As we enter another new year, healthcare leaders are closely watching trends that are poised to reshape the industry.
Leaders from Red Cell Partners — a McLean, Virginia-based investment and incubation firm that funds, builds, and scales startups in the healthcare and national security industries — shared some trends they are keeping their eyes on this year with MedCity News. Below are three of the most notable trends that these leaders highlighted.
Medicaid will see the largest structural changes since its inception
In 2025, Medicaid will undergo sweeping structural changes — including caps on federal cost sharing and block grants, work requirements for beneficiaries, reduced eligibility flexibility and some waiver programs being at-risk — pointed out Kunal Sethy, an entrepreneur in residence. He leads Sparrow Healthcare, which is a startup incubated by Red Cell.
“These changes will not all be phased in at once and will take time, but they will undoubtedly lead to downward pressure on the overall Medicaid program leading to fewer covered benefits and services and more consumers becoming uninsured,” Sethy said.
At the same time, this will create more opportunities for innovation amongst a variety of stakeholders, including startups, regulators, legacy health plans and health systems, and state governments, he noted.
We’ll see more healthcare organizations using AI agents
Naimish Patel, president of Red Cell’s healthcare practice, identified AI agent adoption as a key trend he is watching this year.
“AI agents are increasingly seen as creating disproportionate value for healthcare businesses as providers look to move beyond their highly manual, inefficient processes and decades-old legacy tech,” he stated.
Patel thinks the use of AI agents will likely increase across the healthcare value stack. These tools can do things like autonomously perform administrative tasks, assist clinicians with clinical decision support and improve providers’ patient engagement.
Some examples of healthcare startups selling AI agents include Suki, Kairo Health and Owkin.
Employers will redefine GLP-1 management frameworks
This year, employers will continue to examine how to best meet employee demand for GLP-1 medications. While small and mid-size employers will primarily weigh their coverage decisions, larger organizations will likely dive deeper and evaluate which utilization management techniques yield the best results, predicted Borislava Marcheva, Red Cell’s head of market engagement.
“We will see more open information sharing among employers, pharmacy benefit managers, navigators and third-party vendors in an effort to manage GLP-1 spend. As a result, some meaningful frameworks could begin to emerge to better define best UM solutions based on employee demographics, prevalence of chronic disease, healthcare consumption patterns and regional healthcare dynamics, among others,” she declared.
Photo: elenabs, Getty Images
