Healthcare Trends to Watch in 2025

As I sat down to gather my thoughts on the state of our industry moving into 2025, I have to admit it wasn’t clear where to start. With the election behind us and a new administration vowing to shake things up, it feels like almost everything we know is likely to change over the next four years. Everyone in Washington, myself included, is trying to read the tea leaves these days. While there may be uncertainty about many things, it is probably safe to assume that value-based care and its components, including cost and quality are likely to be supported by the federal government.

That’s because one of the few things we can all agree on is that value-based care works. It’s the one system where if done right, patients, providers, healthcare organizations, and payers—can all win together. And it is virtually impossible to implement value-based care without some sort of measurement system(s). Much of how all this plays out will also depend upon who is in charge. While it may be too early to speculate, it may be worth considering areas of highest interest with some of the key nominees.

From obesity to vaccines to fluoridated water, Robert F. Kennedy Jr., is already promising to make enormous waves as Secretary of Health and Human Services. Even more important to Medicare and Medicaid is the appointment of Dr. Mehmet Oz as CMS Administrator for the next 4 years. Some of his previous ideas are outlined in this. ABC News piece.

On the technology front, Micky Tripathi, the current Assistant Secretary of Technology Policy (ASTP) National Coordinator (formerly ONC National Coordinator) will be leaving the department, while a nominee is yet to be named. It is likely that the emphasis on nationwide interoperability, Trusted Exchange Framework and Common Agreement (TEFCA), countering information blocking and Fast Healthcare Interoperability Resources (FHIR) supported digital health and quality measure adoption will continue as important initiatives. Learn more about ASTP here.

Public reporting of quality measures that are relevant to consumers in selecting healthcare services may even get a boost given the new administration’s emphasis on market-driven solutions and increased competition.

While quality measures based on hospital care are publicly reported, their use in choosing a hospital is somewhat limited mostly to elective care. Therefore, publicly reported quality measures are more likely to be used by consumers in selecting hospital outpatient surgery and ambulatory surgery centers.

On the topic of transparency, it’s worth remembering that “greater transparency” was one of the many goals around the MIPS Value Pathways (MVP) framework when CMS introduced it to the QPP in 2023, especially for large multi-specialty groups that often reported only six primary care measures at the group level. By tracking measures that are specific to a provider’s specialty, consumers could make better informed decisions when choosing a specialist. As the MVP framework matures and is refined further, we can expect additional eCQMs and potentially MVP specific cost measures instead of the current much broader Cost Per Capita or Medicare Spending Per Beneficiary measures.

It also looks like the QPP program won’t be the only home to specialty-based measurement tracks. Based on this year’s OPPS Final Rule, CMS is strongly considering adapting this approach within the Ambulatory Surgery Center Quality Reporting (ASCQR) program through one of two possible frameworks.

• ASCs would be required to report all specialty-specific, claims-based measures and select a specified number of the remaining non-claims-based specialty-specific measures or report specialty-specific measures for which case counts reach a specified case threshold minimum.

CMS has not provided a timeline for implementation and has only stated that it will be discussed in “future rulemaking.”

Reducing provider burden by removing less meaningful or topped-out measures from CMS quality reporting is another important CMS goal. Simultaneously, there is a need for additional measures in a few important areas where gaps in quality have been identified.

• PC Measures – Maternal health measures, like the now-mandatory PC-02 and PC-07 eCQMs, will likely continue to be a nationwide priority. With public reporting of these measures in the fall of 2025. Birthing-Friendly Hospital designation and value-based payments could be additional use cases of these measures. Check out our guide to the common pitfalls of PC eCQMs to make sure your hospital is ready for public attention.
• Hospital Harm Measures – By 2026, there will be seven specific Hospital Harm eCQMs available to report in the IQR program. By 2028, five of those seven will be mandatory. Some of these eCQMs are “de novo” measures while others are digital versions of the Claims-based Patient Safety Indicators (PSI) developed and maintained by AHRQ for the last several years. Explore our Education Center to find free “how to” guides on each and every Hospital Harm measure like this one on the Opioid-Related Adverse Events eCQM.
• Health Equity Measures – As we saw in the OPPS Final Rule, CMS made a big decision this year to roll out its health equity measures, which are already required in the IQR and IPFQR programs, to its OQR, REHQR, and ASCQR programs. There has also been talk of converting two of the three measures – SDOH-01 and SDOH-02—into eCQMs. With these moves, it’s clear that health equity will continue to be a fundamental strategic priority for CMS in the years ahead.

Finally, no conversation in healthcare today is complete without discussing FHIR and AI. The opportunity to transform healthcare using these technologies has caught everyone’s imagination, and rightly so. Like every other technological breakthrough of this magnitude, change will not be easy or in a straight line. It will be costly and take longer to scale than many of the rosy predictions today. In the meantime, a variety of stakeholders will need to decide whether to lead, follow, or get out of the way of this enormous change. Both CMS and NCQA are taking the lead in FHIR-based digital measurement.

• CMS’s Center for Clinical Standards and Quality (CCSQ) has set up a dedicated group within CCSQ to facilitate further development and implementation of FHIR-enabled eCQMs/dQMs in their quality reporting programs.
• In tandem, NCQA currently has a number of its most important HEDIS measures specified in FHIR/CQL as part of their transition to an all-digital HEDIS strategy.

Both entities are also looking to collaborate on a FHIR-based digital measurement transformation.

It is not too early for quality measures vendors and their provider and/or payor clients to start down this path with pilot projects to familiarize themselves with these new standards and technology.

As we all slog through this messy middle, we need to keep our eyes on the fantastic future without getting bogged down by entrenched legacy systems.

What are your new year’s resolutions for quality improvement? Medisolv is here to help you conquer them. Schedule a 1:1 call with a Medisolv Clinical Quality Advisor, or check out some of the latest tools in our Education Center:

• eBook: 2025 Hospital IQR Requirements
• Workbook: 2025 CMS vs TJC Measure List Comparison
• Article: Changes to the QPP Under the 2025 PFS Final Rule
• Article: 2025 TJC ORYX Requirements