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 organizationsâincluding 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.
Editor’s Picks
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Two More States Announced For CMS AHEAD Model; Six In Total Participating
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Nearly 1.5 Million Part D Enrollees Reached Out-of-Pocket Limit By June 2024
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Four States Approved To Allow Medicaid Coverage For Traditional Health Care Practices
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Small, Private For-Profit Hospitals Had Lowest Rate Of Health Care-Associated Infections
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- Rescinded: Reinforcement Of EMTALA Obligations Specific To Patients Who Are Pregnant Or Are Experiencing Pregnancy Loss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 ModelÂ
- BlueCross BlueShield Of Tennessee Winding Down Shared Health Subsidiary, With Dual Eligible Plans In Mississippi & TexasÂ
- Humanaâs CenterWell Business Agrees To Acquire The Villages Health In FloridaÂ
- Cherokee Health Systems Rebrands As River Valley HealthÂ
- Medicare-Eligible Beneficiaries With Psychological Distress Made Fewer Outpatient Mental Health VisitsÂ
- 14.5% Of Oregon Residents Delayed/Avoided Health Care In 2024 Due To CostÂ
- Impact Of Health Care Costs On People In Oregon, 2024
- Ivy Rehab Expands In June With New Clinics & Strategic PartnershipsÂ
- Joint Commission Launches Simplified Accreditation Standard With Fewer RequirementsÂ
- Publicly Traded Health Care Companies Increased Shareholder Payouts By 315% Over 20 Years
- Hospital CEO Exits Declined In 2024 Compared To 2023Â
- 41% Of Current Drug Shortages Started In 2022 Or EarlierÂ

- Three Health Care Professions Ranked Among Top 10 Best JobsÂ
- Guardian Pharmacy Services Acquires Washington-Based Mercury Pharmacy Services, Expands Pacific Northwest FootprintÂ
- EmpiRx Health PBM Launches New Clinical Review Messaging SolutionÂ
- CSI Pharmacy Expands Its Chronic Disease Pharmacy Care To California, Achieving Nationwide ReachÂ
- Prompt EMR Rebrands As Prompt Health To Reflect Expanded Vision & PlatformÂ
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Government Contract Award Announcements
- Michigan’s Macomb County Awards Jail-Based Cognitive Behavioral Group Services Contract To CARE Of Southeastern Michigan
- New York Awards Danielson Framework Training Services Contract To Rosa Educational Consulting, Inc.
- Nevada Awards Pharmacy Benefits Manager Services Contract To Ramsell Corporation
- Delaware’s New Castle County Awards Off-Site Program Services For 18-20 Year Olds With Disabilities Contract To Opportunity Center, Inc.
- Nevada Awards Staff Wellness Program Curriculum & Mobile App Services Contract To EmbGro