (AMA) survey, physicians reported spending nearly two business days per week completing an average of 43 prior authorizations—many of which end in denial.
Vijaya Krishna Veeravalli
In terms of denials, the surge is driven in large part by the growth in commercial and government third-party audits, including an increase in the volume of prepayment audits. According to MDaudit, external audit volume more than doubled between 2023 and 2024 and total at-risk dollars increased fivefold. The result was a sharp uptick in final denial dollars across professional (34%), hospital outpatient (84%), and hospital inpatient (148%) settings.
Healthcare providers participating in increasingly popular Medicare Advantage (MA) plans have been especially hard-hit. MDaudit reports that MA-related denials increased by 59% on average across professional and hospital settings in 2024, and the total denials amount for MA plans rose by 51%—a trend that has a growing number of providers reconsidering or dropping participation based on high denial rates and poor payments.
The impact of these trends goes deeper than financial. They add to already high administrative demands that in turn increase the strain on an overburdened—and increasingly costly—workforce that RCM leaders struggle to shore up in a tough recruitment and retention environment. To avoid staff burnout, healthcare leaders are continuing to adapt strategically, including exploring onshore, nearshore, and offshore outsourcing models.
Healthcare access in the United States remains fraught with barriers, none as pervasive as the issues surrounding prior authorizations (PAs). Originally designed as a mechanism to ensure that care is both necessary and cost-efficient, PAs have become one of the largest obstacles to timely and affordable healthcare.
A recent survey revealed that over 80% of patients have delayed or foregone necessary procedures, lab work, or medications due to confusion or frustration over PA processes. These numbers highlight an urgent call to address systemic inefficiencies.
This is not just a patient problem—it is a systemic issue with implications for providers and the broader healthcare ecosystem. As healthcare policies evolve, including recent Medicare Advantage proposals from the Centers for Medicare & Medicaid Services (CMS), the need to streamline PA processes and enhance transparency becomes increasingly urgent.
CMS’s proposed changes, aimed at tightening rules around PAs, reflect a growing recognition of their role in impeding care. One proposal calls for Medicare Advantage plans to respond to routine PAs within seven days and urgent cases within 72 hours, a move intended to reduce patient wait times and administrative burdens.
However, challenges persist as stakeholders navigate the complexities of balancing oversight with access.
The Tangled Web of Prior Authorization
Survey data underscores the widespread impact of PA inefficiencies. More than half of patients experience delays in care, with over 40% waiting one to two weeks or more for authorization approvals1. For conditions requiring timely interventions, such delays can lead to deteriorating health outcomes, increased stress, and higher long-term costs for patients and payors alike. Financial burdens further compound these delays, with nearly 40% of patients reporting paying out-of-pocket because of denials or unclear coverage details.
The administrative toll on providers is equally staggering. Navigating PA requirements drains time and resources that could otherwise be directed toward patient care. The recent CMS proposals highlight this strain, as Medicare Advantage enrollees now make up over half of all Medicare beneficiaries. Administrative overhead for these plans often includes increased scrutiny of claims, leaving providers overwhelmed with inconsistent policies and requirements.
By Errol Weiss, chief security officer, Health-ISAC.
Healthcare data breaches are reaching unprecedented levels, with attacks that target the industry surging in both frequency and sophistication. Cybercriminals are zeroing in on vulnerabilities across healthcare systems, exploiting outdated and unpatched systems to steal and manipulate sensitive patient data.
From medical histories to genomic information, this data has immense value, making it a lucrative target for ransomware, phishing schemes, and insider threats. As healthcare organizations scramble to shore up defenses, the risks extend beyond financial losses to jeopardize patient safety and trust.
The urgency is exemplified by two landmark pieces of legislation—the Healthcare Cybersecurity Act of 2024 and the Health Infrastructure Security and Accountability Act of 2024 (HISAA). These laws aim to confront the mounting threats, but they also raise critical questions: Can they outpace the rapidly evolving tactics of cybercriminals? Are they enough to close the gaps left by outdated regulations like HIPAA?
Limitations of existing legislation
The limitations of existing regulations like the Health Insurance Portability and Accountability Act (HIPAA), reveal why new measures are necessary to address today’s cybersecurity challenges. When HIPAA was enacted in 1996, its primary focus was ensuring the confidentiality of patient information and establishing basic standards for privacy and compliance. While it has played a pivotal role in protecting patient data, HIPAA’s framework has not kept pace with the increasingly sophisticated cyber threats facing healthcare organizations.
As it stands, HIPAA has become largely a reactive framework for punishment, focusing on penalizing organizations after data breaches occur, rather than implementing proactive measures to prevent them. Its provisions leave much of the “how-to” for securing digital infrastructure undefined, offering flexibility but creating wide disparities in cybersecurity practices. Large healthcare providers with robust resources have the ability to invest in advanced protections, while smaller clinics and rural providers struggle to implement even basic measures due to financial and technical limitations.
Healthcare professionals dedicate their lives to caring for others, and while encountering traumatic events is an unfortunate part of their job, physical or verbal assault is unacceptable and should never be tolerated.
Nevertheless, healthcare workers are under the constant threat of violence, a disturbing trend that continues to plague our healthcare systems. Workplace violence has become so endemic that 40% of healthcare employees have experienced such acts in the last two years, according to a 2023 Premier’s survey.
Although some strategies have shown promise, a truly effective approach should incorporate three key elements:
A discreet means of alerting security
Accurate location tracking, indoors and outdoors
Unhindered communication with the necessary personnel
A Discreet Means of Alerting Security
Traditional wall-mounted panic buttons, often located at the head of a patient’s bed or in other fixed positions, can pose challenges. Their stationary nature limits accessibility, particularly during escalating incidents with patients or visitors. Moreover, the act of reaching for and pressing these buttons can further escalate tensions, contrary to the intended purpose of a duress solution.
To help address the issue, RTLS platforms started offering wearable badges that allowed staff to signal for help during escalating situations. However, early models often lacked the desired level of discretion, potentially alerting aggressors to the staff member’s call for assistance. Manufacturers then developed discrete personal staff buttons designed to be easily concealed, enabling staff to signal for help without drawing attention to themselves. To alleviate anxiety and uncertainty, some safety solutions incorporate a haptic response feature. This silent alert, triggered after activating the panic button, confirms that a duress call was sent, providing the distressed staff member peace of mind.
Accurate Location Tracking, Indoors and Outdoors
Time is of the essence when a staff member activates a duress badge. These incidents can unfold rapidly and unpredictably, potentially moving across different areas of the hospital or even spilling into the parking lot or garage. Therefore, a robust solution is required to accurately locate, both indoors and outdoors.
Unfortunately, legacy RTLS solutions often struggle with outdoor operation due to their reliance on heavy infrastructure, making installations costly or infeasible. Additionally, they leverage technology that doesn’t provide the needed accuracy. For example, cellular technology is great at providing GPS coordinates; however, it struggles with accurate altitude measurements in multi-story buildings, returning someone’s GPS coordinates but failing to determine which floor they are on.
AI-based location intelligence overcomes these challenges, resulting in a highly accurate system that provides real-time location intelligence within a facility or outdoors. Unlike traditional RTLS platforms, AI-enabled staff duress solutions use ultralight infrastructure, which makes them easy and inexpensive to install across an entire campus, inside and outdoors.
Despite the rapid adoption of digital tools, healthcare practices still rely heavily on manual workflows, with staff spending countless hours on phone calls, paperwork, and fragmented systems. While most solutions focus on automating individual tasks, Confido Health secured a $3 million funding round to tackle creating digital workers that manage end-to-end operations in specialty healthcare practices.
Together Fund led the seed funding round, with participation from MedMountain Ventures, Rebellion VC, DeVC, Operators Studio and strategic healthcare operators. The company previously raised a pre-seed round led by Momentum Capital.
Founded by serial entrepreneurs Chetan Reddy and Vichar Shroff, Confido Health represents the culmination of their expertise in AI-driven automation. The founders’ journey began with winning a prestigious Lockheed Martin grant for innovative technology, leading to their first venture, DroneNation. This AI infrastructure mapping company operated across India, Australia, and US markets, earning recognition in The New York Times before its successful acquisition. Now with Confido Health, they’re joined by Simran Parikh, who brings extensive government healthcare department expertise to the team.
“When building Confido Health, we focused on what healthcare providers truly need: tools that don’t just automate tasks but take on the operational burden entirely,” said Chetan Reddy, CEO of Confido Health. “Our digital workers are designed to integrate seamlessly with legacy systems like EHRs, IVRs, and even outdated communication tools. By automating and optimizing entire workflows, we’re not just saving time; we’re helping enterprises recover lost revenue and create sustainable growth.”
Confido Health’s platform creates specialized AI workers that handle specific tasks like appointment management, insurance verification, and care coordination. These digital workers connect to existing healthcare systems in under five minutes through no-code deployment, delivering end-to-end task automation without requiring practices to overhaul their infrastructure. Unlike traditional software companies, Confido Health charges on an hourly basis similar to full-time employees, eliminating integration and training fees.
By Grace Nam, Strategic Solutions Manager, 
Despite the rapid adoption of digital tools, healthcare practices still rely heavily on manual workflows, with staff spending countless hours on phone calls, paperwork, and fragmented systems. While most solutions focus on automating individual tasks,