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

• Federal Budget Bill Makes Major Changes To Health Care Policy For Medicaid, ACA Marketplace & Medicare 
• OBBB Myth vs Fact
• Estimated Effects On The Number Of Uninsured People In 2034 Resulting From Policies Incorporated Within CBO’s Baseline Projections & H.R. 1, The One Big Beautiful Bill Act
• The 2025 Federal Budget Reconciliation Bill (H.R.1 – One Big Beautiful Bill Act)
• The Mindful Lemon Selects Qualifacts To Support Rapid Expansion & Enhance Client Care 
• Humana’s CenterWell Business Agrees To Acquire The Villages Health In Florida 
• Cherokee Health Systems Rebrands As River Valley Health 
• BlueCross BlueShield Of Tennessee Winding Down Shared Health Subsidiary, With Dual Eligible Plans In Mississippi & Texas 
• Joint Commission Launches Simplified Accreditation Standard With Fewer Requirements 
• CMS Rescinds EMTALA Guidance On Emergency Abortions 
• 61% Of Nurses Plan To Make A Job Change Within One Year 
• Medicare Advantage Capitation Payments To Increase By 7.2% For 2026 
• CMS Releases Final Rule To Address ACA Exchange Enrollment Fraud, Saving ACA Enrollees 5% 
• Centers For Medicare & Medicaid Services Announcement Of Calendar Year (CY) 2026 Medicare Advantage (MA) Capitation Rates & Part C & Part D Payment Policies
• HHS EMTALA Letter To Health Care Providers

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Alaska To Support Practice Transformation To Integrate Primary & Behavioral Health

The Alaska Department of Health, Division of Behavioral Health (DBH) is planning to help three primary care provider organizations offer integrated mental health and addiction treatment services via the Collaborative Care Model (CoCM). The selected primary care provider organizations will be awarded grants of up to $270,000 each per year for a 4.5-year period to develop the staffing and systems needed to implement the CoCM. CoCM focuses on defined consumer populations who are tracked in… Read

• Rescinded: Reinforcement Of EMTALA Obligations Specific To Patients Who Are Pregnant Or Are Experiencing Pregnancy Loss
• Craft Telemedicine Launches To Provide Telehealth Treatment & Access To Specialty Compounded Medications, Without A Subscription Model 
• Medicare Beneficiaries With Psychological Distress Made Fewer Outpatient Mental Health Visits After Age 65, But Used More Acute Care Services 
• 14.5% Of Oregon Residents Delayed Health Care In 2024 Due To Cost 
• Impact Of Health Care Costs On People In Oregon, 2024

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