What 2025 will bring to a payer’s care management teams—and how to transform trends into success

Breaking down silos through collaboration

Care management in 2025 must prioritize breaking down internal silos and aligning benefit design, claims, and care management around a unified foundation of evidence. The fragmentation between medical and pharmacy benefit teams in many payer organizations often leads to inconsistent decision-making, inefficiencies, and member frustration. Addressing this challenge requires aligning processes and fostering collaboration between teams to ensure cohesive and data-driven outcomes.

One key strategy is the use of shared, evidence-based technology. When all teams—whether handling benefit design, claims processing, or care management—work from the same source of clinical and drug data, they can make more consistent decisions. This synchronization ensures that coverage policies are both accurate and current, minimizing confusion for members and providers.

Additionally, centralizing data sharing across medical and pharmacy benefit teams is critical for streamlining operations. When both teams access the same patient and claims data, discrepancies can be reduced, and care management strategies can be better tailored to member needs. For example, by cross-referencing pharmacy benefit decisions with medical claims data, care managers can proactively address member issues, such as gaps in medication adherence or coverage misunderstandings.

By fostering collaboration through shared evidence, unified workflows, and centralized data, care management teams in 2025 can create a more integrated approach.

Harnessing the power of personalized care

Healthcare today is no longer one-size-fits-all, and this shift will only continue throughout 2025. Personalized care strategies, fueled by patient data and advanced analytics, align closely with the goals of value-based care. They focus on meeting patients where they are—whether that’s managing a chronic disease, addressing social determinants of health, or tailoring communication styles to individual preferences.

By leveraging technology, such as predictive health models, care management teams can anticipate patient needs before they arise. For example, if data indicates that a patient with diabetes is at high risk for complications, their care manager can schedule proactive check-ins, coordinate medication reviews, or launch a nutrition support program. Personalization ensures that interventions are timely and relevant, driving better health outcomes and patient satisfaction.

Preparing now for success later

The anticipated trends for 2025 will bring immense potential, but will also require both vision and action to ensure success. Care management teams can set themselves up for success by aligning operations with the principles of value-based care:

• Invest in technology: Explore platforms that enhance efficiency and patient engagement while providing actionable insights.
• Strengthen partnerships: Build bridges with internal teams and external organizations to collectively address patient needs.
• Commit to personalization: Develop care models that prioritize individual journeys over standardized approaches.

By proactively addressing these trends, care management teams won’t just keep pace with change—they’ll lead it, transforming challenges into measurable successes.

The future of care management is bright for those ready to innovate. With digital tools, enhanced collaboration, and patient-first frameworks, 2025 can be a year of extraordinary achievements for care management teams striving to deliver on the promise of value-based care. Now is the time to lay the groundwork for this transformation—because the future always belongs to those who prepare today.

For more insight, access our ebook “Unlocking the potential for smart payer care management”.