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

• Ohio I/DD Provider Organization I Am Boundless Launches Leadership Podcast 
• Illinois Implements Laws To Oversee PBMs & Ban Health Plan Use Of Prior Authorization For Outpatient & Partial Hospitalization Mental Health Services 
• Doceree Launches Co-Pay.Com To Support Point-Of-Care Access To Insurance Benefits Checks & Medication Cost Assistance Programs 
• Blue Cross & Blue Shield Of North Carolina – Winning Proposal & Contract For Medicaid Children & Families Specialty Plan Services To North Carolina Department Of Health & Human Services, 2024
• Illinois House Bill 1697: Prescription Drug Affordability Act
• Illinois House Bill 3019: Healthcare Protection Expansion Act
• Northern Hospital District Acquires Hospice Of Surry County, North Carolina 
• Public Health Dashboards Launch For Salem & Covington, Virginia
• Federal Medicaid Funding To Be Cut By $911 Billion Over 10 Years, Estimates Say
• Health Insurance Premiums Consume From 4% To 19% Of Median Household Income By State
• Colorado Medicaid Implements New Payment Model For Essential Mental Health Provider Organizations 
• Odds Of Food Insecurity Higher Among Adults Needing Surgery
• Integrated Ventures, Inc. Health Care & Wellness Company Transforms To MedWell Ai, Inc. 
• California Strengthens Mental Health Parity Act To Expand Access 
• Healthee Launches Smarter, Simpler, AI-Powered Benefits Platform 

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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

• Everlab Secures $10 Million For AI Preventative Care Platform
• Center For Behavioral Health Workforce In Florida Awards Inaugural Research Grants
• ‘Choose Medicare Act’ Introduced To Create ‘Part E’ Opt-In Program For Individuals & Employers 
• UnitedHealthcare Loses Challenge Over Minnesota Law Banning For-Profit Medicaid Plans 
• Order In The Case Of UnitedHealth Group Incorporated v. State of Minnesota

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