Health Care System

The United States health care system encompasses a mixture of private and public entities that are either non-profit or for-profit. Health care coverage may be financed through federal and state government programs or can be purchased through the health insurance marketplace. In contrast, a smaller proportion of the U.S. population is uninsured. The resulting effects of a decentralized system has led to considerable challenges for provider organizations—including cost pressures, a push towards alternative payment models, and market consolidation. Despite these challenges, there are opportunities for provider organizations in reducing excess costs and utilization, particularly as payers look for innovative approaches that can demonstrate a return-on-investment in terms of cost and consumer outcomes.

Latest Resources

• Medicaid Reductions To Stay Within SFY 2025-26 Rebase Funding
• North Carolina DHHS Medicaid Rebase NCGA Letter
• Oracle Health Launches An AI-Powered EHR For Ambulatory Care
• Healthcare Outcomes Performance Company Acquires Caro Health To Advance AI-Powered Health Care Innovation
• Rush Connect Launches Suite Of Digital-First Care Options
• GoHealth Urgent Care Partners With UPMC To Expand Care
• Blue Shield Of California Launches Mobile Pharmacy Price Check Tool
• AI In Behavioral Health: Ethics, Innovation, & Real-World Applications
• Another Year, More Mergers
• Public Has Negative Perceptions Of AI Use In Health Care Settings
• CMS Approves Moving The Healthy Texas Women Demonstration Waiver From Fee-For-Service To Managed Care, With A Five-Year Extension
• Medicaid Expansion Reduced Mortality Among Low-Income Adults By 2.5% Between 2010 & 2022
• Humana To Drop Some Outpatient Prior Authorization Requirements
• An All-Virtual, At-Home Acute Care Program Reduced Participant Costs For Uninsured & Medicaid Beneficiaries
• 90% Of Medicaid Expansion Beneficiaries Already Work, Are Looking For A Job, Are In School, Have A Disability, Or Have Health Issues

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Federal Budget Bill Brings Major Administrative & Financing Changes To Medicaid, ACA Marketplace & Medicare 

On July 4, 2025, President Trump signed the 2025 federal budget reconciliation package called the One Big Beautiful Bill (OBBB) Act, which enacts significant administrative and financing changes to health care policy affecting Medicaid, Medicaid expansion plans, Affordable Care Act (ACA) Healthcare Marketplace plans, and Medicare. An early analysis by the Congressional Budget Office (CBO) projected that the overall number of uninsured people will increase and health insurance premiums will likely increase as a result.   Medicaid … Read

• Suing Former CEO & Insiders, Steward Health Plans To Use Proceeds To Repay Creditors
• 44.1% Of Rural Medicare Beneficiaries Travel More Than One Hour For Surgical Care
• CMS To Test Prior Authorizations To Reduce Wasteful Or Inappropriate Services In Fee-For-Service Medicare
• Teladoc Health Acquires Telecare, Expanding Access To Specialist & Allied Health Care For Australians
• Rural Areas Lose 43% Of Independent Physicians

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