Healthcare in 2025: The Great Recalibration of U.S. Healthcare

A year when the economics finally caught up to the system

The year 2025 will be remembered less for crisis and more for correction. After half a decade of emergency responses, temporary funding, and policy exceptions, American healthcare entered a period of recalibration driven by economic reality rather than ideology. In practical terms, healthcare in 2025 became a year defined by economic recalibration rather than crisis response.

This was not a philosophical shift. It was a financial one.

The United States continues to spend more per capita on healthcare than any other country, while experiencing rising rates of chronic disease, uneven access to specialty care, and persistent inefficiencies across the care continuum. By 2025, the gap between cost, outcomes, and sustainability had narrowed to the point where incremental fixes were no longer sufficient.

At Corstrata, this recalibration was not theoretical. Working with health systems, rural hospitals, and hospital-at-home programs, we saw the same pressures everywhere: tight margins, limited workforce availability, rising administrative burden, and increasing scrutiny around value. The questions being asked were no longer about how to grow faster, but how to operate better.

Hospital operating margins remained between 1% and 2% throughout the year, well below historical norms. Roughly 40% of hospitals operated at a loss through September. Healthcare EBITDA as a share of national health expenditure remained approximately 200 basis points below 2019 levels. These were not cyclical fluctuations. They reflected a structural imbalance.

Federal Policy Moves From Expansion to Discipline

One of the most consequential developments of the year was the passage of the One Big Beautiful Bill Act. Whatever one’s political interpretation, the economic rationale was clear: federal healthcare spending had reached a trajectory that required correction.

Public programs have long struggled with eligibility leakage, improper payments, administrative inefficiency, and inconsistent alignment between utilization and outcomes. OBBBA introduced mechanisms intended to tighten eligibility verification, increase accountability, and slow spending growth.

The projected increase in the uninsured population over the next decade is significant and carries real implications for access and provider finances. At the same time, the legislation reflects a broader acknowledgement that coverage expansion without sufficient cost control, utilization management, and fraud prevention is not sustainable.

For providers, the near-term impact is increased coverage churn and financing pressure. For policymakers, the intent is to reintroduce guardrails around spending growth. Both dynamics now coexist, and health systems must plan accordingly.

Changes to Medicaid financing reinforced this message. Reductions in provider tax safe harbors and limits on state-directed payments signal that supplemental funding mechanisms can no longer quietly absorb inefficiency. Operating discipline is becoming a requirement rather than a preference.

CMS Signals Accountability Over Volume

In parallel, CMS clarified its strategic direction through the Innovation Center. The message was practical, not ideological.

Fee-for-service incentives have not controlled cost growth or consistently improved outcomes at scale. Value-based care, once treated as experimental, is now an embedded infrastructure. More than half of Traditional Medicare beneficiaries are aligned with accountable care relationships.

CMS’s emphasis on interoperability, transparency, and patient access to data reflects a broader shift toward accountability. The objective is clearer alignment between spending, outcomes, and patient experience.

For health system leadership, this signals that success will increasingly depend on measurable performance rather than negotiated protection.

Mandatory Risk Becomes Real

What changed materially in 2025 is that value-based care stopped being optional.

CMS’s rollout of the TEAM model and the expansion of population-based initiatives like ACO ACCESS signaled a clear shift from encouragement to enforcement. TEAM, in particular, introduced mandatory episode-based risk for selected hospitals, tying financial performance directly to complications, length of stay, and post-acute outcomes.

The message embedded in these models is straightforward: variation is expensive, preventable complications are no longer reimbursed, and margin recovery depends on execution rather than volume.

For operators, this changes the internal math. Clinical domains that were once treated as cost centers now represent financial swing factors. Post-acute coordination, wound complications, readmissions, and delayed healing are no longer secondary concerns. They directly affect margin under bundled and population-based payment structures.

This shift helps explain why health systems increasingly focused in 2025 on tighter care pathways, specialty standardization, and extending expert oversight beyond traditional inpatient walls. Managing risk now requires managing what happens between encounters, not just during them.

At Corstrata, we see this alignment clearly. As payment models push accountability downstream, demand increases for specialty expertise that can be deployed consistently across settings without adding fixed cost.

Access, Utilization, and the Mismatch of Care Delivery

One of the clearest lessons of 2025 is that access challenges cannot be solved by coverage alone.

In many regions, patients face long travel times and extended waits for specialty care. In others, utilization remains high but fragmented, with significant volumes of duplicative or low-value services. Scarcity and excess coexist within the same system.

Telehealth helped address parts of this mismatch, but uneven infrastructure and regulatory uncertainty limited its reach. Improving access does not mean delivering more care everywhere. It means deploying clinical expertise more intelligently.

At Corstrata, we saw growing demand for virtual specialty care models precisely because they address both sides of the equation. Extending experienced clinicians across multiple sites without adding fixed labor costs allows systems to improve access while reducing unnecessary utilization.

Rural Health: From Stabilization to Redesign

The announcement of the Rural Health Transformation Program marked a meaningful shift in federal rural health strategy. At $50 billion through 2030, the program reflects recognition that preserving struggling models is not a long-term solution.

The funding is intended to support structural change: workforce redesign, technology modernization, preventive care, and new forms of partnership between rural and urban systems. The inclusion of technical assistance underscores a focus on execution and outcomes.

For rural providers and the systems that support them, the opportunity is substantial, but so is the responsibility. Care models built during this period must remain viable when the funding ends. Distributed care teams and virtual specialty support will be central to that sustainability.

Medicare Advantage Enters a More Disciplined Phase

Medicare Advantage growth slowed in 2025 as payers confronted rising utilization, risk model changes, and margin compression. This reflects market maturation rather than failure.

For providers, Medicare Advantage remains important, but it now requires greater precision. Documentation accuracy, appropriate utilization, and alignment between clinical decisions and financial outcomes matter more than scale alone.

Reimbursement Discipline Reaches Advanced Wound Care

Another meaningful recalibration in 2025 occurred in advanced wound care reimbursement, particularly around skin substitutes and related cellular and acellular products. After several years of rapid spending growth and inconsistent clinical application, CMS began tightening payment structures, moving away from incentive-heavy reimbursement toward standardized rates, clearer medical-necessity expectations, and increased audit scrutiny. 

For providers, this wasn’t just a coding change; it was a signal that outcomes, documentation, and product selection now matter more than volume. In this environment, providers are being pushed to standardize wound care pathways, reduce unwarranted variation, and demonstrate appropriateness and efficacy. 

At Corstrata, we’ve seen this shift accelerate demand for independent, specialty-driven oversight - not only to support the right product for the right patient, but to ensure evidence-based wound and disease management is consistently applied. That includes ongoing clinical assessment, clear documentation of wound response, and timely intervention when therapies are not producing expected outcomes, aligning care delivery with both clinical best practice and reimbursement expectations.

Labor and Technology Converge Around Efficiency

Workforce challenges are no longer temporary. They are structural.

Flexible staffing models, virtual deployment, and AI-supported workflows gained traction because they address real constraints. These approaches are not about replacing clinicians. They are about allowing limited expertise to cover more ground without compromising quality.

AI adoption accelerated where it delivered clear return: reducing administrative burden, improving revenue integrity, and supporting earlier clinical intervention. The most effective deployments were grounded in real workflows and high-quality clinical data.

Efficiency, not novelty, drove adoption.

Retail Healthcare Adjusts Expectations

The pullback of retail players from direct care delivery reinforced a straightforward lesson. Complex medical care does not scale like consumer retail.

What remains is partnership. Technology platforms, logistics, and access points can add value, but durable care delivery still requires clinical depth, integration, and accountability.

What Healthcare in 2025 Made Clear

By the end of 2025, several conclusions were difficult to dispute.

The system must address waste, fraud, and misaligned incentives. Cost control and access improvement must advance together. Expertise must be deployed more efficiently across geography. Technology must be tied to operational discipline. Growth strategies must be grounded in sustainable economics.

These are not political positions. They are financial realities.

A System Operating on New Assumptions

Healthcare entering 2026 looks familiar from the outside. Internally, it operates on different assumptions.

Spending must be justified. Outcomes must be measured. Expertise must travel further. At Corstrata, we view the Great Recalibration as overdue but necessary. It reflects a system beginning to align cost, access, and accountability.

The recalibration is complete. What matters now is execution.

About Corstrata

Corstrata is a virtual care solution that utilizes technology to create access to scarce certified wound, ostomy, and continence nurses (WOCNs) at the patient's bedside in multiple provider settings, including home health, hospice, skilled nursing facilities, and hospitals across all 50 states. Corstrata's team of WOC nurses provides consultations with provider staff at the patient's bedside, either through HIPAA-compliant video or through review of store-and-forward wound images, to improve clinical and financial outcomes for providers.