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

• Mount Sinai Obstetricians First In New York City To Use FDA-Cleared AI Tool That Enhances Fetal Screening For Congenital Heart Defects
• Manifest MedEx & SCHIO Announce Strategic Affiliation To Connect California & Advance Statewide Health & Social Services Data Infrastructure
• Cedars-Sinai & Healthcare In Action Work Together To Provide Post-Discharge Care To Those Experiencing Homelessness
• The Public Health Implications Of Housing Instability, Eviction, And Homelessness
• The Health Cost Savings Of Quality Affordable Housing
• The Impacts Of Affordable Housing On Health: A Research Summary
• IntelyCare Acquires CareRev To Create Comprehensive Workforce Staffing Platform For Health Systems
• Claim Health Launches AI-Powered Revenue Infrastructure For Post-Acute Care With $4.4 Million Seed Funding
• Intermountain Health Finalizes Acquisition Of Steinberg Diagnostic Medical Imaging In Las Vegas
• Alcohol-Related ED Visit Volume Nearly Doubled Over 20 Years
• $1.16 Million Awarded To Mississippi State University To Support State’s Behavioral Health Workforce
• University Of Montana Awarded $1.2 Million Grant To Launch Rural Youth Behavioral Health Career Pathways
• North Carolina Launches Student Loan Repayment Program To Strengthen Mental Health, Substance Use, I/DD & TBI Workforce
• Louisiana Invests $17 Billion To Extend Its Medicaid MCO Contracts Through December 2026
• Owlet & Locus Health Partner To Seamlessly Deliver Infant Health Data Into Remote Patient Monitoring Programs

See All

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

• President Trump Issues Health Care Reform Proposal
• More Than 22.8 Million ACA Health Insurance Enrollments For 2026, 1.2 Million Lower Than 2025
• APA Sues New York Insurer EmblemHealth Over Mental Health ‘Ghost Network’
• 2026 Medicaid & CHIP Beneficiary Profile: Enrollment, Expenditures, Characteristics, Health Status & Experience
• From 2002 To 2021, Annual Out-Of-Pocket Costs Increased 125.2% For Commercially Insured People With Multiple Sclerosis

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