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.

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California To Phase Out Prior Authorization For Health Care Services With Approval Rates Of 90% Or Higher

New legislation in California, signed on October 6, 2025, directs health plans and health insurers to phase out prior authorization for health care services with approval rates of 90% or higher by January 1, 2028. The legislation is supported by the California Medical Association (CMA). The goal is to reduce the administrative burden on health care provider organizations and to reduce delays in care for consumers, according to the CMA. The legislation does not apply… Read

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