Healthcare in 2025: AI, Regulation, and Operational Modernization for Strategic Advantage
The healthcare industry stands at a pivotal crossroads as we approach 2025, facing unprecedented technological advancement alongside evolving regulatory demands. This convergence presents both extraordinary opportunities and complex challenges for healthcare organizations.
Lyric's leadership team, representing diverse expertise across medical, technological, legal, and operational domains, offers comprehensive insights into the trends, challenges, and opportunities they see becoming more on the minds of healthcare organizations in 2025. These perceptive prognostications are not official statements or guidance from Lyric. We hope they provide readers with insights as they plan our evolving world of healthcare technology.
Lab Testing Coverage and Clinical Innovation
Bernard Steinbacher, MD, MS, CPC, Senior Medical Director at Lyric, forecasts change specific to the testing in the realm of precision medicine. He notes, "Over the next 12-24 months, expect to see broader coverage for biomarker testing, particularly in cancer treatment and prenatal genetic screening. With over 22 states either enacting or considering legislation to expand access to biomarker testing, payers will need to adapt quickly." This shift towards precision medicine not only promises improved patient outcomes but will likely bring new considerations for coverage determinations.
Steinbacher also emphasizes the revolutionary impact he sees AI bringing to clinical settings: "AI-powered tools are rapidly being integrated into electronic medical record (EMR) systems, transforming how clinicians make decisions about patient care. These tools are already reducing diagnostic errors and enabling personalized treatment plans based on real-time data analysis." This integration of AI into clinical decision-making represents a significant step forward in healthcare delivery, with the promise of reducing costs while improving patient outcomes.
AI's Transformative Impact
Akshay Sharma, Lyric's Chief AI Officer, presents a comprehensive vision for AI's evolution. His first prediction sets the tone: "2024 was the year of CoPilot; 2025 will be the year of early Autonomous Agents." He sees these agents as having the likely ability to "revolutionize operations by automating tasks previously thought to require human oversight" as well as "handling complex multimodal tasks like voice and vision processing in call centers and document management with unprecedented efficiency."
This shift toward autonomous agents will be more than just technological advancement; it signals a future fundamental change in how organizations will approach operational efficiency and service delivery. Not shying away from what’s on the mind of many, he also sees that AI agents will cause some job displacement, with respect to industries reliant on repetitive tasks.
Regarding language models, Sharma predicts a dual trajectory: "Language models will continue to see tremendous growth, with both colossal models pushing the boundaries of reasoning and multimodal capabilities, and smaller, highly specialized models dominating enterprise applications." More specifically he notes, “small language models (SLMs) will excel on constrained devices, driving ambient computing across smartphones and edge devices, while larger models will tackle complex, resource-intensive tasks like real-time decision-making and advanced analytics.”
According to Sharma, 2025 will see growth of innovative models with the shift in political leadership, as well as evolving regulation from the federal government." In light of the growing threats of adversarial attacks and ethical challenges, Sharma emphasizes that "companies that embrace early AI governance strategies will gain a critical edge."
On Security and Governance
Jan Sbarbaro, Chief Legal Officer at Lyric, emphasizes the critical importance of AI governance. She predicts: "Healthcare organizations will utilize a multi-team, or committee approach to implement and evolve their AI governance and AI initiatives." These committees, comprising AI and data scientists, legal, clinical, IT, and compliance representatives, will help ensure comprehensive oversight of AI systems' safety, fairness, and regulatory compliance.
Sbarbaro also forecasts: "Real-time computational AI governance systems will become a standard requirement for healthcare AI deployments." She draws the analogy: "Similar to how aircraft engines are continuously monitored during flight, healthcare organizations will strive to implement monitoring systems that capture millions of data points to optimize performance and compliance."
Kevin Heineman, Lyric’s Chief Information Security Officer, outlines crucial security imperatives that will be prevalent in 2025. On disaster recovery, he notes: "The outage many companies experienced due to the global CrowdStrike outage has revealed how interdependent and single threaded many organizations are with their technology suppliers." This observation highlights the critical need for building resiliency in business models, and organizations keeping a close eye on business continuity risk.
Regarding vendor/partner management, Heineman predicts: "The Healthcare supply chain is complex, and data may flow through several different companies to fulfill a business process. Understanding this supply chain and how data is protected throughout the process will become an increased focus." He also sees security questionnaires and attestations evolving from a risk function into a complete security control assessment of the integrated data supply chain.
Modernizing COB Operations
Brian Berkowitz, Chief Product Officer at Lyric, anticipates significant evolution in Coordination of Benefits (COB) programs. His first prediction addresses operational shifts: "COB programs will move more strongly toward prepay capabilities in 2025. Though not all COB operations can or will be integrated in the prepay environment, this shift will reduce administrative costs and burden.” He also predicts that the shift to prepay will help drive greater health system efficiency, as well as improving alignment and relationships between providers and payers.
This evolution in COB operations will become a meaningful change in how health plans manage benefits coordination, requiring fresh approaches to data management, greater accuracy in identification, and improving post-pay pass layering with specialized vendors.
Berkowitz also forecasts a fundamental change in timing measurements: "Healthcare organizations will shift from using calendars to using clocks to measure COB response times in 2025." He notes that "this change acknowledges that the industry's current reliance on data lags and delayed processing needs modernization."
For COB-related data integration challenges in the coming year, Berkowitz predicts that improved COB offerings and approaches to handling multiple data sources and time periods will help plans better manage the complexity and administrative expense. He believes that more plans will focus on these new approaches, considering challenges involving eligibility, job changes, open enrolment, retirement age, disability, and third-party liability.
Looking Ahead to 2025
The predictions shared by Lyric's leadership team paint a detailed picture of healthcare's evolution in 2025. From Bernard Steinbacher's insights on legislative changes in claims processing and biomarker testing coverage, to Akshay Sharma's vision of autonomous agents and AI-generated software, the industry stands at the cusp of significant technological advancement. The transformation extends to fundamental operational processes as well. As Brian Berkowitz predicts, the shift toward prepay capabilities in COB programs and the transition from calendar-based to clock-based measurements reflect the industry's broader move toward modernization and efficiency.
The convergence of these trends - from AI advancement and security evolution to operational modernization and regulatory changes - signals a pivotal moment for healthcare organizations in the coming year. More than ever, organizations will need to embrace a complex balance of planning, investment, vendor strategy, and forward-thinking.
About Lyric
Lyric, formerly ClaimsXten, is a leading AI healthcare technology company, committed to simplifying the business of care. Over 30 years of experience, dedicated, expert teams, and top technologies help deliver up to $14 billion of annual savings to our many loyal and valued customers—including 9 of the top 10 payers across the country. Lyric’s solutions leverage the power of machine learning, AI, and predictive analytics to empower health plan payers with pathways to increased accuracy and efficiency, while maximizing value and savings. Lyric is investing in AI driven technology to ease implementation and speed to value for customer savings, while offering enhanced and newly available solutions through internal product development and strategic partnerships, including recently announced partnerships with Concert Genetics, Autonomize AI, and now, Codoxo. Discover more at Lyric.ai.
