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

• Contract Upset Changes Florida Medicaid MCO Landscape
• Dana-Farber Cancer Institute Launches Neuro-Inclusive Program That Integrates Palliative & Behavioral Health Care
• UCI Health Acquires Four Hospitals From Tenet Healthcare  
• Walgreens Plans To Close More VillageMD Locations  
• Family Hospital System Closes Two Nebraska Hospitals  
• Oregon Adopts Legislation On ‘Physician Associate’ Title  
• Oklahoma Seeks TRICARE Services
• Montana, South Dakota & Nebraska Have Best Business Environments For Physicians
• Colorado Medicaid eConsult – FAQ
• Private Payers Deny 15% Of Medical Claims, Even Some That Were Pre-Approved
• 25% Of Health Care Provider Organizations Plan To Deploy Generative AI To Enhance Consumer Engagement
• Praia Health Raises $20 Million, Spins Out From Providence  
• 21.4 Million People Enrolled In 2024 ACA Plans
• National Telehealth Utilization Averaged 5% Of Claims In January
• Colorado Medicaid Launches eConsult Platform To Improve Access To Specialty Care Advice For Primary Care Professionals

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Spying The Health Care Megatrends

The Colorado Department of Health Care Policy and Financing (HCPF) recently launched the Colorado Medicaid eConsult platform to give primary care professionals (PCP) access to electronic clinical consultations with a wide variety of specialists for adults and children with Health First Colorado Medicaid. The platform was developed by Safety Net Connect (SNC), which provides virtual care solutions. HCPF will be able to receive federal Medicaid matching funds for the eConsults that take place via the… Read

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