Trilliant Health, a leading analytics and market research firm specializing in healthcare economics, has released its 2025 Trends Shaping the Health Economy Report, offering a comprehensive analysis of six major forces that are expected to define the direction and challenges of the U.S. healthcare system over the coming decade.
The report provides a data-rich, unflinching look at a system in crisis — one that consumes more economic resources than any other sector while delivering less favorable health outcomes compared to other developed nations. As U.S. health spending continues to outpace the overall economy, the report highlights that healthcare expenditures are projected to reach 20.3% of GDP by 2033 — a milestone that underscores a system increasingly burdened by inefficiency and unsustainable costs.
“The reputation of the U.S. healthcare system precedes itself — it is expensive, complex, and inefficient,” said Dr. Allison Oakes, Chief Research Officer at Trilliant Health. “Understanding why begins with the recognition that, regardless of tax status, the system is fundamentally a collection of profit-seeking businesses treating illness, rather than a comprehensive approach to promoting health.”
Dr. Oakes emphasized that this reality — “no margin, no mission” — captures how market dynamics have shaped healthcare delivery, often at the expense of value, equity, and prevention.
The 2025 Health Economy Report, supported by more than 90 data stories, is organized around six key trends that, together, paint a portrait of a fragmented system struggling to adapt to economic, demographic, and technological pressures.
1. Price Sensitivity and Affordability Concerns Are Reshaping Demand
Trilliant’s analysis shows that medical prices have risen by 54.5% since 2009, far outpacing inflation across most other sectors. This steep growth has placed enormous pressure on both patients and employers, driving heightened sensitivity to costs and growing concerns about affordability.
One of the most striking findings in the report is the staggering variation in healthcare pricing. Across the United States, commercially negotiated rates for identical inpatient procedures can differ by an average of 8.5 times, depending on location (p. 18). Even within the same hospital, prices can vary up to sevenfold depending on the payer (p. 19).
These discrepancies, the report argues, are not only evidence of inefficiency but also highlight the lack of price transparency and accountability that has allowed the cost of care to spiral beyond the reach of many consumers.
2. Stakeholders Are Slow to Adapt to Changing Demographics and Lifestyles
Despite the U.S. spending far more on healthcare than peer nations, Americans live shorter lives and spend more years in poor health. The report attributes part of this decline to demographic and lifestyle changes that have been met with slow institutional response.
Mortality rates among adults aged 18 to 44 are rising, while fertility rates continue to fall. This demographic shift not only signals broader social challenges but also poses a serious economic threat, as the proportion of Americans with employer-sponsored insurance — a key financial pillar of the U.S. healthcare system — continues to shrink.
Trilliant warns that without major reforms to improve population health and adapt to these demographic realities, the system’s cost structure will become even more untenable.
3. The Delivery System Rewards Specialty Intervention Over Primary Prevention
A central theme of the report is the misalignment of financial incentives within the U.S. healthcare system. The analysis finds that high-margin specialty services continue to receive far greater emphasis than primary or preventive care, even as population health metrics decline.
In 2024, behavioral health visits rose 11.4% year-over-year, while primary care visits dropped 5.6% — marking the first time behavioral health utilization surpassed primary care (p. 43).
Trilliant links this trend to a larger systemic issue: declining health outcomes such as rising chronic disease rates and late-stage cancer diagnoses. As the report notes, “The system rewards intervention over prevention — treating disease after onset rather than investing in upstream solutions that keep people healthy.”
4. Fraud, Waste, and Abuse Remain Pervasive
Trilliant’s report also calls attention to the persistent problem of inefficiency and manipulation within the U.S. healthcare payment structure.
Between 2018 and 2024, the share of high-complexity emergency department (ED) visits surged from 36.6% to 47.8% — a trend that the report attributes partly to upcoding, the practice of billing for more complex (and higher-paying) services than actually delivered (p. 57).
The report also points to vertical integration as a growing concern. For example, UnitedHealthcare frequently pays its subsidiary Optum higher rates than competing providers, distorting market dynamics (p. 58).
Additionally, Trilliant highlights the lack of cost-effectiveness standards in the U.S. drug approval process. More than 75% of FDA-approved drugs are not recommended by the UK’s National Institute for Health and Care Excellence (NICE), which emphasizes cost-effectiveness in its evaluations (p. 70).
5. The Shift Toward Alternative Care Settings and Therapies Is Accelerating
Healthcare delivery continues to migrate away from hospitals and toward ambulatory surgery centers (ASCs), retail clinics, and home-based care models. In 2024, ASCs performed more than half (50.8%) of all ASC-eligible surgeries (p. 79), demonstrating how care is increasingly shifting toward lower-cost, higher-efficiency environments.
At the same time, pharmaceutical innovation is disrupting traditional procedure-based care. Utilization of GLP-1 therapies — medications initially developed for diabetes but now widely prescribed for obesity — increased an extraordinary 744.6% between 2018 and 2023. In contrast, bariatric surgery volumes remained stagnant or declined, illustrating how new drug classes are replacing invasive, high-cost procedures (p. 86).
This trend reflects both the adaptability and fragility of the U.S. healthcare economy: while innovation offers new therapeutic options, it also threatens established revenue models.
6. Government May Step In if the Industry Fails to Deliver Value
Trilliant concludes that the U.S. healthcare system faces mounting pressure for structural reform. If private-sector stakeholders fail to deliver measurable value improvements, the government may be compelled to act — potentially through price controls or more aggressive regulation.
The report points to the Medicare Shared Savings Program (MSSP) as a cautionary example. Despite its intentions to reduce costs, the program’s savings equaled less than 1% of total Medicare spending (p. 101), underscoring how modest reforms have failed to “bend the cost curve.”
As federal debt surpasses $37 trillion and cost inequities persist, political appetite for sweeping healthcare reform is growing. Trilliant suggests that government intervention could soon move from discussion to action.
A Call to Action for Industry Leaders
“Everybody says they ‘know’ about these problems,” Dr. Oakes observed, “but the lack of action by industry stakeholders has allowed them to persist.”
According to Oakes, the U.S. healthcare system now stands at a crossroads: either stakeholders must lead transformational change from within, or they will be forced to adapt to changes imposed from outside.
The report urges payers, providers, and policymakers to confront the structural inefficiencies driving costs upward and outcomes downward. Meaningful reform, Trilliant argues, requires collaboration, transparency, and a willingness to challenge the entrenched incentives that have long shaped the system.
Conclusion: A System Under Pressure
Trilliant Health’s 2025 Trends Shaping the Health Economy Report delivers a stark message: the U.S. healthcare system, already consuming one-fifth of the nation’s GDP, is approaching a breaking point.
Its six identified forces — rising prices, demographic challenges, misaligned incentives, pervasive inefficiencies, emerging care models, and government scrutiny — together form a call for urgent structural transformation.
If the healthcare industry fails to adapt proactively, Trilliant warns, the transformation will not come from within — it will be mandated from above.
For an industry known for its resilience and innovation, the question is no longer whether change will come, but who will lead it.
