Health care impacted by cybersecurity, regulation and AI in 2025

Cybersecurity, regulation, and artificial intelligence will be the top trends impacting health plans in 2025, according to a panel of BakerTilly analysts during a recent webinar.

In 2024, cyberattacks severely disrupted health care operations, compromising patient data, causing financial losses and threatening patient safety. Health care ransomware attacks doubled since 2023, said Garrett Gosh, principal at BakerTilly. With the average cost of a data breach estimated at $10 million and 191 days as the average time to discover such a breach, health care organizations must take steps to identify cyber security concerns and protect themselves from an attack.

He outlined the steps health care organizations must take to strengthen against a cyber attack.

1. Take an inventory of all business assets and identify the criticality of each asset.
2. Identify the risks associated with the business and the assets that support it.
3. Prioritize cybersecurity investments to align with the risks identified and the criticality of each business asset.

Regulation and a new administration

The outcome of the 2024 election is expected to significantly influence health care policy, potentially affecting costs, access and regulatory framework across the industry, said Kevin Coonan, BakerTilly principal. Among the changes that could come out of Washington are:

• Increased support for Medicare Advantage plans.
• Potential changes to the Affordable Care Act, including the introduction of risk pools, loss of enhanced subsidies to purchase marketplace plans and introduction of nonqualified health plans.
• Potential increase in Medicaid eligibility requirements.
• Fewer limitations on mergers and acquisitions due to more lenient Federal Trade Commission actions.
• Pharmacy benefit manager reform.

Increasing use of AI in health care

AI has the potential to revolutionize the health care industry by enhancing areas such as patient care and streamlining administrative processes. But the increasing use of AI also raises concerns about data privacy and ethics, Coonan said.

A March Microsoft study showed that 79% of health care organizations already use AI. Some possible uses of AI in health care include:

• Automating claims processing.
• Adaptive and responsive underwriting.
• Legal and compliance monitoring.
• Fraud detection and prevention.

Increased focus on member engagement

Health plans are putting a greater focus on member engagement, said Heather Herc, director at BakerTilly. Health plans must evolve to respond to increasing customer expectations in several ways, including:

• Ongoing focus on rollout and tailoring of member engagement tools.
• Tailored care management and ability to coordinate care across primary care providers and specialists.
• Ongoing innovation through AI and interoperability advancements with cyber security practices in mind.

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Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].