Health equity remains a central priority in healthcare policy and provider strategy. On the one hand, The Centers for Medicare and Medicaid Services (CMS) is moving forward to support fair access to high-quality care regardless of socioeconomic or demographic factors. On the other, regulatory changes in 2025 could prove tumultuous, shifting under a new administration.
Surveys indicate some good financial news for providers, increasing equity pressures on health plans and a shift toward execution over strategies.
Below, we explore six themes that signal opportunities for providers, health plans and care delivery service companies this year.
What is health equity?
Everyone has the fundamental right to health. Achieving health equity requires that all have the opportunity to reach their highest level of well-being. This is despite differences in social, economic, geographic or other factors such as gender, ethnicity, disability or sexual orientation.
Access to equitable healthcare is shaped by the conditions in which someone is born, lives, works, plays and ages, along with biological influences.
Other factors—including political, legal and economic systems—determine how power and resources are distributed, ultimately affecting these conditions.
Many individuals experience worsened living conditions due to discrimination, bias and systemic barriers.
Ensuring healthcare for all requires a deliberate effort to identify and address disparities, working toward eliminating health and social inequities.
Important health equity themes in focus this year
1. Health equity priorities are shifting
According to a recent Deloitte survey, less than 25% of health plan and health systems executives cite health equity as a priority for 2025. As it relates to equity, their focus is on practical execution and not on audacious strategies.
Many see equity as a growth lever and a way to focus efforts and tailor services while addressing unmet needs and expanding consumer bases.
Some take a different view of health equity beyond the racial category. They're broadening their approach to hone in on patient populations across age, geography, disability, disease states, risk levels and socioeconomic status.
2. Deepening preventive care and engagement
Deloitte's research pointed to increasing commitment to preventive care as a foundation of health equity. Preventive care leads to better outcomes, lower complications and reduced costs. These outcomes have an outset and positive impact, particularly for underserved and vulnerable populations.
CMS is supporting greater preventive care through a host of new programs and expanding reimbursable billing codes, including:
Advanced Primary Care Management (APCM): Launched in 2025, APCM is a bundled care management program that not only expands coverage for Medicare beneficiaries with no chronic conditions but provides enhanced reimbursement for Qualified Medicare Beneficiaries.
Annual Wellness Visit (AWV): In response to the need to identify social determinants of health (SDOH), CMS established the standalone code G0136 for administering a standardized, evidence-based Social Determinants of Health risk assessment.
When the SDOH risk assessment is conducted within the AWV, Medicare will pay 100% of the allowance with no beneficiary cost-sharing. In addition to coverage for SDOH screening, Medicare care management programs provide reimbursable time that can be used to:
- Coordinate care and resources
- Remove barriers to care
- Support patients with goal-setting, referrals and self-management
Caregiver support: Recent program additions, including Community Health Integration (CHI) and Principal Illness Navigation (PIN), help patients with health-related social needs access resources to support their treatment plan.
3. Concentrating on key populations and variables
Healthcare organizations are focusing on targeted population health strategies to drive equitable outcomes.
Through data analysis, care teams can identify patient groups with specific variables that match the provider's or health plan's capabilities and technology. Through specialized initiatives and targeted programs, they can create momentum where opportunities for change exist.
For example, Kaiser Permanente is adding new programs focused on vulnerable populations through climate-event interventions and older adult care models. Their efforts emphasize delivering the right intervention at the right place and time, utilizing a tech-enabled, multichannel outreach approach.
Additionally, organizations are accentuating local implementation.
By leveraging Health Information Exchanges (HIEs) and Community Information Exchanges (CIEs), organizations are driving practical initiatives tailored to community needs.
Through public-private and payor-provider partnerships, organizations are putting greater focus on the social risks they can address.
4. Expanding non-clinical and SDOH data analytics
Collecting and incorporating non-clinical patient data is emerging as a key strategy for addressing care gaps.
Through Annual Wellness Visits and Social Determinants of Health assessments, providers and health plans can act on information that indicates social risk, including:
- Food access
- Housing
- Transportation
- Medication
- Personal safety
Healthcare leaders are doubling down on standardized practices to gather, access and use non-clinical information.
These data are growing in importance for patient engagement, as well.
Incorporating health-related social needs screening garners key patient details. These support building rapport and promoting preventive care, behavioral change and referrals for community resources.
5. Establishing equity as foundational to any initiative
Equity is becoming not only a healthcare business imperative but also a foundational element of design and strategy.
As providers and health plans review current initiatives, create new strategies or products, embark on novel partnerships and invest in technologies, the impact on health equity is a fundamental consideration.
Leaders can weigh each decision based on how it could hurt or help their patient populations.
For example, how could a new digital tool, care management program, specialized service or community resource support overarching goals?
Address health equity with ThoroughCare
ThoroughCare gives providers the tools and support to make care coordination effective.
We help providers, based on their specific needs, build programs or scale existing services. ThoroughCare supports a comprehensive software platform, clinical advising to optimize workflows, and reporting tools for quality improvement.
ThoroughCare offers features that support health equity initiatives, such as:
Embedded health-related social needs assessment
ThoroughCare offers a health risk assessment and SDOH screening as part of an Annual Wellness Visit. This can help care teams identify patient-specific issues, prompting clinicians to ask more targeted questions and comprehensively assess the patient's environment.
The HRSN dashboard and report highlight individuals at a higher social risk due to poverty, housing instability, food insecurity, and lack of access to healthcare.
Patient stratification and population health analytics
ThoroughCare offers population health and patient stratification data dashboards.
These provide actionable insights to help leaders hone in on particular populations and target cohorts for interventions.
The population health dashboard features a resource difficulties bar graph. This indicates how many patients struggle with each SDOH category. Other data visualizations list the number of patients at risk for falls, who have problems with pain, or are in need of assistance with ADLs and IADLs.
The patient stratification dashboard identifies high-risk patients across several categories, such as:
- Highly comorbid: Patients managing three or more chronic health conditions simultaneously
- Chronic future risk: Patients over 65 with one chronic condition and additional risk factors like numerous medications or primary care visits in the last 12 months
- Frequent ER: Patients that have visited the emergency room three or more times in the past year
- Frequent inpatient: Patients with at least one chronic condition who’ve been admitted two or more times in the past year
- Risk for readmission: Patients discharged in the last 90 days with a high-risk health status
In addition to data analytics and various dashboards and reports, ThoroughCare makes data and insights actionable through care coordination workflows, including:
- Facilitating patient care plan creation
- Standardized workflows with guided, validated assessments
- Motivating patients through clinical recommendations and SMART goals
- Monitoring key performance metrics to spot gaps in care
- Tracking and logging services for an audit-proof record of care
- Streamlining compliant billing
Key questions answered
How is health equity changing in 2025?
Healthcare leader surveys indicate that providers are encouraged by improving financials, while health plans are concerned about increased equity requirements. Despite the deemphasis on health equity in 2025, healthcare organizations are shifting their priorities to focus on execution rather than strategy.
Providers and health plans are emphasizing preventive care, narrower patient cohorts and common variables, non-clinical and SDOH data analytics, and expanding their view of health equity beyond race.