It seems like we have been here before, but let’s hope that this time, we see some meaningful changes. I could be wrong but I am not hopeful. But if I am wrong, what might we see over the next four years?

The healthcare industry stands on the cusp of transformative change as policymakers, providers, and innovators address shifting demographics, evolving technology, and the aftermath of a global pandemic. Over the next four years, several trends could redefine healthcare delivery, access, and outcomes.

One major shift involves advancing telehealth and digital health solutions. The pandemic accelerated the adoption of virtual care (which was languishing), and this trend will continue, with more investments in telemedicine platforms, remote monitoring devices, and digital health apps. These tools aim to improve access to care, particularly for rural and underserved populations, while also reducing healthcare costs.

Value-based care will likely gain more traction as governments and private payers focus on outcomes rather than volume. This model incentivizes healthcare providers to improve patient outcomes while managing costs, emphasizing preventive care, chronic disease management, and patient-centered approaches. Again, we have seen glimpses of this new focus and have yet to see the expected definitive results.

Policy changes may further shape the landscape. Expanding Medicaid (not likely for Florida), revising drug-pricing policies, and addressing staffing shortages are key areas of focus. Efforts to mitigate the growing mental health crisis, exacerbated by the pandemic, could lead to increased funding and integration of behavioral health services into primary care (this is a critical area of need and it may not rise to the top of programs requiring additional funding for the next administration).

Technological advancements such as artificial intelligence (AI) and precision medicine will continue to evolve, offering personalized treatment plans and predictive analytics. AI-powered tools can assist in diagnosing diseases earlier and more accurately, while genomic research opens new doors for customized therapies.

Finally, addressing workforce challenges will be critical. The number of successful initiatives directed to the recruitment, training, and retention of healthcare professionals are growing, alongside policies promoting equity, diversity, and inclusion across the sector.

As the healthcare landscape changes, collaboration between stakeholders will be crucial. By leveraging innovation, addressing policy gaps, and focusing on patient-centered care, the next four years could herald a more efficient, equitable, and technologically advanced healthcare system.

What we could see versus what we will see might be quite different.



A potential second Trump administration would likely continue prioritizing deregulation and market-driven healthcare solutions. During his first term, former President Trump emphasized reducing government involvement in healthcare, favoring policies that foster competition among providers and insurers. That first term “was characterized by efforts to chip away at key tenets of the Affordable Care Act, curtail the Medicaid program, and deregulate the healthcare industry.” [Healthcare Dive November 7, 2024] Key areas of focus may include the Affordable Care Act (ACA), drug pricing, and healthcare transparency.

The Trump administration’s repeated efforts to dismantle the ACA suggest that a second term could reignite efforts to repeal or replace key components, such as the Medicaid expansion or marketplace subsidies. These changes could have significant implications for hospitals and providers, particularly those serving low-income or underserved populations. Any substantial alterations to Medicaid would ripple through the healthcare sector, affecting revenue streams and patient coverage.

Drug pricing reform, a hallmark of Trump’s first term, may resurface with policies aimed at lowering prescription costs. Initiatives like drug importation or international price indexing could challenge pharmaceutical companies but offer savings to consumers and insurers. These proposals, however, often face legal and industry pushback, delaying their implementation. Some indication about the impact on the pharmaceutical industry was exposed by the stock market where pharmaceutical stocks gained value after the election results were known. This doesn’t speak well for the consumer/patient.

Transparency initiatives would likely remain a priority. Trump’s executive orders requiring hospitals and insurers to disclose negotiated rates sought to empower consumers and reduce costs. A second administration could expand such mandates, further pushing the industry toward price transparency. Transparency efforts for both hospitals and insurers seem ineffectual.

Healthcare providers may also encounter more flexibility through continued deregulation. Measures like expanded telehealth reimbursement and reduced reporting requirements, initiated during the COVID-19 pandemic, align with the administration’s market-oriented approach and could become permanent features.

While the Trump administration’s policies often favored cost reduction and deregulation, the industry remains cautious about potential disruptions, especially concerning insurance coverage and funding for safety-net providers. The healthcare sector should prepare for a blend of continuity and renewed regulatory challenges under a second Trump presidency.



By: Jaime Caldwell

The stresses associated with delivering healthcare services during the COVID epidemic brought many issues into focus. While prior to COVID we had been reading periodic articles about burnout in the medical profession, articles after the epidemic waned came fast and furious.

The more recent articles are providing evidence about the toll from COVID and about how the workforce has changed as a result.

In a recent edition of McKinsey & Company’s “Leading Off” and article entitled, “Nurturing employees’ mental health: A leader’s guide” talks about, “Mental health is a key element of well-being in the workplace and an increasingly important area of focus for business leaders.”

The links between anxiety and depression and burnout came to life before our eyes. The linkages are so noteworthy that mental health insurance coverage for many healthcare workers is a critical factor in making a decision to stay in a current job or more to a new one.

“About 3 in 4 Generation Z workers said they prioritize access to mental health resources when choosing an employer,” says Becker’s Hospital Review October 21, 2024. Moreover, potential employees are looking for other mental health benefits like yoga and meditation APP subscriptions.

Clearly we are still recovering from the effects of COVID. When talking about what we need to do to make work situations tolerable, most experts say that change has to come from the top. Management has to articulate “a vision and mission that inspires their employees”.

Leaders will also have to figure out how to make their employees “feel supported, respected, and included”. “Healthcare leaders have also noted emerging priorities as more Gen-Zers enter the workforce. It is important to consider how to accommodate work-life balance while maintaining values and service to patients”.

Meeting the challenges of managing a multigenerational workforce will continue to vex healthcare leaders. Clearly baby-boomers continuing to retire in larger numbers will definitely change the healthcare working environment. Perhaps for the better.



We thought that we knew what the healthcare implications would be in a rematch of Biden/Trump. Well, that comfort level quickly dissolved when we learned that President Biden decided to endorse Kamala Harris as the next President of the United States. In some sense, the slate was clean.

Let us take a minute and look for some hints we might find in the platforms of both national political parties. First, the Republican National Committee (RNC) had their convention in mid-July and their voices were somewhat mute in terms of what we might see from a Republican administration given the reelection of former President Trump.

Borrowing from Paul Keckley, “The RNC healthcare platform boils down to two aims: ‘protecting Medicare’ and ‘granting states oversight of abortion services. Promises to repeal and replace the Affordable Care Act, once the staple of GOP health policy, are long-gone as polls show the majority (even in Red states (like Texas and Florida) favor keeping it.” [Note: Given the reports about some of the findings from the release of the Project 25 report, I am not sure about the “protecting Medicare” part of their platform.]

At the recent Democratic National Convention held in Chicago, I think we saw more of the healthcare veil being lifted in terms of what we will see if we have Democratic majority led by a Harris Administration.

Again, to quote Paul Keckley, “Women’s health and access to abortion, excess profitability by “corporate” drug manufacturers, hospitals and insurers, inadequate price transparency, uneven access and household affordability will be core themes in speeches and ads, with a promise to reverse the Dobb’s ruling by the Supreme Court punctuating every voter outreach”.

Given that I have not fully digested, the implications of what healthcare might look like if some of the Project 25 proposals become law, let us take a few minutes to look at what we can see under a continued Democratic Administration

I think we will see an expansion of eligibility in one of our federal healthcare programs (Medicare, Medicaid) or a shoring up of the Affordable Care Act given that there is more national support for the Affordable Care Act then there was during the Obama Administration.

Given that both Harris and Walz have expressed strong commitments to equity, particularly racial and economic disparities, I suspect that their administration will focus on equity in healthcare. Could this possibly lead to population health on steroids?

I think we might also see more focus on something that has been a growing issue since 2020 (COVID isolation). A Harris/Walz administration might push for greater integration of mental health services into primary care, expanding funding for mental health programs, and addressing the opioid crisis with a public health approach. [Imagine that, a refocus on public health!]

Some of the more obvious areas that might be addressed includes reproductive health and rights; healthcare workforce and infrastructure; pharmaceutical pricing and regulation [expansion of drug price negotiation]; climate change and healthcare [have we not witnessed this summer some growing impacts of global warming]; healthcare innovation and technology [have we forgotten about AI in healthcare?]; and, probably, Veteran’s healthcare improvements.

These next few months leading up to the national general election will be exciting. I think we will see the different party’s positions changing and becoming clearer and I will update this article as those new positions become known.



I just got finished reading an article published in Stat News (www.statnews.com) entitled, “Unnecessary insurance claim denials compromise patient care and provider bottom lines.” At our last Board meeting of the year, we take a moment to review with our Board members what the critical issues for the next year will be. In 2023, our Board suggested that patient access and insurance denials would be those issues in 2024.

I am not writing this article from one perspective. I know that hospitals try their best to produce a “clean claim” in the hopes that these claims will navigate insurer payment systems with little delay. Hospitals and all health care providers are depending on these reimbursements to fund continued operations.

I also know that insurers, representing the interests of their members and wanting to keep those members for the long term, want that process to work in a way that protects the interests of those members by providing the needed due diligence to ensure that, in this world fraught with bad actors, legitimate claims are paid timely.

While there is nothing new about this age old challenge of competing interests, it seems that in this time of increasing use of technology to assist in the both the preparation of these claims and the processing of the claims by insurers, we seem to be getting further off the “rails.” Health care providers are growing increasing frustrated with the numbers and economic impact of these denied claims and many are resorting to more extreme measures to exact payment.

Who wins in this battle, I do not think anyone. The patient does not win as they are now brought into the fray. The provider does not win, as they have to invest more and more resources leading to successful adjudication of the claim. The insurer does not win as they try to explain to their members why the claim for services, which the member received, is not paid. And, certainly the courts don’t win as their docket of cases multiplies.

Let us take a moment and briefly talk about this challenge to the health care system.

In the article mentioned above written by Michael J. Alkire. He surveyed hospitals to get a picture of claims for 2022 and the returned data was weighted by the acute bed capacity of the hospital. I am not attesting to either the accuracy of the method or even the derived results. What is helpful is to see these results as one tool used to help identify the size of the challenge.

In summary, the author suggests that, overall, 15 percent of all claims submitted for payment are denied. He then looks at the type of payer and determines that Medicaid managed care plan have the highest denial rate, followed by Medicare Advantage, Managed Medicaid, Commercial, and, last, Medicare. He also looks at the average dollar threshold above which receiving a denial is more common.

There are also studies that cut similar data in a way that allows the reader to see those denials by insurer. You can look those up and see for yourself as I see the publishing of that information here as counterproductive. What we do see in the growing weight of data is that there is a disconnect between medical providers and insurers that needs to be repaired. Again, no one wins if we continue down this path.

Therefore, we have listened to our Board and we are in the planning stages for a program to be held in early November that looks at this challenge and with the intent that attendees will leave the program with additional tools to put into their toolbox that will move us forward in the discussions between healthcare providers, insured, and insurers. To continue to do what we are doing today is not sustainable and invites federal and state oversight. Those types of political solutions rarely get us to a win-win.