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

• Medicaid Autism Therapy Under Pressure—Georgia MCO Cuts ABA Rates 20% As States Move To Restrict Rapidly Rising Treatment Costs
• UofL Health Selects SimpliFi To Manage Workforce Strategy & Vendor Management System
• Optum Introduces Two AI-Powered Digital Prior Authorization Tools
• Cigna Group To Exit Affordable Care Act Exchange Market Beginning 2027
• The Ripple Effect
• 25% Of U.S. Adults Use AI For Health Information, But Only 4% Strongly Trust Results
• 90.3% Of U.S. Adults Report Having A Usual Source Of Care, But Younger Adults Increasingly Rely On Urgent Care & Retail Clinics
• ACA Individual Market Enrollment Is Estimated To Drop 17%–26% In 2026 Following Expiration Of Enhanced Premium Tax Credits
• EmpiRx Health Launches Infusion Therapy Management Program For Employer Health Plans
• When You’ve Seen One
• Health Care & Education Account For 94% Of March 2026 Private Job Growth As Other Sectors Stall Or Decline
• Source Of Usual Health Care For Adults Age 18 & Older: United States, 2024
• Chapter Raises $100 Million To Continue Building Its Trust Layer Between Seniors & Technology For Medicare Navigation Platform
• Inovalon & AlayaCareLaunch Integration Linking ScriptMed & Nursing Management Platforms
• Combining Care & Collaboration

See All

Maryland Expands Advanced Primary Care To Medicare & Medicaid Members

On January 21, 2026, the Maryland Department of Health announced that the state expanded its advanced primary care delivery system to cover approximately 1.2 million residents enrolled in Medicare and Medicaid. The expansion, which took effect January 1, aims to improve preventive care and reduce unnecessary hospital visits by focusing on coordinated care and addressing social determinants of health. The state now operates three advanced primary care programs designed to give care teams more time… Read

• 81% Of Retirement-Age Adults Cite Health Care Costs As Top Financial Concern
• 50% Of Health Care Organizations Have Implemented Generative AI Tools
• 78% Of Americans Concerned About Health Care Costs In Retirement, But Only 48% Have Planned For Them
• Maven Clinic Expands Fertility & Family Building Program With Earlier Diagnosis & Personalized Care Pathways
• Tracking The Upswing

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