Effects and unknowns related to industry disruption, GLP-1s, artificial intelligence, the election and the sustainability of the healthcare workforce don't stop here.
Below are a handful of pressing questions that hang over healthcare leaders at the start of the new year informed by events of the past year. Each question reflects not just the complexity of the challenges ahead, but also the potential for thinking big toward solutions that stand to influence the industry for years to come.
1. Who will be the next surprise to deliver real healthcare change?
Mark Cuban has emerged as one of the most effective — and unexpected — figures driving measurable improvement in healthcare. A decade ago, few would have predicted that the billionaire entrepreneur and former Shark Tank host and NBA team owner would spearhead a disruptive force like Cost Plus Drugs, which now manufactures injectables in shortage, works with thousands of healthcare facilities (including Penn Medicine, Community Health Systems and MultiCare Health System) and offers more than 2,000 discounted generics and about a dozen branded medicines. Even Mr. Cuban himself might not have foreseen it; after all, the venture started with a cold email pitch labeled just that: "Cold pitch."
The healthcare industry often attracts would-be "disruptors" who focus more on proclamations than results. This is one reason Mr. Cuban stands apart. Well-resourced but uninterested in profiteering ("I don't need any more money. I'm rich as hell," he has bluntly put it), Mr. Cuban surrounded himself with smart people and dove into the industry's Frankenstein-like complexity — its patchwork of incongruous parts, outdated incentives and tedious mechanics — to understand the root causes of dysfunction. His ability to articulate and challenge the intricacies of PBMs, inflated drug costs and overlooked employer healthcare expenses rivals that of the most seasoned industry executives.
More importantly, Mr. Cuban didn't stay on the sidelines critiquing the system. He worked to create a product that people notice, trust and cheer for. This is what true disruption looks like. Healthcare CEOs and other industry leaders should take note: there's a lesson here for anyone claiming they want to drive change.
2. When will healthcare be treated as the economic issue it is?
The 2024 election failed to position healthcare as central to the economy despite representing nearly a fifth of the U.S. GDP. Voters were inundated with debates over the costs of essentials like gas and food while healthcare remained on the sidelines, with neither Democrats nor Republicans making the meaningful connection between healthcare and the financial wellbeing of everyday Americans. (Voters outright said healthcare should have received more attention in the campaign.)
The result? A missed opportunity to mobilize voters around the most urgent economic issue of our time.
It's appalling that it took the assassination of a healthcare CEO, Brian Thompson, to spark broader conversations about the broken system. Instead of outrage or reflection, many Americans responded with chilling cynicism and by indulging in dark corners of faceless online commentary. Digital noise and performative outrage grew louder and continued to overshadow any sort of substantive healthcare discussion.
Meanwhile, the stakes are high and growing. Medicare's Hospital Insurance Trust Fund is projected to be depleted by 2036 — just 11 years from now. Meanwhile, Medicare Advantage enrollment has soared, covering 54% of beneficiaries in 2024, despite glaring issues like prior authorization delays and slow payments that lawmakers themselves have flagged.
2025 offers a chance to reset the conversation. Will any voices finally emerge to frame healthcare as an economic concern directly tied to household budgets and the nation's financial sustainability? Will leaders have the courage to address meaningful changes to Medicare, moving beyond token measures like 2.8% payment cuts — the equivalent of rearranging deck chairs on the Titanic? Can voters, policymakers and corporate leaders rise to the occasion and prioritize real solutions, or will sound bites and superficial debates continue to create an illusion of progress?
3. What's the long game for the healthcare workforce?
It often feels as though healthcare leaders approach short-, mid- and long-term workforce solutions with equal weight. This obscuration might stem from the whirlwind of retention efforts during COVID-19, when staffing was largely managed quarter by quarter, relying heavily on short-term measures like signing bonuses and mid-term goals like reducing contract labor costs. Such efforts demanded a lot of energy and may have left less room for a broader, long-term vision.
In 2025, the pressure to shift gears will intensify — particularly for mid-sized and large health systems. Certain measures, such as signing bonuses, portal message fees and workflow optimizations, will become table stakes. These tools can help address immediate pressures, but the workforce crisis requires more than reactive management.
One of the most encouraging developments of the past year has been the collaboration among public schools, philanthropy, and health systems to create healthcare-focused high schools. Here's the reality about the workforce: no single measure will solve the crisis. These schools alone won't eliminate shortages of physicians, nurses, advanced practice providers, techs, and therapists. But they symbolize exactly what the industry needs — bigger swings, longer timelines and bolder investments.
2025 is the year to embrace the long game. Building a sustainable workforce requires a commitment to ambitious, forward-thinking strategies that address roots of the problem — not just symptoms.
4. What will be the next GLP-1?
The boom of GLP-1s in the past few years can make one forget that these drugs didn't fall from the sky. The FDA approved Ozempic in 2017, for instance, years before it became a household name.
As debates persist over who should have access to GLP-1s for weight loss and who should foot the bill, the arrival of the next game-changing drug is only a matter of time. This won't be the last time a blockbuster drug becomes a societal phenomenon. It won't be the last time healthcare providers, employers, drugmakers, insurers, and patients grapple with thorny questions about "access" — not just in terms of appointment wait times, but also in the supply of drugs and the ability to afford and fund them.
The U.S. healthcare system's handling of GLP-1 drugs reveals a troubling pattern: a reactive, piecemeal approach to a breakthrough drug class that could have helped tackle the staggering $600 billion annual costs of diabetes and obesity. Beyond the financial toll, the disproportionate burden these conditions place on underserved communities remains largely under-addressed. The piecemeal funding and abrupt treatment discontinuation for financial reasons also raise serious concerns about health outcomes, including potential withdrawal effects.
The challenge now is to reflect on this flat-footedness and to learn from it. When the next blockbuster drug inevitably emerges, will healthcare leaders act more decisively, or will we repeat the same mistakes — leaving patients to bear the cost of systemic inertia?
5. What will disciplined AI spend look like — and deliver?
AI has captured significant attention across industries in recent years, and healthcare is no exception. As systems work to maintain progress they've made with their operating margins and staffing stability, they must also exercise restraint and discipline when considering what could become an all-consuming cost. The allure of AI is strong, but without clear-eyed evaluation and management, it risks draining resources with little to show for it.
Consider the experience of a major multi-state health system that evaluated 100 AI products: only 10 progressed to pilot mode, and of those, just five delivered the intended outcomes. Other health system technology leaders report success rates below even 5%. As much as it may seem that health systems are doing with AI, imagine the lesser-seen category of investments that don't deliver. Beyond the pilots are questions and unknowns about the long-term costs of maintenance and continued AI oversight.
Occasionally, AI missteps make headlines, raising public scrutiny about how the technology is implemented and how it affects human judgment. Health system leaders would be well-served in 2025 to act as though every AI investment, pilot and outcome were subject to public review. If your AI spending made headlines, would it withstand scrutiny? (Warren Buffett's "newspaper test" has long been a guiding principle for a reason.)
It's worth noting, too, that CIOs and other technology leaders in health systems can be powerful voices of reason here. Many C-level leaders and leadership teams are excited about AI within their health systems, and this excitement can take a turn and run the risk of overenthusiasm, overestimation and expectations for instant gratification. A big part of technology leaders' job is not only running the pilots, managing the budget and making scaling decisions, but also educating their leadership teams and managing their expectations — a heavy lift.
In 2025, the conversation may shift from highlighting AI success stories to examining those wins in the context of overall spending and savings. Organizations that succeed will be those that approach AI with clear goals, rigorous oversight and a realistic understanding that not every innovation is worth pursuing.