Do Your 2025 Healthcare Predictions Match Up With What an Expert Says?

Mark Masselli (00:04)
What healthcare revolutions are on the horizon in 2025? How will they affect healthcare providers and patients?
Our guest has tried to sort it out with his annual list of top 10 healthcare industry predictions that he shared on
the Forbes website.

Sachin Jain (00:20)
I think we're entering wartime in American healthcare, where we're gonna need to rebuild things from the studs.
And the folks who renovate the house aren't necessarily, going to be the people who built the house.

Margaret Flinter (00:31)
Our guest is Dr. Sachin Jain. He's held top positions at the Centers for Medicare and Medicaid Services and the
Office of the National Coordinator for Health Information Technology. In recent years, he's been a leader in the
private sector and has a unique perspective on the entire field.

Sachin (00:46)
Gone are the days where, you know, your, your doctor was an independent practitioner who had a ton of pride in
his or her job. What you have today now is everyone works for health systems. Everyone feels anonymous. The
health systems are large. The health plans are big, you know, and it's the big battling the big.

Margaret (01:06)
This is conversations on Healthcare.

Mark (01:18)
Well, Dr. Sachin Jain, welcome back to Conversations on Healthcare.

Sachin (01:23)
It's great to be with you. Thanks For having me.

Mark (01:25)
Yeah, and first of all, it's been too long. It's way back in 2018, and then we, were focusing on chronic disease
management, and we know that really remains a concern, but we're gonna broaden our conversation by
discussing your annual list of predictions for healthcare. And, and you write, the crystal ball never fails until Of
course it does. First, how accurate have you been through the years? And maybe tell our listeners, how do you
go about making these predictions?

Sachin (01:55)
I've, I've been very accurate, but I wanna say on the fact that I haven't been on your, your show is that I've been
waiting by my phone and, you know, six, it took six, seven years for us to get back in touch, so I really
appreciate the outreach

Mark (02:09)
Absolutely.

Sachin (02:09)
It's great to be with you and your listeners. So my crystal ball is really the synthesis of everything that I'm
hearing. I've got my ear to the ground. You know, there's a certain amount of things that I'm hearing, certain
amount of things that I'm feeling. And then there's a, a number of inferences that I make every year just based
on trying to connect dots and the pattern recognition of now having worked in this industry, for over two
decades, and, I've been making these predictions now for, I, I don't know, six, seven years. And, you know,
they're probably the thing that I write that gets read the most every year, you know, on average 20, 30, 40,000,
listener, readers. And so, you know, I feel an obligation to try to put out, you know, some predictions that will
provoke people. Sometimes it's wishful thinking. Sometimes it's just kind of a sober state of, of where things
are. Probably the, the prediction that got the most attention this year is the D-I-D-E-I, as we know it, or health
equity as we know it, is going to end. And I think, you know, the early signs are, that I'm, I was correct. You're
seeing this in administration, take aim at DEI and health equity programs pretty aggressively and pretty directly.
And I think, you know, the most benign view of it is that we're gonna see, you know, improvement of healthcare
for everybody. But without kind of specific focus on specific populations. But perhaps the more sobering view
of it is that, you know, a lot of the progress that we've made over the last couple of years in the health equity
arena, is going to be put on pause or, will be set back. Mm-hmm.

Margaret (03:48)
Well, a significant number of those, predictions that you've made focused on what's happening. And
Washington, and we all of course, are paying attention to what's happening in Washington. But number one on
your list, it seems to be that wellness will be front and center. And you say this will occur because of Robert F.
Kennedy Jr's expected role leading HHS. You wrote that here to four fringe ideas about wellness and disease,
causation and medications will continue to go mainstream. So fill us in more on how you see this actually
playing out. It's, it's more than a bully pulpit. You actually have somebody in a position to affect change. And
what do you think might happen?

Sachin (04:27)
I think the American public is, by and large sick of the sick care system. They feel like the system shows up
when they're sick, but does very little to keep them healthy in the first place. And I think you have for the very
first time, a, an HHS secretary who's speaking that language, who's appealing to them in that way. And I think
has some, interesting ideas, to support the health and wellness of people. And then some controversial ideas,
about supporting the health and wellness of people. What I will say is, it's time to put your seatbelt on because
we're in for a ride. I think the FDA is going to be, looked at very closely in terms of what it does, not just on the
medication, the drug side, but also on the food side. And you have a really activist, you know, FDA
administrator appointed in Marty Makary, somebody whose ideas I think are actually pretty smart. And he's
building a, a pretty good team. And so, I think there's gonna be a hard look at the work of the FDA and
potentially a lot of FDA reform. I think the combination of Dr. Oz, and, RFK Junior two words you probably
never thought would be mentioned, in the same sentences, two names that you'd never thought you'd be, you'd
mention together, is gonna be, a dynamic one. I think, you know, Robert F. Kennedy is gonna be focused on
wellness, chronic disease prevention, and chronic disease management. And I think, you know, having someone
like Dr. Oz in the CMS administrator seat, somebody who's written extensively about the need for reform in the
Medicare program, he's been pretty pro Medicare Advantage, I think will be, interesting for the American
public, which is really divided right now between people who are in traditional Medicare, and people who are in
Medicare Advantage. But this program, which in 2010, you know, covered just 25% of Americans, I'm talking
about Medicare Advantage now covers over 50% of Americans. Right? And, but there hasn't been the regulatory
kinda revolution that needed to happen to really administer that program and kind of evolve that program. And
so look for that to happen over the next couple of years as well with, Dr. Oz and that seat.

Mark (06:37)
Alright. So we have an implicit prediction that RFK will be the next HHS secretary?

Sachin (06:44)
Do you think He won't be?

Mark (06:46)
No, I'm just asking. No, no, I'm just, yeah, I, I know there are a lot of people lined up. It sounds like…

Sachin (06:51)
He’s gonna get confirmed this week. If, if he doesn't, I'll eat these words.

Mark (06:57)
That's okay. We got it, we got it on tape. But let, let me just pull up and, pull the thread on that because, you
also predict that some obscure government deputies will matter more. And I, I should note you've been in
government at, at, CMS…

Sachin (07:11)
I've Been obscure go government deputy. I've been an obscure government deputy. I know how much those
people can matter and how much they, they, they don't matter. When you've got strong executives in place.
Look, this is Dr. Oz's first tour of duty at, at CMS. What I've heard consistently though, and and positively is
that he's like learning, learning the job. He is calling former CMS administrators. He's, he's really trying to
understand how to sit in that job and be highly effective in that job. But I think part of what he's heard from
people is really appoint great deputies. And so he's gone to, you know, white House staffers, historic White
House staffers. He is looked at congressional staffers, and he's trying to put together the best team that he can
put together, to really, you know, run the Center for Medicare to run the Center for Medicaid, to run the Centers
for Medicare and Medicaid Innovation. I will say I'm a little worried about the Centers for Medicare and
Medicaid innovation. I think that, it's probably a prime target for Doge, the Department of Government
Efficiency. Yeah. Because it's had a mixed record, $10 billion budget that sell for news every, every 10 years.

Highly politicized agency that hasn't necessarily lived up to the hype and promise. I was part of the founding
team. So I can take some responsibility for it myself. But, but I can say that, you know, this is CMS is gonna
look and operate very differently, in, in 20 26, 27, 28, than it did in 2021 and 22.

Margaret (08:44)
Well, also, while we stay on the federal level, I think this is a quote that you think Medicare Advantage will
make a roaring comeback. I didn't think it ever left, actually. It seems to me it's been kind of a steady, pill. And,
and certainly we've heard the, Medicare administrators talk about the desire to get everybody into a value-based,
plan into a Medicare Advantage or another value-based plan. You lead a nonprofit Medicare Advantage plan,
scan. So knowing it as, as well as you do, what makes you feel bullish about Medicare Advantage? What do
you, how, what's gonna take it this next distance?

Sachin (09:21)
Well, the last couple years have been hard for the industry. I would say the, the new risk model, you know,
what, everyone in the industry calls V 28, you know, kind of was an effective rate cut to the industry. So I think,
you know, plans were forced to do more with less, the star rating system, has become, you know, more and
more challenging and harder and harder to achieve high star ratings. And you're starting to see, you know, some
of the flaws with the star rating systems, with all the lawsuits that have followed scan's, lawsuit against, you
know, the Biden administration, for its use of, of, you know, cut points that seemed, out of line with what had
been published in the regulation. And so I think, you know, most people who have worked in Medicare
Advantage would say that the last couple of years have been years where we've been forced to imagine doing
more with less. And, you know, the, the curve that you're talking about, that kind of steady upward curve had
actually flattened a little bit the last couple of years. And I would say, you know, what's, what's now happening
is I think you now have a CMS administrator who is on record, who is on record as having said that, he thinks
all Medicare beneficiaries should be in a Medicare Advantage plan. I don't think we're gonna get all the way
there. To be clear, I think, you know, traditional Medicare is still very popular for those people who can afford
it. But I will say that Medicare Advantage is gonna become more and more mainstream. It's going to get, I think
some of the, you know, kind of regulatory changes that made it harder and harder to perform in Medicare
Advantage may get rolled back or slowed down. And I think for that reason, this industry is going to see even
more growth in the next couple of years than it did the last, last few.

Mark (10:59)
You don't think it would be DOGE’d in any way here, just because of its cost between the regular plan?

Sachin (11:05)
I think Medicaid is going to get DOGE’d a bit. I don't, I think Medicare is not going to get DOGE’d. Do I think
that there's gonna be some fixes because of, you know, the, the shift, the, the differences in costs? I think there
may be, but I would say, you know, on the margins, this is an administration that's gonna try to see more and
more people in Medicare Advantage, and they know what it takes to do that, which is, you've gotta make those
plans more generous. And the truth is, Medicare Advantage is, is a better deal for low income Americans. And
we forget that. I think a lot of the academics who kind of have taken an aim at, at Medicare Advantage have not
looked sufficiently at traditional Medicare, which in 2025 is a bad program. It doesn't cover dental, it doesn't
cover vision, it doesn't cover audiology. It leaves people with very high copays. It forces them to pay very high
premiums, both for part B as well as for Part D as well as for supplemental policies. You know, a, a couple, a
husband and wife can be out of pocket for over a thousand dollars a month and extra premiums in, you know,
traditional Medicare. Whereas Medicare Advantage, Southern California, there are many zero premium plans.
Sure. After people have paid their part B premiums.

Mark (12:18)
You sound a little like Bernie Sanders on dental's not covered, vision's not covered. So, but maybe from a
different perspective of where it should be covered.

Sachin (12:27)
No one's, no one's ever said, I sound like Bernie Sanders reflect on how I feel about that.

Mark (12:32)
Tell me this, you know, you talked a little bit about Medicaid in terms of it being DOGE’d. What, what, what's,
again, it has far more, members than Medicare does. It's grown over the years. Where, where do you particularly

see, a focus in terms of cutting it back on the FMAP program? Or where, where, where do you, what's the broad
array of changes you might, see in the Medicaid program?

Sachin (13:02)
Look, I think you're gonna, you're gonna see no new states adopt Medicaid. So Medicaid expansion is gonna hit,
you know, a full pause or a halt. I think you might even see some states pull back their Medicaid plans. I think
you're gonna see work requirements introduced in almost every, red state in the country. And I think you're
gonna see, you know, make it, you're gonna see the administration make it harder and harder for people to
access these benefits, particularly targeting, you know, undocumented and immigrant populations, which, you
know, have been accessing Medicaid in some states. And so I think you're gonna see a, a major, major rollback
of the Medicaid program, which I think is, is gonna be difficult to watch for, for many of us who I think have
fought a good portion of our careers to get people universal coverage. Right. If, if we're cutting it, you know, in
service of trying to get people coverage of another format, I think that's gonna be great. But I'm, I'm not
optimistic that that's an area of focus for this administration.

Margaret (14:02)
Well, one of President Trump's, first moves, and you've alluded to this, was to kind of fire the diversity, equity
and inclusion officials throughout, federal government. And, and you've, written, I think I noted that the health
equity field will end as we know it. But, what follows what we know? Do you have a sense of what will replace
it? Because the data is unlikely to change just because we stop the officials with the titles. We know that we
have huge issues of health equity in the country. I'm sure you see it in your own plan, and respond accordingly.
So what will, what will replace it, even if we're not calling it what we did a year ago or six years ago?

Sachin (14:42)
Look, let me be clear. I think, you know, those of us who've been focused on trying to right these wrongs and to
address, you know, huge disparities in populations are gonna continue to do so, right? Scan health plan is going
to continue to do so. But I do think the federal efforts around this are gonna, you know, be, are gonna hit pause.
And you know, I, I think there were a number of different health equity initiatives that were launched. There's a
health equity index that's being built into the Stars program. And I think those are areas that we gotta watch
really closely as an industry and see, you know, are they gonna go away? My, my suspicion, my strong
suspicion is they're gonna go away. I think the work is going to really sit with the private sector now, and you're
gonna see that there's gonna be organizations who are gonna lean into continuing this work. You're gonna also
see organizations that are gonna press pause, they're gonna fire their diversity officers in the next round of
layoffs. So I think there's gonna be a, a lot of change here. Yeah. But as a, but I, but I will say, I will say, I think
there, there's a lot of resentment about how this agenda was pursued over the last couple of years, in part
because it almost felt like the agenda was pursued singularly as opposed to, you know, a, a broader focus on re-
imagining like the whole Medicare program or, you know, all of healthcare, which is broken for everyone. And
so I do think that those of us who care about this need to take note, and we need to actually balance our
messaging, which is that, you know, we are gonna focus on improving health equity, we're gonna, but we're also
gonna be focusing on improving the system for everyone. And I think that that's a more winning message. And
that's, I think, the message that the American public needs to hear, in this time where this country is as divided
as it is.

Mark (16:23)
Dr. Jain, you think misinformation is gonna get much worse. I'm wondering if you could explain why you think
it will get worse. I don't know how it could get worse, but, and also, you've also been thinking about ideas to fix
the problem.

Sachin (16:37)
Look, I think, you know, most of us these days are digging holes and jumping into them because we don't know
what, what information to process, and what, and so we're just avoiding information altogether, is what I'm
seeing a number of people do. They're tuning out of, both alternative forms of media as well as mainstream
media. Because, you know, the more you know a topic, the more you realize how misinformed, you know,
people are, and how much misinformation actually really spreads. Look, I think the work really sits on the
shoulders of society to number one, regulated itself, the tech companies to give society to regulate, you know,
the information that is spread. And then I think it's also just important for us to become better consumers of
information. I think when I was in elementary school, we had intensive education on like the sources of
information and the quality of sources. And we were trained on how to scrutinize the quality of evidence and the
quality of sources. And I think for whatever reason, that's been beaten out of our, our education. And I think
people have forgotten that not all sources of information are created equal. And I think that there's, there's this

egalitarian ideal around information, which is like, everyone's opinion matters equally. And I think everyone's
opinion and experience matters, but I think, you know, expertise also matters. And I think what we've
experienced is almost the end of expertise the last five years, in part because people feel betrayed by experts
who maybe were too definitive at different points in conveying, you know, firm opinions where they should
have conveyed doubt or hypothesis. And we saw that play out in Covid where everyone became a covid pundit,
and was very definitive very quickly, when in fact, you know, this was an evolving field. And, you know, for a
guy who talks a lot, I kept my mouth shut, most of the pandemic because I wasn't close to it and didn't know
enough about it. I'm not an epidemiologist, but lots of people who are not epidemiologists started speaking up.
And the American public actually listen to those people sometimes to their own detriment. And so, again, I think
we, we have to work on restoring trust. And I think it starts with all of us becoming better communicators and
more nuanced communicators. And I, and I think, you know, many times we, we've disrespected people's
capacity to absorb nuance and uncertainty, and we've actually conveyed things with more certainty than we
should. And I think we have to actually train people to think in terms of probabilities and uncertainties and
possibilities, as opposed to, you know, living in a world where there's black and white. And I think
unfortunately, that's at the heart of a lot of misinformation is people's desire to live in black and white.

Mark (19:20)
Well, I think that's gonna come into, into play now as we hear more about bird flu happening and we're at that
early stage and people are framing up, you know, what they think it is or, what impact it might have. But any
thoughts about, the implications there as we may be, you know, pre pandemic, one hopes there's never a
pandemic, but I think we've heard from all the experts, they happen every 20 years or so. What, what's your
sense there in terms of what people should be doing and discerning information about what's happening in that
world?

Sachin (19:53)
Look, I think, even, even as we get better information, I think people's capacity to hear it right now is
compromised. And, I think we're in for, this is gonna be one of these situations where things are gonna get
worse before they get better. People are gonna get burned because of misinformation and because of myth.
People did get burned because of misinformation. But people forget that lots of people died early in the covid
pandemic, like died of covid, you know, wasn't, they didn't die of the vaccination. Like, you know, the, the, you
know, that, you know, and the way that people are talking about today, people died of Covid. And so again, I
think a lot of times things are gonna get worse before they get better. And I don't think that there's any clear,
easy answer, unfortunately to the, to the misinformation wards right now, because people realize that
misinformation is power. We used to say information is power. And now I think misinformation is power, and
we've gotta move beyond, that world. And I think we're, we're gonna have to go back to a world where, we have
some confidence and expertise and authority. 'cause, you know, Joe Public is not trained to necessarily inform
us about what the treatments are and what a double blind, you know, controlled, trial is. And why, you know, an
observational study is, is inferior to a double, double-blind, you know, placebo-controlled study. So again, I
think that, you know, the, this is maybe a hard learn lesson for the American public, but you know, I think we're
destined to learn those hard lessons the hard way.

Margaret (21:26)
Well, Dr. Jain, you, continue with your, predictions. Obviously, we've seen a lot of turnover in the top, federal
elected official positions, and we're gonna see a lot more in the appointed people, but you've also predicted that
there's gonna be a considerable turnover in the top corporate jobs, I assume, in healthcare you were referencing,
as well as the return to big corporate transactions. I'm really curious, what, what do you see happening at the
leadership level in organizations like your own, in these large health systems, large, privatized health systems
that we have all over the country? What's this next generation of leadership, going to be like, do you think? And
how will it change things?

Sachin (22:05)
Well, what I would say is, I, I think we're in a period right now where things are really hard. It is not easy to run
a health system. Things are not always up and to the right, it's not easy to run a managed care plan right now.
And I think when the going gets tough, you know, organizations sometimes need different kinds of leaders. I, I,
I talk about the notion of wartime leaders versus peacetime leaders. And I think we're entering wartime in
American healthcare, where we're gonna need to rebuild things from the studs. And the folks who renovate the
house aren't necessarily, going to be the people who built the house. Because you need a fresh pair of eyes on
just about everything in order to really, you know, reimagine things. And I think you saw this after Brian
Thompson's murder. I mean, this, this, you know, cold-hearted, unforgivable murder, was received with a lot of
corporate platitudes, from an industry that should have been saying more, and should be saying, you know,

we're sorry and we can do better. Not that anything about that murder was excusable, but you know, the, the
aftermath was that, you know, we have an American public that is sick and tired of the broken status quo of
American healthcare, and it's this last generation of leaders, who got us here. And I think it's gonna be a next
generation of leaders who's going to pull us out of it. And I do think that leadership matters. I think, you know, a
number of people will say to me, you know, you overestimate the importance of leadership. It's all about the
incentives. It's about, you know, what shareholders want, and it's about what boards want. But the truth is, is that
there are things we can be doing today to make things better that we have just normalized. We've normalized the
abnormal in American healthcare, and I think we have an opportunity to take a fresh look at how we do
utilization management, how we deny claims, how we price services, how we actually represent those prices to
consumers, how we treat people when they walk through our doors. All of those things are changeable without
acts of, you know, congress. They're all changeable just through lead better leadership. And you see it in
organizations that are well run, and then organizations that treat people, like they're not people.

Mark (24:09)
Well, let, let's, let's pull the thread on, on the private sector and what's happening there. You highlight, states
like, Oregon and California who've put in a place some healthcare transaction review boards to regulate the role
of private equity in healthcare. And you think this kind of scrutiny will, will continue, it's gotten pretty bad. You
can see whether it's, there, there are a whole number of, of, of folks that have been, in the, eye of the FTC and
others and state regulators across the country. Tell us a little more about what type of scrutiny, we might see,
going forward.

Sachin (24:49)
Look, our federal regulators were asleep at the wheel for the last two decades or three decades as big healthcare
got bigger and small healthcare kind of evaporated. Gone are the days where, you know, your, your doctor was
an independent practitioner who had a ton of pride in his or her job. What you have today now is everyone
works for health systems. Everyone feels anonymous. The health systems are large, the health plans are big, you
know, and it's the big battling the big. And the truth is, is that it's gotten too big and, you know, the patients are
less happy. The people who work in healthcare are less happy and the prices are higher. There's literally no
evidence that, you know, the consolidation that we've experienced over the last two decades, which was
supposed to create administrative efficiencies, which was supposed to drive quality improvement, actually
improved anything. And so, you know, the FTC has gotta look at itself. All of the organ, all the bodies that
regulate healthcare need to look at themselves and say, Hey, this thing that we enable, this thing that we
supported, this thing that we let happen unfettered, you know, maybe wasn't the right thing. And maybe we need
to think about breaking up health systems or breaking up large con conglomerates. And again, I think some
decisions will be made that aren't going to be in the best interest of patients. I do think we should probably see,
you know, you know, it's gonna be a, a market-by-market situation by situation judgment that needs to be made.
But right now, you know, there's been, you know, there's too much quote unquote big healthcare right now. And
I think we need to take a hard look at it and think about how do we create healthcare that feels smaller to people,
and more personal and more intimate and is delivered in a higher quality way. Quality.

Margaret (26:32)
Well, I have to, I, I can't resist following that, up with a question about what one might call public-private,
systems. And I'm thinking of veteran affairs public, and I'm thinking of the community health center movement,
you might think is public, private, a lot of, federal rules most skewed to the benefit of, low income and special
populations, but all private organizations. What's the place in this landscape for those kinds of organizations to
do what you're talking about, to make care personal even though they're wrapped within a strong structure that
really tries to skew towards access and quality?

Sachin (27:11)
Look, I think some of those organizations do an incredible job. I'm a VA doctor, and I can tell you create,
provides a highly integrated experience to our veterans, and has gotten dramatically better over the last couple
of decades. Right, right. And, and I think that there's lots of lessons that we can learn from those types of
models. That said, I think, you know, you'd have to be very countercultural. You'd have to kind of build some
regulatory relief for, you know, people who did want to, go, you know, put the genie back in the bottle, and
support private practice in, in a different way. You know, I, I work with a number of different, you know,
startup companies. And the ones that I think are most exciting are the ones that are focused on, you know,
physician autonomy and restoring you, you know, kind of a sense of pride and capability to private practice
physicians, in the context of quote unquote big healthcare. And you know, I think that that's where we need to,
you know, enable people more.

Mark (28:09)
You know, I wanna talk a little bit about joy and confidence. How do we bring back joy to the people who are
working in healthcare and how do we bring back confidence by the public in our healthcare system?

Sachin (28:20)
Well, it's not through more chief wellness officers. It's not through, you know, more yoga classes for the people
who work in healthcare. It's not through, you know, providing people with access to the Headspace app, even if
the Headspace app is a good app. It's, it's through actually making the work better. And I think that that's where
we've lost focus, is you gotta make the work better. You gotta make it easier to be a doctor or a nurse in
American healthcare today. And I'll include pharmacists in that too. Walk into, you know, your average retail
pharmacist, pharmacy chain pharmacy, the lines are incredibly long. The experience is terrible. The people are
harried, and they are doing the very best that they can walk into any emergency room today. You know, people
don't, are not powered to do the work that they need to do. They don't have the equipment, they don't have the
tools, they don't have the solutions. I think there's gonna be some relief through some of the ambient
documentation tools that have been developed. You know, the bridges of the world that will make it easier for
people to document and take some of the, you know, least rewarding work out of being a doctor. But I think,
you know, the, the reality is, is that a lot of re-engineering of the work needs to happen. And there's right now
people are buried in administrivia and, you know, that administrivia comes both from the health systems as well
as the health plans.

Margaret (29:44)
Well, I think this is a good note to wrap up on for today, but I think we'll have you back on the show as we
move forward into this new future that's ahead of us.

Sachin (29:52)
You've said that before, Margaret. You've said that before, So I,

Margaret (29:55)
I know. Gonna do it, gonna to do it sooner.

Sachin (29:56)
This time I'm not gonna be sitting on my phone, okay?

Margaret (30:01)
Yeah. But I'll, I'll know, I'll know how to find you.

Sachin (30:03)
Alright.

Margaret (30:04)
So thank you Dr. Jain for joining us and thanks to our audience for being here. Just a reminder, be sure to
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