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

• Superpower Launches $199 Membership To Help Democratize Concierge-Level Health Care Nationwide
• Eden Health Expands Personalized Care Platform Through Acquisition Of Contigo Compounding
• Hospitals Did Not Capture Half Of Consumer Harm Events Among Medicare Beneficiaries
• 96% Of Health Care Executives Are ‘Ready’ To Use Digital Health Solutions
• Hospitals Did Not Capture Half Of Patient Harm Events, Limiting Information Needed To Make Care Safer
• Citizen Health Raises $30 Million To Build AI Advocate, Ushering In A New Era Of Care
• Evolve Health Announces New Services, Expanded Footprint & Provider Organization Growth
• Visana Health Women’s Virtual Clinic Secures $24 Million In Series A Funding
• DarioHealth & OneStep Announce Plans To Integrate Smartphone-Only, Clinical-Grade Fall Risk Assessment Technology Into Dario’s Digital Health Multi-Condition Platform 
• West Virginia Employs The Largest Percentage Of Health Care Workers Compared To Its Total Workforce, Highest Of Any U.S. State
• Oregon Medicaid CCOs Had Mixed Financial Results & Higher Costs Due To Higher Health Care Utilization
• Neighbourly Accelerates National Growth With 33 Pharmacy Acquisitions
• 2024 Public Brief – CCO Financial Performance
• Employer Health Care Costs Projected To Increase By 9.1% For 2026 Plan Year
• Hospital Addiction Consultation Services For New York Medicaid Beneficiaries With Opioid Use Disorder Reduced Emergency Department Visits

See All

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

• Proposed Health Insurance Premiums For Small Group Market Rise 11% For 2026
• CMS Issues Preliminary Guidance For Medicaid Managed Care State-Directed Payments
• CMS Letter: Section 71116 Of The One Big Beautiful Bill Act On State Directed Payments
• Gomo Health Launches The Women, Children & Families Engagement Hub To Improve Whole-Family Care & Health Outcomes In Every Life Stage
• Medicare Shared Savings ACOs Saved Medicare $2.5 Billion In 2024

To sign-up for monthly Health Care System alerts, you must be signed in to your account.