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AHA’s 2025 Environmental Scan Reports Key Trends Shaping the Future of Healthcare

As a new year begins to unfold, what might we expect in healthcare? The potential for artificial intelligence (AI) to improve mental healthcare, the impact of climate change on health, and innovative programs aimed at preventing violence are just some of the trends the American Hospital Association AHA) highlights in its latest Environmental Scan.

Providing valuable information on the challenges facing hospitals, the issues impacting patients, and how they receive care, the 2025 Environmental Scan delves into eight healthcare and population trends. These insights can help hospitals and health systems anticipate the impact on their communities and develop strategies to address these challenges.

Aging in the U.S.

According to AHA, by 2030, Americans aged 65 and older will make up more than 20% of the population — an increase from 2022’s 17%. By 2050, they’re projected to make up 23%.

Americans born in 2023 have a life expectancy of 79 years and a healthy life expectancy — defined as a person's disability-free lifespan — of 66 years.

As the American population continues to age, the Age-Friendly Health Systems initiative is designed to meet the needs of older adults, engage the whole community and achieve better health for older adults. Learn more at www.aha.org.

Coverage

The Congressional Budget Office projects that most people will continue to be covered under employer-sponsored insurance plans over the next decade, with enrollment between 164 million and 170 million. Medicare enrollment is expected to grow substantially, from 60 million to 74 million in 2034.

Enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) peaked in 2023 at 94 million and is declining as states complete the redetermination process. In 2019, 71 million Americans, compared to 81 million in April 2024.

According to AHA, the Affordable Care Act Marketplace coverage has grown considerably in recent years with some experts attributing the growth in part to the availability of enhanced advanced premium tax credits (APTC). The number of ACA enrollees receiving APTCs nearly tripled between 2014 and 2024.

Behavioral Health

AHA reports that 1 in 5 adults live with a mental illness, and more than 1 in 5 youth ages 13-18 either currently or at some point during their lives have had a seriously debilitating mental illness.

The Scan highlights the impact that artificial intelligence (AI) is making to improve mental healthcare in three areas:

• Personal sensing: Using digital data to measure and monitor someone’s mental health and detect relevant behavioral changes.
• Natural language processing: Tracking the use of language in conversations and detecting patterns that might correlate with mental issues.
• Chatbots: Asking questions the same way a mental practitioner would, the chatbot can analyze the patient’s answers and suggest different kinds of therapies or propose seeking medical advice.

Rural Health

Nearly 46 million American reside in rural areas, where hospitals serve not only as vital providers of care but also as essential pillars of the local economy and social fabric. The economic challenges of delivering care in these communities contribute to significant gaps in access.

Providing care in rural settings can be more expensive on a per-patient basis, as rural residents often have more complex health needs, higher uninsured rates, and are more dependent on public assistance. As rural hospitals face a higher risk of closure, vulnerable rural populations may encounter increased challenges in accessing healthcare.

As of October 2020:

• There have been 151 total closures and conversions of rural hospitals since 2010. This consists of 66 conversions to other services and 85 complete closures.
• 30 additional hospitals have converted to Rural Emergency Hospitals.

Climate and Health

The White House and the Department of Health and Human Services launched the Health Sector Climate Pledge, a voluntary initiative encouraging private-sector healthcare organizations to commit to climate resilience and emissions reduction. The pledge includes a goal to reduce greenhouse gas emissions by 50% by 2030 and achieve net-zero emissions by 2025. As of July 2024, more than 1,180 federal and private-sector hospitals have made this commitment, collectively representing more than 15% of U.S. hospitals.

AHA reports that 4 in 5 clinicians surveyed believe it’s important for their hospital to address climate change and that doing so is aligned with their organization’s mission. In addition, 3 in 4 feel it’s important that they themselves work to reduce their environmental impact, both at work and at home.

There are numerous implications of increased temperatures, including: heat illness, increased transmission of disease, and accelerated death from respiratory, cardiovascular or other chronic disease.

Hospital-Based Violence Intervention Programs

Hospital-based violence intervention programs (HVIPs) are multidisciplinary programs that identify patients at risk of repeat violent injury and link them with hospital and community-based resources aimed at addressing underlying risk factors for violence.

More than 85 cities currently have HVIPs. Violence prevention professionals begin outreach at violence survivors’ hospital bedsides, then continue engagement over the next six to 12 months, offering crisis intervention, counseling and referrals to services such as job training, housing assistance, substance-use disorder counseling and more.

Vaccines Work

AHA reports that of the children born between 1994 and 2023, routine childhood vaccinations will have prevented about 508 million cases of illness, 32 million hospitalizations and 1,129,000 deaths over the course of their lifetimes, at direct savings of $540 billion and societal savings of $2.7 trillion.

Notable vaccination stats and projections:

• 7% of U.S. adults (17.8 million) have had long COVID as of early 2023. Adults who received a COVID-19 booster had lower rates of long COVID than both unvaccinated adults and adults who received only the primary vaccination series.
• The 2023-2024 COVID-19 vaccine may reduce the risk of emergency/urgent care or hospitalization by half in adults.
• The 2023-2024 seasonal flu vaccine may reduce pediatric hospitalizations by at least 52% and adult hospitalizations by at least 41%.

Public Trust and Confidence

In this evolving environment, strong relationships between patients and their providers are critical. Patients identified three ways for hospitals to build trust:

• Competence: Effectively treating health issues, providing a safe and clean hospital environment and having clinicians who are knowledgeable and thorough.
• Caring: Hospital culture that prioritizes patients’ comfort, a welcoming physical environment and clinicians who are compassionate.
• Communication: Hospital culture of listening to patients and explaining clearly, particularly with treatment and discharge plans.

You can view the full Environmental Scan by visiting www.aha.org.