Blog

Immediate Strategies to Transform Healthcare Today

medappinsider By medappinsider December 24, 2025

The healthcare system in the United States faces ongoing challenges related to access, cost, and quality. While political debates often overshadow practical solutions, there are numerous actionable steps that stakeholders can implement right now to create meaningful improvements. These strategies, grounded in evidence and innovation, have the potential to expand coverage, reduce expenses, and enhance health outcomes for millions.

By focusing on targeted reforms such as adjusting eligibility criteria, promoting competition, and harnessing technological advancements, we can lay the groundwork for a more equitable and efficient healthcare landscape. Implementing these measures requires a combination of policy changes, industry accountability, and community engagement. As we explore each idea, consider the profound impact these changes could have on individual lives and the broader health ecosystem.

1. Expand Medicare Eligibility to Younger Adults

The adage “an ounce of prevention is worth a pound of cure” underscores the importance of early and consistent healthcare engagement. Currently, approximately 11,000 Americans turn 65 and qualify for Medicare daily, yet many have had limited access to preventive services beforehand. Notably, about 10% of individuals lack health insurance and report fewer screenings for conditions like high cholesterol or cancer, increasing their risk of preventable complications.

Lowering the Medicare eligibility age to 55 could bring an estimated 3.45 million more Americans into regular, preventive care. This proactive approach not only improves health outcomes but can also lead to substantial savings by reducing the need for costly treatments later. Such a policy shift would help redirect health expenditures from reactive treatment toward proactive wellness initiatives, ultimately benefiting the entire system.

2. Strengthen Antitrust Enforcement in Healthcare Markets

Between 1998 and 2021, there were 1,887 hospital mergers, resulting in a 25% decrease in the total number of hospitals nationwide. Currently, nearly half of physicians are employed by large health systems, many of which are increasingly consolidated under venture capital interests. While business consolidation can sometimes drive efficiencies, extensive research indicates it often leads to higher healthcare costs and diminished care quality.

Voters and policymakers need to recognize that these market concentrations directly impact their wallets and access. The Biden administration’s pledge to curb anticompetitive mergers is a step forward, but a robust debate is necessary to establish guardrails that prioritize patient care over profits. Enforcing competition laws can help prevent monopolistic practices that inflate prices and limit choices, ensuring that healthcare remains accessible and affordable.

3. Develop Multiyear Enrollment and Care Continuity Plans

In both public and private insurance markets, patient churn is a persistent challenge. Medicare Advantage (MA) plans, for instance, often see members switching annually based on benefits, which discourages long-term preventive investments. When health plans can retain clients over multiple years, they are more incentivized to prioritize proactive health management.

Creating models that promote multiyear enrollment—such as portable plans that span employment changes or periods of unemployment—would foster sustained relationships between patients and providers. These systems would encourage plans to report on long-term outcomes and invest in population health initiatives, ultimately leading to better health stability and reduced costs over time.

4. Recognize Community Trust as a Vital Component of Care

Recent studies highlight declining trust in physicians and hospitals, which poses a barrier to effective healthcare delivery. Engaging trusted community figures—particularly health insurance brokers—can bridge this gap. These brokers, already essential in guiding patients through plan options, can be further empowered to serve as community health advocates.

By standardizing and incentivizing their role in providing health education, guiding healthy behaviors, and connecting individuals to local resources, brokers can help rebuild confidence in the healthcare system. Such integration would ensure that trust-based relationships translate into improved health behaviors and better utilization of services, especially among underserved populations.

5. Standardize Benefits to Promote Fair Competition and Focus on Outcomes

Health plans in the Medicare Advantage program often compete by offering flashy perks—such as golf clubs or fishing gear—that do little to improve health. While benefits like dental or vision coverage are valuable, benefit design should prioritize clinical effectiveness and health outcomes.

Implementing standardized benefit packages rooted in evidence-based care would allow consumers to compare plans based on quality rather than extraneous incentives. This approach would reinforce the primary goal of health coverage: delivering effective treatment and preventive services. A focus on transparent, outcome-oriented benefits would also motivate plans to improve care quality and patient satisfaction.

6. Elevate the Significance of Star Ratings in Consumer Choice

Current Star Ratings primarily evaluate process measures, such as medication adherence, which may not fully reflect patient health improvements. To truly differentiate quality, plans should be held accountable for meaningful health outcomes—like recovery after falls, management of chronic diseases, or transition to palliative care.

Making these ratings more outcome-focused would encourage plans to compete on the quality of care during critical moments that shape long-term health. Transparent reporting on these metrics would empower consumers to select plans that deliver tangible benefits, ultimately driving industry-wide improvements.

7. Modernize Risk Adjustment with Real-Time Data Analysis

Risk adjustment is essential for fair compensation, but current CMS methods rely on retrospective audits that are often slow and incomplete. They depend heavily on paper records and outdated data, which hampers the ability to accurately reflect patient complexity.

Advancing to real-time, technology-driven risk coding audits would enable health plans to correct inaccuracies promptly, reducing unnecessary penalties and fostering more accurate reimbursement. This technological upgrade would also promote better resource allocation, ensuring that plans are appropriately compensated for the true health needs of their populations.

8. Reform Medical Licensure to Enable Cross-State Practice

The current state-by-state licensure system restricts physicians from practicing across borders, limiting access—especially in rural and underserved areas. With the rise of telemedicine, this barrier is increasingly obsolete.

Reforming licensure at the federal level would facilitate broader access to specialized care, reduce patient travel burdens, and help address physician shortages. Streamlining licensure processes would also allow physicians to serve where they are needed most, improving healthcare availability and reducing disparities.

9. Incentivize Capitated Care to Improve Utilization Management

Many payers currently employ utilization management strategies that can delay or deny necessary care, often driven by fee-for-service models. Transitioning toward capitated payment systems—where providers receive a fixed fee to manage all patient care—aligns incentives toward prevention and cost-effective management.

Global capitation encourages providers to invest in health promotion and early intervention, reducing unnecessary procedures and hospitalizations. While some clinicians hesitate to accept financial risk, embracing capitated models can foster more sustainable, patient-centered care and better resource stewardship.

10. Launch a Maternal Health “Moonshot” Initiative

Maternal mortality rates in the US surged during the COVID-19 pandemic, with disparities widening among minority groups and rural populations. Addressing this crisis requires bold, targeted action.

Key steps include mandating Medicaid coverage for postpartum women for at least one year, increasing funding for maternal health research, and expanding culturally competent care. Programs like the Nurse-Family Partnership demonstrate how home visits by nurses can improve outcomes, but broader implementation is needed. Such initiatives can reduce preventable deaths, improve maternal health, and restore US standing among developed nations in maternal safety.

These ten strategies provide a roadmap for meaningful reform—driven by policy, innovation, and community engagement—that can be implemented immediately. While they are not exhaustive, they represent a practical starting point for meaningful change. As the healthcare landscape evolves, continuous dialogue and action are essential to delivering better, more equitable care for all.

Author Information

Dr. Jain is CEO of SCAN Group and SCAN Health Plan in Long Beach, California, and serves on the editorial board of Population Health, Equity & Outcomes.

References

  • Kiger PJ. What’s it like to turn 65 in 2024? AARP. December 27, 2023. Accessed September 24, 2024. https://www.aarp.org/retirement/planning-for-retirement/info-2023/silver-tsunami-late-boomers-turn-65.html
  • Sneed R. Lowering the age for Medicare eligibility: who benefits? Innov Aging. 2023;7(suppl 1):641-642. doi:10.1093/geroni/igad104.2089
  • Levins H. Hospital consolidation continues to boost costs, narrow access, and impact care quality. University of Pennsylvania Leonard Davis Institute of Health Economics. January 19, 2023. Accessed September 24, 2024. https://ldi.upenn.edu/our-work/research-updates/hospital-consolidation-continues-to-boost-costs-narrow-access-and-impact-care-quality/
  • Schwartz K, Lopez E, Rae M, Neuman T. What we know about provider consolidation. KFF. September 2, 2020. Accessed September 24, 2024. https://www.kff.org/health-costs/issue-brief/what-we-know-about-provider-consolidation/
  • Fact sheet: Biden-Harris administration announces new actions to lower health care and prescription drug costs by promoting competition. The White House. December 7, 2023. Accessed September 24, 2024. https://www.whitehouse.gov/briefing-room/statements-releases/2023/12/07/fact-sheet-biden-harris-administration-announces-new-actions-to-lower-health-care-and-prescription-drug-costs-by-promoting-competition/
  • Perlis RH, Ognyanova K, Uslu A, et al. Trust in physicians and hospitals during the COVID-19 pandemic in a 50-state survey of US adults. JAMA Netw Open. 2024;7(7):e2424984. doi:10.1001/jamanetworkopen-2024.24984
  • Mathews AW. CVS made a big bet on Medicare. It’s looking risky. Wall Street Journal. May 1, 2024. Accessed September 24, 2024. https://www.wsj.com/health/healthcare/cvs-health-q1-earnings-report-2024-7275f25b
  • DuBard CA, Shrank WH, Cavanaugh S, Mostashari F. Why the Star Ratings medication adherence measures must go. Health Affairs Forefront. January 10, 2024. Accessed September 24, 2024. https://www.healthaffairs.org/content/forefront/why-medicare-star-medication-adherence-measures-must-go
  • Hoyert DL. Maternal mortality rates in the United States, 2021. CDC National Center for Health Statistics. March 2023. Accessed September 24, 2024. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.pdf
  • Maternal Health: Outcomes Worsened and Disparities Persisted During the Pandemic. Government Accountability Office. October 2022. Accessed September 24, 2024. https://www.gao.gov/assets/gao-23-105871.pdf
  • Implementing a Maternal health and Pregnancy Outcomes Vision for Everyone (IMPROVE) initiative. National Institutes of Health. Accessed September 24, 2024. https://www.nichd.nih.gov/research/supported/IMPROVE
  • Fact sheet: President Joe Biden to announce first-ever White House Initiative on Women’s Health Research. The White House. November 13, 2023. Accessed September 24, 2024. https://www.whitehouse.gov/briefing-room/statements-releases/2023/11/13/fact-sheet-president-joe-biden-to-announce-first-ever-white-house-initiative-on-womens-health-research-an-effort-led-by-first-lady-jill-biden-and-the-white-house-gender-policy-council/
  • Goldstein J. Why New York has faltered in making childbirth safer for Black mothers. New York Times. Updated January 10, 2024. Accessed September 24, 2024. https://www.nytimes.com/2024/01/07/nyregion/childbirth-maternal-mortality-black-women.html