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

• Centers For Medicare & Medicaid Services Announcement Of Calendar Year (CY) 2026 Medicare Advantage (MA) Capitation Rates & Part C & Part D Payment Policies
• HHS EMTALA Letter To Health Care Providers
• Rescinded: Reinforcement Of EMTALA Obligations Specific To Patients Who Are Pregnant Or Are Experiencing Pregnancy Loss
• Craft Telemedicine Launches To Provide Telehealth Treatment & Access To Specialty Compounded Medications, Without A Subscription Model 
• BlueCross BlueShield Of Tennessee Winding Down Shared Health Subsidiary, With Dual Eligible Plans In Mississippi & Texas 
• Humana’s CenterWell Business Agrees To Acquire The Villages Health In Florida 
• Cherokee Health Systems Rebrands As River Valley Health 
• Medicare-Eligible Beneficiaries With Psychological Distress Made Fewer Outpatient Mental Health Visits 
• 14.5% Of Oregon Residents Delayed/Avoided Health Care In 2024 Due To Cost 
• Impact Of Health Care Costs On People In Oregon, 2024
• Ivy Rehab Expands In June With New Clinics & Strategic Partnerships 
• Joint Commission Launches Simplified Accreditation Standard With Fewer Requirements 
• Publicly Traded Health Care Companies Increased Shareholder Payouts By 315% Over 20 Years
• Hospital CEO Exits Declined In 2024 Compared To 2023 
• 41% Of Current Drug Shortages Started In 2022 Or Earlier 

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Alaska To Support Practice Transformation To Integrate Primary & Behavioral Health

The Alaska Department of Health, Division of Behavioral Health (DBH) is planning to help three primary care provider organizations offer integrated mental health and addiction treatment services via the Collaborative Care Model (CoCM). The selected primary care provider organizations will be awarded grants of up to $270,000 each per year for a 4.5-year period to develop the staffing and systems needed to implement the CoCM. CoCM focuses on defined consumer populations who are tracked in… Read

• Three Health Care Professions Ranked Among Top 10 Best Jobs 
• Guardian Pharmacy Services Acquires Washington-Based Mercury Pharmacy Services, Expands Pacific Northwest Footprint 
• EmpiRx Health PBM Launches New Clinical Review Messaging Solution 
• CSI Pharmacy Expands Its Chronic Disease Pharmacy Care To California, Achieving Nationwide Reach 
• Prompt EMR Rebrands As Prompt Health To Reflect Expanded Vision & Platform 

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