At Meritain Health®, we take responsibility for understanding what trends are emerging across the health care landscape. We use our experience to understand cost drivers, industry benchmarks and risks that may develop for clients. Here are five emerging trends we’re noticing for 2025.
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- Tackling access and affordable care. Since 2017, health care costs have increased more than 50 percent. Health care inflation is also expected to continue to grow to the highest rate in a decade. This is largely due to continuous rises in utilization, costs of behavioral health and prescription drug prices. To counter these, we expect to see an expansion of value-based care solutions, along with improved primary care options. We also predict more exploration into alternative health plans, like SimplePay. Finally, early preventive screenings, second opinion services and access to biosimilars all play a role in addressing rising costs.
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- Member engagement. Getting members more engaged in their health has been a huge area of focus for 2025. Streamlining and targeting benefits based on need, while narrowing point solutions is part of this. More big picture goals include lowering overall costs, while attaining better outcomes. When members proactively approach care, this can be achieved through lesser reliance on emergency care and less need for expensive medical procedures (including lower hospitalization rates). Plus, enhanced access solutions for members can also add up to improved retention and member satisfaction.
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- Mental health. There’s continued focus on mental health this year, including removing barriers to care. According to data from the Business Group on Health (BGH), this is an overwhelming area of focus for employers. Their survey shows 79 percent of large employers are seeing an impact from an increase in use of services to treat mental health and substance use disorders1. On the whole, spending on mental health has increased more than 50 percent since the pandemic. Plus, this is an area where patients continue to go out-of-network to seek care. Strategies employers can consider to remove barriers to care include:
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- No- or low-cost telehealth and virtual care.
- Offering coverage for out-of-network treatment.
- Zero or limited copay for mental health conditions.
- Adding access to on-site mental health counselors.
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- Optimizing care delivery. Streamlining care delivery is also big for 2025. This includes using highly skilled facilities for specialized care for members, such as Centers of Excellence (COEs). More data from BGH shows 82 percent of employers will pursue use of centers like this in 2025. Actions that can impact quality of care in a meaningful way include:
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- Transparency of quality.
- Steerage to higher quality sites of care and providers (narrow networks and COEs).
- Movement away from fee-for-service towards value-based care.
- Adoption of alternative health plan designs.
- Stressing the importance of and increase in access to primary care.
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- Women’s health. While there have been more focused efforts on closing gaps in women’s health, there’s more to do. Many factors, including delayed childbearing, higher maternal risk factors and a rural shutdown of services have placed strain on women’s health. In addition, a broader focus from health systems is needed to include:
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- Fertility, menopause and other women’s health issues.
- Comorbidities and why they disproportionately affect disenfranchised groups.
- Cardiovascular health for women, which often goes unchecked.
- Musculoskeletal conditions, like back pain and osteoarthritis, which often impact women more frequently and more severely.
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As a leading TPA, we ensure employers and consultants have both the data and solutions to manage what’s unique to the modern workforce population. We’re here to consult on the best point solutions to address emerging trends we’re noticing for 2025. In addition, we help to evaluate customer risk and deliver thoughtful benefit design to create health packages tailored to today’s employees.
This article is for informational purposes only and is not meant as medical advice.
Sources:
1BGH 2025 Employer Health Care Strategy Survey
PwC Medical Cost Trend: Behind the Numbers 2025
Advisory Board 2024 Women’s Health Market Trends
