Key trends are set to significantly shape the future of healthcare. From the integration of cutting-edge technologies to evolving workforce dynamics, healthcare organizations must navigate a complex environment to enhance patient care and operational efficiency. Our subject matter experts at AGS Health recently shared critical trends to watch this year:
Revenue Cycle Management: Mitigating Denials
Healthcare organizations face challenges in revenue cycle management (RCM) with denials, payer relationships, staffing, and administrative issues. Ryan Chapin, Executive Director of Strategic Solutions at AGS Health, states "Denials and payer relationships are expected to remain among the top challenge for healthcare providers, with denials increasing in tandem with administrative burdens as they navigate complex payer requirements. Workforce challenges will also continue impacting RCM, particularly in terms of recruiting and retaining skilled talent amid rising workforce costs. Despite progress toward easing them, administrative demands will also remain heavy, especially with prior authorizations. Finally, streamlined RCM processes will be more essentiala than ever as rising denial rates and costs associated with Medicare Advantage plans add to these pressures."
Addressing Workforce Challenges
Ongoing labor shortages continue to require healthcare leaders to adapt strategically to avoid staff burnout. Matt Bridge, Senior Vice President of RCM Services at AGS Health, notes that "Clinical staff shortages will continue to place immense pressure on vital resources as administrative demands grow. As a result, I expect to see more organizations exploring onshore, nearshore, and offshore outsourcing models in 2025 as they seek to prevent burnout and allow clinicians to dedicate more focus to patient care. Advanced automation will also be in higher demand as a way to support clinical staff with essential administrative tasks like clinical documentation integrity (CDI), utilization management (UM), prior authorizations, and clinical denial appeals. This hybrid approach will help streamline operations, reduce costs, and improve both patient care and revenue outcomes in the years ahead."
Embracing AI and Automation
AI and automation continue to be a transformative force in healthcare, particularly in revenue cycle management (RCM) and administrative functions. Emily Bonham, Senior Vice President of Product Management at AGS Health, emphasizes that "adoption and integration of AI and automation in healthcare will continue to grow and refine, particularly in RCM and other administrative areas. There will also continue to be an ongoing reduction in administrative burdens for clinical staff through deployment and refinement of ambient technology at the point of care. I believe physicians will begin to see technology as helpful rather than intrusive or cumbersome—which has been a struggle over the past 10 years as they’ve tried to achieve balance in their interaction with electronic health records (EHRs). Room must be left for technology disruptors as the EHR industry consolidates into a small handful of companies. We need to not lose sight of all the opportunities to save time, reduce costs, and improve patient care."
Additionally, Chapin predicts that "in 2025, healthcare providers will increasingly adopt predictive analytics to stay ahead of rising payer denial rates. By analyzing data before and after billing, they can work to proactively prevent denials and prioritize denials with the highest return on investment. We’ll also see more payer-facing AI calling technology capable of gathering complex information from payer representatives, both bots and humans. This will streamline tasks like denial overturns and authorization checks. On the automation front, we’ll see continued advancement for AI handling both clinical and non-clinical appeals, drafting appeal packets that humans review before submission."
Elevating the Patient Experience
During a time when patient expectations are evolving rapidly, the integration of technology is key to enhancing the patient journey. Chapin remarks, "AI, machine learning and other technology integration will enhance the patient journey. We are also seeing providers investing more heavily in self-pay technology and automation to both educate patients on their financial responsibilities and offer simple, accessible payment options and plans. This approach boosts patient satisfaction and increases patient revenue. CAentralizing administrative functions in patient access is another trend I see as it will enable front desk staff to spend more time interacting with patients rather than handle tasks like prior authorizations and insurance verification."
Thwarting Cybersecurity Threats
As digital threats grow more sophisticated, cybersecurity remains a critical focus for healthcare organizations. Vijaya Krishna Veeravalli, Senior Vice President - Cloud Engineering at AGS Health, predicts, "In 2025, healthcare’s cybersecurity landscape will be shaped by evolving ransomware tactics, heightened regulatory pressures, and the integration of advanced AI-driven defenses. To avoid disrupting operations and patient care, prevent service delays, and protect patient safety against the rising threat of ransomware attacks capable of disrupting operations and patient care. Financial impacts will likely escalate, with healthcare organizations incurring direct ransom demands and higher costs related to compliance, cybersecurity improvements, and reputational recovery. AI will play a larger role in cybersecurity, with new AI-powered tools providing enhanced detection and automated response capabilities. However, as AI itself becomes a target for cybercriminals, rigorous oversight must be implemented to manage these tools responsibly. To stay resilient, organizations should prioritize advanced strategies like network segmentation, vulnerability disclosure policies, and regular third-party assessments. Further, proactive approaches, such as reducing dependence on legacy systems, applying multi-factor authentication, and maintaining a strict security patch schedule will be critical to maintaining robust defenses against both established and emerging threats."
The trends shaping the future of healthcare are transformative, requiring industry leaders to adapt and innovate throughout 2025 and beyond. Contact us to learn how we can help navigate these complexities associated with revenue cycle management, workforce challenges, AI integration, patient experience enhancements, and cybersecurity.
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