2025 Outlook: What's driving health equity work amid Trump 2.0 uncertainty?

On the face of it, it may seem like the buzz around health equity is dying down. Less than a quarter of payer and health system executives cited health equity as a priority for 2025, a recent Deloitte survey found.

But the facts haven’t changed. The U.S. healthcare system continues to have an abysmal record on most equity, access to care and outcome metrics compared to other wealthy countries. The U.S. also far outpaces other countries on healthcare spending. By now, this is old news to everyone in the sector.

Some might argue 2024 was a year for plotting and planning: building out staff, infrastructure and strategy for equity work. Looking ahead, leaders predict 2025 will be a year for execution. Fierce Healthcare talked to more than two dozen stakeholders, including health systems, academics, health tech vendors, investors, consultants and trade groups, to understand what they expect of health equity in the next 12 months. 

Here are their top four predictions.

1. Preventive care is king

Patient engagement drives preventive care, which in turn drives better health outcomes. Engaged patients are more proactive about their health. They are more likely to take their medications as prescribed, resulting in fewer complications. They are also more likely to get vaccinations, mammograms and other preventive health measures.

In order to engage patients, care coordination is a necessary step, argues Bill Watts, managing director at investment bank BGL. Watts also leads the health tech investment banking practice within the firm’s healthcare and life sciences group. As a banker, Watts recognizes that this can look very different depending on the person and place. A high-tech approach is not right for all patients. Some might prefer a door knock than an app reminder.

“If there are reimbursement dollars to be had, you see companies building innovative models and finding a way to engage these patients,” Watts said. He expects more consolidation in the care coordination space over the next two years, particularly in the Medicaid and Medicare Advantage spaces.

The need’s not going to go away because people don’t like DEI as a word.
Adam Mariano, general manager and president of healthcare, LexisNexis Risk

 

A big market opportunity is on the horizon for anyone focused on the elderly, according to Andy Miller, senior vice president at the AgeTech Collaborative from AARP. Large companies have historically ignored the group, he said. But now, with 10,000 Americans turning 65 every day, “the numbers are so great that they can’t avoid those markets.”

Most adults aged 50 or older want to stay in their home and community as long as possible, an AARP survey found. Nearly half will need to make changes to their home so they can keep living there, and 64% will need to integrate tech into their home to help them live independently longer.

“People want to stay in their homes,” Miller said. “The only way to do that is to try to be preventative and proactive.” That requires preventive education and monitoring, so providers and caregivers can have insight into what is happening inside a home. More companies are trying to figure out how to “stitch together, contextually, your day,” Miller said. “They have to connect dots to create significant value.”

American seniors also need help affording healthcare, but navigating benefits can be complicated. Older adults from minority groups, with lower levels of education and income or who live in certain regions, are less likely to know their plan benefits.

“Ultimately, those who don’t prioritize empowering older adults to take an active role in their healthcare journey by working to fix fragmented government programs and insurance benefits will fall behind,” Karl Ulfers, co-founder and CEO of DUOS, noted.

As adults age, social needs can significantly impact their chances of staying healthy. From the accessibility of a neighborhood to loneliness to medical record literacy, these factors play a significant role in their health and well-being. Kaiser Permanente plans to focus more on this population, Anand Shah, M.D., vice president for social health, explained. “We’re spending a concerted effort in 2025 with older adults, given the somewhat greater prevalence of needs,” Shah said.

The health system has a new focus on what it means to deliver the right interventions at the right place and time. For instance, it has initiatives to identify and help older adults who are at risk of extreme climate events. This past year, the health system took a tech-enabled, multichannel approach to outreach, growing how many patients it was able to reach.

To monitor social needs, it behooves health systems to team up with community-based organizations that best understand populations. “Using the community resources that are already in place can be an effective and efficient way for providers to leverage existing infrastructures without having to reinvent the wheel,” Gregory Fosheim, a partner in McDermott Will & Emery's healthcare practice, said. He expects to see more of these collaborations in 2025.

“I see our role as largely the connector, but not necessarily the service provider,” Shah said. “Community organizations and community-based services are of the community and know their community tremendously well. We see they have trust and a track record of partnering with the community. We want to uplift them and empower them to deliver their services.”

2. Doubling down on sophisticated data analytics

More and more data are being collected. And the methods for doing so are getting more refined and precise. But with all those data comes a huge responsibility: doing something actionable with them.

“Leaders are clamoring to find ways to instead operationalize the insights, especially given healthcare’s history of collecting enormous amounts of data they aren’t leveraging effectively to help patients,” Carrie Kozlowski, co-founder and chief operating officer at patient engagement company Upfront Healthcare, said. That feedback rang loud and clear at the company’s past few client advisory board meetings. The meetings included chief medical officers and leaders across population health, operations, ambulatory quality and more. “Leaders ultimately fear that their inability to translate this information into action … will erode patient trust.”

So far, Kozlowski added, health systems are having luck collecting data in context, identifying barriers where they know they can immediately take action.

"In 2025, we’re excited to focus on companies that elevate the quality of data in healthcare,” Lynne Chou O'Keefe, managing partner at Define Ventures, said. Companies that will shine will build intelligence layers on top of strong databases or create new data sources where they don’t yet exist, she added. “This in turn enables more comprehensive intelligence, better compliance, and more accurate attribution—setting the stage for significant improvements in healthcare."

We don’t see this as like a trend or a fad. That work needs to be done forever.”
Justin Williams, principal, Seae Ventures

 

With its predictive and analytical capabilities, AI can automate important parts of the equation such as stratifying population health data by risk. In 2025, this is a trend Salvatore Viscomi, M.D., co-founder and CEO of Carna Health, expects to grow. “This shift could also significantly improve health equity by tailoring interventions based on diverse patient data,” he noted. Similarly, remote monitoring tools can help automate some of the clinical burden on doctors and empower patients with a better understanding of their own health, he added.

Stakeholders’ understanding of what data are important to look at and measure has also evolved. Nonclinical data are becoming increasingly important as care continues to get pushed outside the four walls of a hospital. An EHR can’t easily tell a doctor who is housing-insecure. But, with community-based data, those insights are easier to come by. “It’s taking advantage of city data, of consumer data … people just haven’t paid attention to those data assets as often,” Adam Mariano, general manager and president of healthcare at LexisNexis Risk Solutions, said.

At the same time, predicting localized obstacles to care delivery based on risk and availability of services will get more difficult, Mariano noted. In an increasingly digital sector, stakeholders need to figure out how to keep digital touchpoints with patients who may have traditionally been analog. That takes trust, which takes time.

In thinking of social infrastructure, Komodo Health, a health data company, has made a bigger investment in SDOH data this past year. In addition to factors like race, ethnicity and ZIP code—which it always tracked—today it tracks dozens of other attributes, such as driving distance to a grocery store, education level, income percentile and vehicle presence.

“We’ve really broadened our definition of what we consider the social determinants of health and how we measure them,” VP of analytics Usha Periyanayagam, M.D., told Fierce Healthcare.

“We see our accredited healthcare organizations actively identifying and addressing healthcare disparities,” the Joint Commission’s president Jonathan Perlin, M.D., Ph.D., said. “Social determinants of health (SDOH) rise to the top of their lists as many healthcare organizations are pinpointing food and housing insecurity and access to transportation as high priorities for action.”

It’s possible to get data in real time now, too, Periyanayagam noted. And AI allows them to be parsed and analyzed quickly for insights. It also allows for better triangulation of data to make important connections. “With AI you can actually start to find these correlations across all the variables more clearly,” Periyanayagam said.

To Mariano, it’s the small language models that are “the winners of the day.” These targeted models with limited hallucinations can focus on specific data and make specific recommendations. That is ultimately most helpful to whomever is seeking those answers. “Healthcare is super specific. You don’t need the whole internet,” Mariano said.

And, it’s also important to remember AI is far from perfect. “It is imperative that as we look at AI … we are making sure that we have the notions of bias and fairness involved at the outset, and that we’re continuously monitoring,” cautioned Simone Colgan Dunlap, a partner at Quarles & Brady and national chair of the firm’s health and life sciences team. “It’s life or death. The stakes are very high.”

3. Equity is quality, and quality is bipartisan

Most agree that quality is a bipartisan issue. “High-quality care is an argument that resonates across policymakers, across stakeholders,” Rachel Harrington, Ph.D., assistant vice president of health equity sciences at the NCQA, said.

The COVID-19 pandemic highlighted how racism and discrimination contribute to health inequities. “When you leave populations behind,” Harrington said, “then you’re not going to have effective, high-quality care.” In her organization’s view, equity and quality are inextricably linked.

“The context of health equity has been misrepresented to be a racial agenda alone,” Yele Aluko, M.D., EY Americas chief medical officer, said. “The truth is health equity is inclusive of a broader demographic, beyond race and ethnicity.” He pointed to Americans’ overall low life expectancy compared to other OECD countries. “Caucasian Americans are not achieving health equity,” he noted. “It is symptomatic of the dysfunction in the health industry.”

The systems that are really grounded in getting feedback from their patient populations and consumers are the systems that you can see evolve, regardless of changes in an administration we are going to see."
Jasmaine McClain, executive director, Health Equity Alliance

 

The NCQA has built trust within the sector because it follows scientific consensus and evidence-based practices. But quality is a practical science, Harrington said, and part of that also means being adaptable and having an open dialogue with others. The bipartisan progress the country has made on insulin pricing and surprise billing is because people have a personal connection to the issues. “It’s because people get it,” Harrington said. “There’s a very compelling human element to this.”

“There's likely to still be bipartisan alignment on the well-known observation that the American system of health is the most expensive system in the world,” Aluko echoed. He hopes that the administration’s interest in containing costs will lead to more attention to value-based care.

The goal of achieving health equity is supported by a “compelling” business case, Aluko added. If costly populations were managed more efficiently, then costs would go down. “Health equity is felt to be a DEI play, and it is not a DEI play,” Aluko reiterated.

Some organizations may not have a good enough picture of their own ROI for undertaking equity efforts, per Aluko. Large numbers, like a recent estimate that addressing inequity could add nearly $3 trillion to the U.S. GDP, get a lot of attention. But what does that mean for one single organization? It is crucial to use financial modeling and actuarial analysis to demonstrate how one’s margins might go up and within what amount of time: “That’s a more localized, granular view that is easier to embrace for an organization, rather than talking in the cloud about the macro numbers that an organization doesn’t have macro influence over.”

Experts are seeing indications that equity work is getting more formally integrated into care delivery systems. The NCQA’s Health Equity Accreditation Plus program is mandated by three states, which range the political spectrum. “What that shows is these programs are being institutionalized,” Harrington said.

The Health Management Academy, which runs peer learning cohorts for health system executives, has similarly seen this trend. Its Health Equity Alliance program, launched in 2021, has revealed how equity is being integrated into departments of quality and safety. Health equity teams are now reporting to chief quality officers or integrating with board-level quality committees, Jasmaine McClain, Ph.D., executive director of the academy's Health Equity Alliance, told Fierce Healthcare.

Considering the data collection and governance structure needed to make this type of work successful, this is still relatively new for health systems, she added. But she expects this integration to continue into 2025, helped along by agendas set by the Centers for Medicare & Medicaid Services and accrediting bodies.

“The systems that are really grounded in getting feedback from their patient populations and consumers,” McClain said, “are the systems that you can see evolve, regardless of changes in an administration we are going to see.”

“The need’s not going to go away because people don’t like DEI as a word,” Mariano at LexisNexis Risk said.

4. The future of the social safety net is unclear

Colgan Dunlap, the healthcare attorney at Quarles & Brady, is prepared for “tumultuous” regulatory changes in 2025. Federal agencies’ mandates and priorities will likely shift under the Trump administration, with the high possibility that some existing regulations are no longer enforced. That could be through a change in a regulation or a rollback of one. Although changing a law requires Congress, Colgan Dunlap said, sub-regulatory guidance can be changed as long as administrative procedures are followed. This type of guidance has historically helped offer interpretations to complex laws. But, since the Supreme Court overturned the Chevron deference this summer, federal agencies’ power to interpret regulations in this way is limited.

“Agencies don’t have the same kind of latitude that they had in the past,” Colgan Dunlap said.

The ruling may lead to regulatory confusion, added Sadena Thevarajah, managing director at HealthBegins, a consulting firm helping providers and payers meet equity requirements. “We’re anticipating a lot of decisions will get pushed down to the states,” Thevarajah said. She also expects deepening disparities in health outcomes, compounded by changes to government programs like Medicaid or attempts to weaken the Affordable Care Act.

Similarly, Seae Ventures, a VC fund focused on early-stage healthcare companies, is preparing for regulatory uncertainty and funding challenges for public programs that support equity initiatives. Though states may want to expand Medicaid, it will be hard for them to absorb the cost of doing so without federal support.

“We're really encouraging our companies and founders to adopt a proactive stance,” Justin Williams, a principal at the firm, told Fierce Healthcare. This means building out partnerships with other stakeholders, including payers, providers and employers, and doubling down on inclusive clinical research. “The goal is to stay resilient in this ever-changing political climate.”

The context of health equity has been misrepresented to be a racial agenda alone. The truth is health equity is inclusive of a broader demographic, beyond race and ethnicity."
Yele Aluko, CMO, EY Americas

 

At the same time, Williams hopes more companies will step up to address health equity. “We don’t see this as like a trend or a fad,” Williams said. “That work needs to be done forever.” Health equity is a “cornerstone” of Seae Ventures’ investment approach, and it is focused on companies with demonstrable outcomes in marginalized communities. “Outcomes data is crucial,” Williams said.

Risk assessments, reducing readmissions and quality program achievement are “just good business all the way around,” Mariano at LexisNexis Risk said. While the future of policy under Trump currently remains “too gray,” it may be a boon for innovation in certain areas. “There’s been some commentary about increasing speed to market for innovative therapies or reducing the red tape for new technology,” Mariano said.

After both Trump wins, in 2016 and most recently, nonprofits saw an uptick in donations in what has been coined rage giving. Under the last Trump administration, there was also a heightened demand from the public that corporations address equity. To support that, companies needed to build out their infrastructure, HealthBegins VP of Learning Glasha Marcon said. They learned the value of planning ahead, and, this time around, Marcon thinks they will be better prepared.

“In talking to colleagues across the social justice sector, that’s a lot of what they were thinking about, is how to start these contingency plans depending on how the election went," she said.