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

• Assessing The Impact
• Cincinnati Children’s Pediatric ACO & Telehealth Expansion Linked To Fewer Emergency Department, Urgent Care, In-Person Visits
• 15 Virginia FQHCs Sue For Reimbursement
• New CMS LEAD Model Aims To Expand Access To Accountable Care, Improve Health Outcomes
• NYC Health + Hospitals To Merge With Maimonides Health
• Cornell Tech Startup Hyro Raises $45 Million To Scale Voice AI In Health Care
• Artera Secures $65 Million Investment To Accelerate Growth & Adoption Of Agentic AI For Consumer Communications
• CMS Announces $50 Billion In Awards To Strengthen Rural Health, Establishes Office Of Rural Health Transformation
• Montana State University Helping Launch A Statewide AmeriCorps Program For Community Health
• Valerie Health Secures $30 Million To Build AI Front Offices For Independent Practices
• Accordion Acquires Pinnacle Healthcare Advisors
• Preparing For Impact
• Medical Loss Ratio As Market Shaper
• Included Health Expands Platform With AI Assistant To Improve Communications With Clinical Professionals
• Medicaid Demonstration & Care Management Waivers: An OPEN MINDS Market Intelligence Report

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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

• Highmark & Blue KC Announce Affiliation Agreement
• Rewriting The County Playbook
• Primary Care Digital Platform For Behavioral Health Decreased PMPM Spend
• Veterans Administration Puts Community Care Network Contracts Out To Bid
• Mississippi To Update Comprehensive State Health Plan Used To Gauge Future Demand, Focus On Rural Health Systems

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