2025, The Year of the Wood Snake: 7 Unconventional Healthcare Predictions

Transformation, wisdom, calculated risk

Dec 31, 2024

Happy New Year from The Surgeon’s Record!

As the Year of the Wood Snake approaches — a symbol of transformation, wisdom, and calculated risk — health care is poised for its own upheaval. Forget recycled trends and safe bets. The following predictions aim to challenge, provoke, and inspire action in 2025.

Next year’s evolving landscape will reflect a ground level change in how we view health care innovation. These forecasts are rooted in my own experiences from the frontlines of musculoskeletal care, my work with startups, and my ongoing journey through the wilds of clinical care and health care policy/economics.

How will health care evolve in 2025? The only certainty is that the old narratives won’t hold. It’s time to embrace new ideas and novel ways of thinking.

To Unionize or Not To Unionize

Prediction: Physician unionization proves itself to be more sound than fury.

With 80% of physicians in some type of employment arrangement and levels of burnout and dissatisfaction high, something has to give. Unionization is a natural reaction to the current state of frontline care delivery. Employed physicians may feel their options are limited despite continued efforts to engage administrators. That doctors have been pushed to this point speaks volumes.

Will physician unions will ever be widespread enough, powerful enough, or cohesive enough to affect high level systemic change? Is it the best option? Unionization provides a sense of empowerment, but independence and autonomy provide actual power. Which one will physicians choose? I’m betting on the latter, and a move away from employment. The pendulum is set to swing back towards practice models that support independent clinicians — MSOs with strong physician leadership, direct primary care, and micropractices. In my mind, these are better solutions than unionization.

[Editor’s Note: This prediction is already aging poorly. As I publish this post, physicians in the Pacific Northwest announced a strike effective January 10th — a situation that bears close monitoring.]

Feeling Special

Prediction: Care delivery innovation pivots from primary care to specialty care.

Big Retail’s attempts at care delivery — specifically primary care delivery — have been a failure. CVS is rumored to be shopping Oak Street Health. Walgreens’s massive bets on VillageMD and Caresyntax came up craps, and the company may be taken private. The One Medical brand continues to expand through Amazon’s online offerings (but is not without its controversies). As has been pointed out over and again, the economics of primary care make it a difficult entry point.

Does that mean care delivery innovation is a path to nowhere? I don’t think so. It’s not that care models don’t beg for innovation; it’s that the focus should be elsewhere. Specialty care is expensive and complex with high variability in cost and quality. Therein lie the opportunities: shifting sites of service, developing population level and condition-specific treatment pathways, and aggregating narrow, high-quality networks.

The specialty care innovation movement is well underway. Maven Clinic, a women’s and family health company, announced a $125 million Series F round in October. That same month, Oshi Health raised $60 million in Series C funding to bridge the gap between virtual and in person GI care. (Disclosure: I recently made a small investment in Oshi through an SPV.) Value-based cancer-care company Thyme Care closed a $95 million Series C in July. In November, Commons Clinic continued its year of impressive growth by adding well-established Long Beach Lakewood Orthopedic Institute to its network. The common thread here? Embracing a hybrid specialty care model.

Trust Me

Prediction: Instead of sowing distrust and hyping AI, smart innovators will highlight physicians and elevate the doctor-patient relationship.

Marc Andreessen’s infamous tweet about trust in doctors "going to zero" sparked a storm in 2024. But the backlash exposed a counter-narrative: people actually want to trust their doctors. In 2025, look for a subtle but significant reversal. Smart health care companies will use "physician trust" as a brand strategy. Patients will seek out human connection in an increasingly impersonal health care system. Clinicians who make themselves visible as thoughtful, transparent, and credible figures will emerge as health care innovation’s secret sauce.

Silicon Valley technocrats and VCs are enamored of the idea that AI will outperform and replace doctors. Some gleefully opine that physicians should be fearful of their job security. As much as I love technology and am excited about AI’s potential, these opinions betray a glaring lack of understanding of how health care is delivered. Enthusiasts would do well to inform themselves by spending time in health care settings. Innovative care redesign puts physicians back at the center, using technology not to replace them but to enhance their ability to connect with patients.

Instead of sitting by idly, doctors will demand a seat at the table — not just as clinicians but as change agents. I see a growing community of "clinical operators," doctors leading health tech ventures, designing care models, and driving reimbursement reform. We don’t know it all and we can’t do it alone, but we’ve seen what happens when doctors (and patients) are pushed to the fringes, discounted, or treated as figureheads. The top of our licenses are not the end of our abilities. Trust remains a valuable currency in health care, and doctors are its most effective purveyors.

Senseless

Prediction: Brian Thompson’s murder will not lead to the hoped for referendum on our care delivery system.

The murder of United Healthcare CEO Brian Thompson became a symbol of health care dysfunction. As with any shocking event that provokes a strong societal reaction, we hope the result is change. The outrage fueled by this episode spotlighted predatory insurance practices, giving the public hope for reform.

Not to be too cynical, but I fear Thompson’s murder will become a character study of Luigi Mangione, not a referendum on the broken insurance system. Mangione is a young, good looking, valedictorian and Ivy Leaguer that comes from a wealthy family. He’s ready-made for the 24-hour news cycle that thrives on spectacle and human-interest stories. Mangione is becoming a folk hero of sorts, and his court appearances are already attracting flocks of supporters.

For their part, the playbook for United and other health insurance companies is to close ranks, increase security, offer platitudes, and let the angst and anger blow over. There’s little incentive to change and few credible threats to the existing model. We might get some political grandstanding, but how often does that lead to any meaningful action? We shouldn’t allow these moments to pass with distraction instead of accountability. While systemic change may seem elusive, this tragedy should remind us of the urgency to find viable solutions. What will it take for a broken system to change? If not now, when?

Spotlight

Prediction: Health care discourse enters a new phase that’s more raw, earnest, and focused on real problems and solutions.

There’s no shortage of discussions on health care and its problems. But to be honest, the discourse has gotten stale. We’ve reached narrative and echo chamber saturation — each camp recycling its talking points. Health care will benefit from deeper, more nuanced discourse — especially from alternative sources (blogs, podcasts, smaller social media platforms) and big-name influencers with large audiences.

I appreciate Mark Cuban’s efforts here. Yes, Mark has an agenda, pushing his Cost Plus Drug Company, in particular. But at least he’s shown the initiative to educate himself and develop a deeper understanding of the problems he’s trying to solve. Scott Galloway’s takes may lack depth at times, but his ability to draw attention to critical issues should not be underestimated. His engagement has the potential to amplify the voices of deeper thinkers in the field. Finally, I appreciate Tim Cook’s sentiments and Apple’s efforts, but the discourse would benefit from Big Tech and Big Retailers focusing more on substance and less on public relations.

Whatever you think about the current and future state of American politics and the health care regulatory environment, a shift in policy discourse seems likely. A fresh, but educated and well-reasoned perspective on how to approach our problems is welcome. Next year, instead of recycling the talking points, let’s educate ourselves, go a little deeper, and have more fruitful conversations.

Bone Chill

Prediction: Shifting musculoskeletal care economics will force hospitals, health systems, and surgeons to re-evaluate their approaches.

Musculoskeletal care has been a focal point of innovation across the health care spectrum, with VC-backed MSK startups, PE platform rollups, governmental VBC programs, site-of-service shifts, and more. Orthopedics is lucrative, but economics are shifting. The migration of highly reimbursed surgeries like spine fusions and joint replacements to the outpatient setting has affected hospitals’ bottom line. Similarly, downward pressure on ancillary reimbursement (PT, MRI) has negatively impacted downstream revenue generation. Orthopedics may not be the economic darling it once was.

With outpatient MSK care approaching equilibrium and verticalization less financially attractive, what comes next? We may see the long-threatened movement to drop Medicare finally gain steam. Concierge-level MSK care will be tested in markets large enough to support it. Innovative, forward-thinking surgeons will make their own path forward — through supergroups, doc-friendly MSOs, and continued advocacy efforts. Smart docs will embrace novel care models instead of running away from them.

Orthopedic surgeons are no strangers to the VBC movement — in fact, MSK has been the proverbial “tip of the spear.” The problem? Traditional VBC programs have proven unsustainable. CMS will keep trying. Mandatory PROMs reporting rolled out this year and TEAM arrives in 2026. Disdain for VBC will not prevent expansion of these programs. Mandatory participation is coming for us, too. Surgeons would do well to understand this future, embrace it, and actively work to shape it. Direct care, direct contracting, global subcapitation, and condition-specific bundled payments are no longer the future. They’re the present.

Peek and Shriek

Prediction: Anticipated health tech IPOs provide an uneven glimpse into the business model and unit economics of virtual chronic care delivery.

Two mature, OG digital health unicorns, Hinge Health and Omada Health, are expected to pursue initial public offerings next year. Hinge last raised money in October 2021, a staggering $600 million at a valuation of more than $6 billion. (Total investment in the company is now more than $1 billion.) Meanwhile, Omada raised a $192 million Series E round in February 2022 at a valuation of ~$1 billion. (Hinge Health is a pure MSK play while Omada offers diabetes care, blood pressure management, weight loss, and chronic MSK care.)

While there’s certainly a place for virtual chronic care platforms, how much of a place is uncertain. Companies love to tout growth and customer acquisition — but how does that translate to clinical and fiscal impact? Two Peterson Health Technology Institute reports paint a mixed picture of digital chronic care platforms. Findings were unflattering for diabetes management platforms (increased spending without meaningful benefits), but more favorable towards virtual MSK solutions (improved outcomes, lower costs).

Of course, markets care more about financial metrics than clinical outcomes. My guess: IPO-fueled belt-tightening has improved fundamentals but can’t hide potential flaws in core business models. Furthermore, questions about adherence, program completion, clinical impact, and financial ROI remain. Both companies last raised money during the ZIRP-fueled feeding frenzy when valuations were divorced from reality. S-1s will tell us a lot more than press releases, VC pumping, fuzzy engagement metrics, and surface-level white papers. Another guess: the impact of virtual chronic care is higher when tied to clinician-led models and in-person care (see above).

A Personal Prediction

Prediction: 2025 will be a seminal year of growth and evolution for The Surgeon’s Record and for me as EIC and Senior Clinical Fellow.

I’m excited for 2025 personally and professionally. Health care’s challenges aren’t going anywhere, but those challenges will continue to create opportunities. Next year, I’m focusing on not just talking the talk but doing more of walking the walk. Elevating the discourse remains an important part of the mission. Meaningful action is the North Star.

Transformation. Wisdom. Calculated risk.

Before we put the cap on 2024, I’d like to thank our readers, many of whom have reached out privately to share words of encouragement, thoughts, and feedback. As anyone with a blog will tell you, it’s not always easy to gauge impact. At times, publishing a piece can feel like shouting into the void. Hearing from readers is rewarding, and importantly, confirms that this work matters.

Finally, a personal thanks to Derek Flanzraich for his guidance and feedback. Derek’s influence has made me a better writer, and without him, The Surgeon’s Record would not be where it is today. We here at TSR wish Derek the best of luck as he pursues other endeavors (and leaves us in Dani Calvo’s capable hands!). Onward and upward, Derek!