Ep 33 | Year in Review: The Healthcare Shifts That Defined 2025 and What’s Ahead in 2026

In this year-end episode of the Only Healthcare Podcast, hosts Randy Vogenberg and Michael Navin reflect on the defining healthcare shifts of 2025 and share what they are watching as the industry moves into 2026 and beyond.

The conversation looks back at the rise of consumer-driven healthcare, expanding price transparency requirements, and the growing pressure on affordability across both medical and pharmacy benefits. Randy and Michael discuss the continued disruption driven by GLP-1 utilization and pricing, emerging direct-to-consumer strategies from manufacturers, and why real change is finally starting to take hold after years of talk.

They also examine the growing role of litigation around ERISA plans, rebates, and fiduciary responsibility, along with increasing employer concern over employee loyalty, recruitment, and retention tied directly to healthcare benefits. Looking ahead, the episode explores trends toward self-funded plans, greater scrutiny of health plans and hospitals, cash-pay and consumer-controlled models, and long-term challenges facing Medicare as demographics and utilization shift.

The episode closes with a forward-looking perspective on economic uncertainty, workforce changes, and why healthcare transformation is likely to accelerate through 2026 and into 2027.

Key Topics Discussed

• The biggest healthcare shifts and controversies of 2025
 • Consumer-driven healthcare and price transparency momentum
 • GLP-1 utilization, affordability, and direct-to-patient pricing
 • Litigation targeting ERISA plans, rebates, and fiduciary duties
 • Employer health benefits, employee loyalty, and workforce pressure
 • Growth of self-funded employer plans and ERISA implications
 • Cash-pay models, HSAs, and consumer-controlled healthcare decisions
 • Medicare strain, demographic shifts, and long-term system risk
 • Economic outlook and its impact on healthcare access and coverage

Chapters

00:00 Year-end welcome and gratitude to listeners
01:00 Consumer-driven healthcare and transparency gains in 2025
03:30 GLP-1 pricing, utilization, and manufacturer responses
04:45 Litigation, ERISA plans, and affordability pressure
07:00 Employee loyalty, benefits strategy, and workforce impact
08:30 Shift toward self-funded employer plans
10:30 Looking ahead to 2026: transparency, disruption, and risk
12:30 Medicare strain, economic uncertainty, and future scenarios
14:20 Closing reflections and what’s next for Only Healthcare

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Institute for Integrated Health (IIH): Health care benefits, insurance coverage regulations, and doing business in the healthcare industry can be complicated. At IIH, Dr. Randy Vogenberg and his team understand these unique challenges and provides strategic guidance customized to every client. To help overcome your unique challenges, IIH delivers education, planning and advisory on market trends, and U.S. health care market intelligence. The firm’s decades of proven success are due to strategic collaboration with associates from the business, clinical, and scientific communities. https://iih-online.com/.