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

• Informational Bulletin Regarding Section 71119 Of The “Working Families Tax Cut” Legislation, Public Law 11921: Requirements For States To Establish Medicaid Community Engagement Requirements For Certain Individuals
• The Technology-Enabled Meaningful Patient Outcomes For Digital Health Devices Pilot Notice
• Survey: 25% Of ACA Marketplace Enrollees Would Go Without Insurance If Premium Payments Doubled
• Florida Hospitals’ Opioid Case Against Retail Pharmacy Chains Results In Mistrial
• Nest Health Raises $22.5 Million To Expand Medicaid Whole Family Home Medical Care Model
• Oracle’s AI-Powered Ambulatory EHR Granted Federal ONC Certification
• Optum Rx To Reduce Reauthorization Requirements For 40 More Drugs
• Connecticut Office Of Health Strategy Approves Hartford HealthCare Subsidiary’s Acquisition Of Manchester Memorial Hospital
• Federal HHS Releases AI Strategy
• Executive Order Launches The ‘Genesis Mission’ To Spur Scientific Research Through Artificial Intelligence
• Medicare Advantage Beneficiaries With Mental Health Diagnoses Made More Mental Health Visits After Switching To Traditional Medicare
• Accreditation Commission For Health Care Expands Assisted Living Accreditation Program Nationwide
• U.S. Department Of Health & Human Services Artificial Intelligence Strategy
• Idaho Department Of Health & Welfare To Transition To Comprehensive Medicaid Managed Care
• Northwell Health & K Health Launch AI-Powered Virtual Primary Care Platform

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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

• Brook.ai Secures $28 Million In Series B Funding To Accelerate Next Phase Of Growth & Innovation In Remote Care
• Reema Health Raises $19 Million To Expand Its Medicaid Member Engagement Services
• Sage Care Procures $20 Million In Funding For An AI-Powered Care Navigation System
• Allegheny Health Network & Heritage Valley Health System Sign Affiliation Agreement
• Cross Country Healthcare Terminates Merger Agreement With Aya Healthcare

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