The state of health plans: Key trends and policy impacts in 2025 

The healthcare landscape is evolving at an unprecedented pace, driven by regulatory changes, technological advancements, and market realignments. In our recent webinar, Baker Tilly’s healthcare experts explore the most pressing topics impacting health plans today. Here are five key insights that emerged: 

1. Rapid regulatory changes – Policy updates and administrative actions continue to arrive at a brisk pace, especially in light of the recent passage of the 'One Big Beautiful Bill.'" Organizations need to monitor these changes closely and adjust compliance strategies to remain ahead, especially with the recent passing of the “One Big Beautiful Bill”.  

2. The No Surprises Act – While designed to protect patients from unexpected medical bills, its rollout has been complex. Recent trends in provider independent dispute resolution (“IDR”) arbitration and NSA compliance enforcement highlight the importance of proactive planning and a thorough understanding of evolving requirements. 

3. Interoperability efforts – Seamless data sharing across systems remains a cornerstone goal for healthcare organizations. Greater interoperability promises not only operational efficiency but also better clinical decision-making and improved patient outcomes. Health plans will be required to continue advancement in this space, as the first requirements of the CMS Interoperability and Prior Authorization Final Rule take effect in 2026. 

4. Artificial intelligence (AI) – AI is transforming how healthcare operates, from automating administrative processes to supporting clinical diagnostics. However, organizations must balance innovation with careful oversight to manage potential risks and biases as many states are actively exploring additional AI-related laws and standards, though most have yet to define a clear regulatory path." 

5. Blue Cross Blue Shield settlement – With opt-outs and legal developments coming into effect, many organizations are reassessing payer strategies, preparing financial implications, and exploring new contracting opportunities.