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

• Chaptered California Assembly Bill 1312 (Chapter 450): Hospital Pricing
• UM Health-Sparrow Opens Youth Health Clinic With East Lansing Public Schools, Second In The Region
• A $10 Million Donation To St. Joseph’s Healthcare Foundation Will Help Develop AI For Blindness Caused By Common Chronic Eye Diseases
• Kyruus Health & Healthgrades Partner To Improve Patient Access & Digital Presence For Health Care Provider Organizations
• Final Rule For Medicare & Medicaid Programs; CY 2026 Payment Policies Under The Physician Fee Schedule, And Other Changes
• Revelstoke Capital Partners Invests In Griffin Concierge Medical
• Briya Partners With Tanner Health To Accelerate Clinical Innovation In Alabama & Georgia
• Qualifacts Becomes The First EHR Solution Provider Organization To Earn AI Management Systems Certification ISO 42001:2023
• PrimeRx Launches First-Ever Real-Time Marketplace Integration In The Dispensing Workflow
• Nevada Health Link Insurance Marketplace Launches ‘Battle Born’ Public Health Insurance Option
• What A Difference A State Makes
• Hospice Of The Western Reserve Selects Netsmart To Enhance Care Delivery For Hospice & Palliative Care
• California To Phase Out Prior Authorization For Health Care Services With Approval Rates Of 90% Or Higher
• Final Nevada 1332 Waiver Application Addendum
• Final Nevada 1332 Application

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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

• CrossMed Healthcare Acquires Summit Medical Staffing & Strengthens Health Care Professional Network
• Carolina Complete Health & The Centene Foundation Award $1.3 Million Grant For Innovative Health Care Workforce Mental Health Program
• Alight Expands Partner Network With The Addition Of Sword Health
• WMCHealth Network Assumes Full Ownership Of Bon Secours System In Hudson Valley, New York
• Centauri Health Solutions Launches Member Insights To Support Dual-Eligible Medicare Advantage Members

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